scholarly journals The influence of quality and respectful care on the uptake of skilled birth attendance in Tanzania

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Myrrith Hulsbergen ◽  
Anke van der Kwaak
Keyword(s):  
Quality Of Care ◽  
Maternal Mortality ◽  
Maternal Mortality Ratio ◽  
Healthcare Providers ◽  
Skilled Birth Attendance ◽  
Birth Preparedness ◽  
Disrespectful Care ◽  
Birth Attendance ◽  
Respectful Care

Abstract Background An increase in the uptake of skilled birth attendance is expected to reduce maternal mortality in low- and middle-income countries. In Tanzania, the proportion of deliveries assisted by a skilled birth attendant is only 64% and the maternal mortality ratio is still 398/100.000 live births. This article explores different aspects of quality of care and respectful care in relation to maternal healthcare. It then examines the influence of these aspects of care on the uptake of skilled birth attendance in Tanzania in order to offer recommendations on how to increase the skilled birth attendance rate. Methods This narrative review employed the “person-centered care framework for reproductive health equity” as outlined by Sudhinaraset (2017). Academic databases, search engines and websites were consulted, and snowball sampling was used. Full-text English articles from the last 10 years were included. Results Uptake of skilled birth attendance was influenced by different aspects of technical quality of maternal care as well as person-centred care, and these factors were interrelated. For example, disrespectful care was linked to factors which made the working circumstances of healthcare providers more difficult such as resource shortages, low levels of integrated care, inadequate referral systems, and bad management. These issues disproportionately affected rural facilities. However, disrespectful care could sometimes be attributed to personal attitudes and discrimination on the part of healthcare providers. Dissatisfied patients responded with either quiet acceptance of the circumstances, by delivering at home with a traditional birth attendant, or bypassing to other facilities. Best practices to increase respectful care show that multi-component interventions are needed on birth preparedness, attitude and infrastructure improvement, and birth companionship, with strong management and accountability at all levels. Conclusions To further increase the uptake of skilled birth attendance, respectful care needs to be addressed within strategic plans. Multi-component interventions are required, with multi-stakeholder involvement. Participation of traditional birth attendants in counselling and referral can be considered. Future advances in information and communication technology might support improved quality of care.

scholarly journals Implementing the skilled birth attendance strategy in Uganda: a policy analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Susan Munabi-Babigumira ◽  
Harriet Nabudere ◽  
Delius Asiimwe ◽  
Atle Fretheim ◽  
Kristin Sandberg
Keyword(s):  
Human Resources ◽  
Maternal Mortality ◽  
Maternal Mortality Ratio ◽  
Obstetric Care ◽  
Skilled Birth Attendance ◽  
Decision Makers ◽  
Birth Attendance ◽  
Nurse Midwife ◽  
Physical Infrastructure ◽  
Attendance Policy

Abstract Background Uganda, a low resource country, implemented the skilled attendance at birth strategy, to meet a key target of the 5th Millenium Development Goal (MDG), 75% reduction in maternal mortality ratio. Maternal mortality rates remained high, despite the improvement in facility delivery rates. In this paper, we analyse the strategies implemented and bottlenecks experienced as Uganda’s skilled birth attendance policy was rolled out. These experiences provide important lessons for decision makers as they implement policies to further improve maternity care. Methods This is a case study of the implementation process, involving a document review and in-depth interviews among key informants selected from the Ministry of Health, Professional Organisations, Ugandan Parliament, the Health Service Commission, the private not-for-profit sector, non-government organisations, and District Health Officers. The Walt and Gilson health policy triangle guided data collection and analysis. Results The skilled birth attendance policy was an important priority on Uganda’s maternal health agenda and received strong political commitment, and support from development partners and national stakeholders. Considerable effort was devoted to implementation of this policy through strategies to increase the availability of skilled health workers for instance through expanded midwifery training, and creation of the comprehensive nurse midwife cadre. In addition, access to emergency obstetric care improved to some extent as the physical infrastructure expanded, and distribution of medicines and supplies improved. However, health worker recruitment was slow in part due to the restrictive staff norms that were remnants of previous policies. Despite considerable resources allocated to creating the comprehensive nurse midwife cadre, this resulted in nurses that lacked midwifery skills, while the training of specialised midwives reduced. The rate of expansion of the physical infrastructure outpaced the available human resources, equipment, blood infrastructure, and several health facilities were not fully functional. Conclusion Uganda’s skilled birth attendance policy aimed to increase access to obstetric care, but recruitment of human resources, and infrastructural capacity to provide good quality care remain a challenge. This study highlights the complex issues and unexpected consequences of policy implementation. Further evaluation of this policy is needed as decision-makers develop strategies to improve access to skilled care at birth.

scholarly journals Lay and healthcare providers’ experiences to inform future of respectful maternal and newborn care in Tanzania and Malawi: an Appreciative Inquiry

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e046248
Author(s):  
Paschal Mdoe ◽  
Tracey A Mills ◽  
Robert Chasweka ◽  
Livuka Nsemwa ◽  
Chisomo Petross ◽  
...  
Keyword(s):  
Healthcare Provider ◽  
Appreciative Inquiry ◽  
Healthcare Providers ◽  
Newborn Care ◽  
Skilled Birth Attendance ◽  
Birth Attendance ◽  
The Government ◽  
Maternal And Newborn Care ◽  
Respectful Care ◽  
Maternal And Newborn

ObjectivesDisrespectful care, which remains prevalent in low and middle-income countries (LMICs), acts as a barrier to women accessing skilled birth attendance, compromising care when services are available. Building on what was positive in facilities, we aimed to explore lay and healthcare providers’ experience of respectful care to inform future interventions.SettingFive maternity facilities in Mwanza Tanzania and Lilongwe Malawi.Participants94 participants in Malawi (N=46) and Tanzania (N=48) including 24 women birthing live baby within the previous 12 months; 22 family members and 48 healthcare providers who regularly provided maternity care in the included facilitiesDesignThe study was guided by Appreciative Inquiry (AI). Semistructured, one-to-one interviews were conducted between January and December 2019. Interviews were audio-recorded, translated where necessary, transcribed verbatim, and analysed using the framework approach.ResultsFour main themes describing participants positive experience and their vision of respectful care were identified: (1) empathic healthcare provider–woman interactions including friendly welcome and courteous language, well-timed appropriate care and information sharing, (2) an enabling environment, characterised by improvement of physical environment, the use of screens, curtains and wall partitions for privacy, availability of equipment and provision of incentives to staff, (3) supportive leadership demonstrated by the commitment of the government and facility leaders to provision of respectful care, ensuring availability of guidelines and policies, supportive supervision, reflective discussion and paying staff salaries timely, (4) providers’ attitudes and behaviours characterised by professional values through readiness, compassionate communication and commitment.ConclusionThe positive experiences of service users, families and healthcare providers provided insight into key drivers of respectful care in facilities in Tanzania and Malawi. Interventions targeting improved environment and privacy, healthcare provider communication and developing positive leadership structures in facilities could provide the basis for sustained improvement in respectful and dignified maternal and newborn care in LMICs.

scholarly journals Maternity Waiting Home and Maternal Mortality Ratio in EI Salvador

2020 ◽  
Author(s):  
Heesang Yoon ◽  
Chong-sup Kim
Keyword(s):  
Maternal Mortality ◽  
El Salvador ◽  
Maternal Mortality Ratio ◽  
Health Indicators ◽  
Skilled Birth Attendance ◽  
Fertility Rate ◽  
Birth Attendance ◽  
Health Factors ◽  
Mortality Ratio ◽  
Maternity Waiting Home

Abstract Background: El Salvador is recognized as a country which could effectively reduce the maternal mortality ratio (MMR). In El Salvador, there was an improvement in health indicators, such as fertility rate, adolescent fertility rate, skilled birth attendance, health expenditures, but this improvement was not extraordinary compared with other developing countries. The reason El Salvador could achieve an outstanding decrease in MMR in spite of a not so special improvement in health or non-health indicators, deserves a deep research.Methods: We used quantitative as well as qualitative methods to show that the reason El Salvador could reduce maternal mortality ratio more than expected is the health policy that not only aimed at reducing the (adolescent) fertility rate, but also provided a safe birth service to pregnant women through maternity waiting home. As quantitative methods we ran regressions using maternal mortality ratio as dependent variable, health and non-health factors as independent variables. As qualitative methods, we carried out a case study of maternal waiting home in El Salvador.Results: El Salvador could reduce maternal mortality ratio through the improvement of health factors, such as fertility rate, skilled birth attendance, and non-health factors, such as GDP per capita and woman empowerment. However, even considering these factors, maternal mortality ratio of El Salvador decreased more than expected. We confirmed this by analyzing the residuals of the regression model. This improvement in MMR, which is more than expected from the regression results, can be attributed partly to the government measures, such as maternity waiting home.Conclusions: The reason of the unexplained reduction in El Salvador’s maternal mortality ratio seems to be attributable to the health policy that not only aimed at reducing the fertility rate, but also provided a safe birth service to pregnant women through maternity waiting home.

scholarly journals How women's experiences and perceptions of care influence uptake of postnatal care across sub-Saharan Africa: a qualitative systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Caitlin Lythgoe ◽  
Kirsty Lowe ◽  
Mary McCauley ◽  
Hannah McCauley
Keyword(s):  
Quality Of Care ◽  
Maternity Care ◽  
Postnatal Care ◽  
Healthcare Providers ◽  
Health Needs ◽  
Sub Saharan Africa ◽  
Disrespectful Care ◽  
Women’S Perceptions ◽  
Sub Saharan

Abstract Background The burden of maternal and neonatal morbidity and mortality is a global health concern with the highest burden documented after childbirth in women and babies living in sub-Saharan Africa. To date, there is limited information on the quality of postnatal care and/or whether evidence-based interventions to improve postnatal care in a way that meets the specific health needs of each mother and her baby have been lacking. There is also limited data related to how quality of care (respectful or disrespectful) influences women's decision to access postnatal care. Objective To systematically review available qualitative evidence for how quality of care (respectful or disrespectful) influences perceptions and experiences of, and decisions to, access postnatal care for women living in sub-Saharan Africa. Search strategy CINAHL plus, Cochrane library, Global Health, Medline, PubMed, Web of Science were searched from 2009—2019. Grey literature was searched on Google Scholar. Selection criteria Qualitative literature in English describing women’s perceptions and experiences of the quality of care they received after childbirth and how this influenced their perceptions of and decisions to access postnatal care. Data analysis Thematic analysis was performed to extract subthemes and themes. Outcomes were themes from the qualitative data used to form a thematic synthesis. Results Fifteen studies were included with data from 985 women interviewed face-to-face across eight countries. Descriptions of respectful care included healthcare providers being kind, supportive and attentive to women’s needs. Women described preferring healthcare services where the healthcare providers communicated in a respectful and caring manner. Descriptions of disrespectful care included verbal and/or physical abuse and power imbalances between women and healthcare providers. Some women were denied postnatal care when attending a healthcare facility after giving birth at home. There is evidence to suggest that vulnerable women (adolescents; women with poor socioeconomic status; women who are HIV positive) are more likely to receive disrespectful care. Conclusions This systematic review describes how aspects of respectful and disrespectful maternity care influence women’s perceptions and experiences of, and decisions to access postnatal care services. There is a need for a renewed focus to prioritise respectful maternity care and to sustainably provide good quality postnatal care to all women and their babies in a way that meets their expectations and health needs.

scholarly journals Satisfaction With Health Care by Dual Sensory Impairment Status

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 798-798
Author(s):  
Lama Assi ◽  
Ahmed Shakarchi ◽  
Bonnielin Swenor ◽  
Nicholas Reed
Keyword(s):  
Quality Of Care ◽  
Healthcare Providers ◽  
Health Determinants ◽  
Sensory Impairment ◽  
Medicare Beneficiaries ◽  
The Past ◽  
Patient Provider Communication ◽  
Care Satisfaction ◽  
Dual Sensory Impairment

Abstract Sensory impairment is a barrier to patient-provider communication and access to care, which may impact satisfaction with care. Satisfaction with the quality of care received in the past year was assessed in the 2017 Medicare Current Beneficiary Survey (weighted sample=53,905,182 Medicare beneficiaries). Self-reported sensory impairment was categorized as no sensory impairment, hearing impairment (HI)-only, vision impairment (VI)-only, and dual sensory impairment (DSI) – concurrent HI and VI. In a model adjusted for sociodemographic characteristics and health determinants, having DSI was associated with higher odds of dissatisfaction with the quality of care received (Odds Ratio [OR]=1.53, 95%Confidence Interval [CI]=1.14-2.06) relative to no sensory impairment; however, having HI-only or VI-only were not (OR=1.33, 95%CI=1.94-1.89, and OR=1.32, 95%CI=0.95-1.93, respectively). These findings have implications for healthcare providers as Medicare shifts to value-based reimbursement. Moreover, previous work that singularly focused on HI or VI alone may have failed to recognize the compounded effect of DSI.

scholarly journals Quality of care in the free maternal healthcare era in sub-Saharan Africa: a scoping review of providers’ and managers’ perceptions

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Monica Ansu-Mensah ◽  
Frederick Inkum Danquah ◽  
Vitalis Bawontuo ◽  
Peter Ansu-Mensah ◽  
Tahiru Mohammed ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Research Question ◽  
Healthcare Providers ◽  
Poor Quality ◽  
Sub Saharan Africa ◽  
Healthcare Financing ◽  
Maternal Healthcare ◽  
Sub Saharan ◽  
The Impact

Abstract Background Free maternal healthcare financing schemes play an essential role in the quality of services rendered to clients during antenatal care in sub-Saharan Africa (SSA). However, healthcare managers’ and providers’ perceptions of the healthcare financing scheme may influence the quality of care. This scoping review mapped evidence on managers’ and providers’ perspectives of free maternal healthcare and the quality of care in SSA. Methods We used Askey and O’Malley’s framework as a guide to conduct this review. To address the research question, we searched PubMed, CINAHL through EBSCOhost, ScienceDirect, Web of Science, and Google Scholar with no date limitation to May 2019 using keywords, Boolean terms, and Medical Subject Heading terms to retrieve relevant articles. Both abstract and full articles screening were conducted independently by two reviewers using the inclusion and exclusion criteria as a guide. All significant data were extracted, organized into themes, and a summary of the findings reported narratively. Results In all, 15 out of 390 articles met the inclusion criteria. These 15 studies were conducted in nine countries. That is, Ghana (4), Kenya (3), and Nigeria (2), Burkina Faso (1), Burundi (1), Niger (1), Sierra Leone (1), Tanzania (1), and Uganda (1). Of the 15 included studies, 14 reported poor quality of maternal healthcare from managers’ and providers’ perspectives. Factors contributing to the perception of poor maternal healthcare included: late reimbursement of funds, heavy workload of providers, lack of essential drugs and stock-out of medical supplies, lack of policy definition, out-of-pocket payment, and inequitable distribution of staff. Conclusion This study established evidence of existing literature on the quality of care based on healthcare providers’ and managers’ perspectives though very limited. This study indicates healthcare providers and managers perceive the quality of maternal healthcare under the free financing policy as poor. Nonetheless, the free maternal care policy is very much needed towards achieving universal health, and all efforts to sustain and improve the quality of care under it must be encouraged. Therefore, more research is needed to better understand the impact of their perceived poor quality of care on maternal health outcomes.

scholarly journals Indicators of Husband's Role in Pregnancy and Maternity Care

2017 ◽  
Vol 6 (2) ◽  
pp. 192
Author(s):  
Apik Indarty Moedjiono ◽  
Kuntoro Kuntoro ◽  
Hari Basuki Notobroto
Keyword(s):  
Maternal Mortality ◽  
Organizational Support ◽  
Maternity Care ◽  
Unplanned Pregnancy ◽  
Health Information System ◽  
Skilled Birth Attendance ◽  
Major Health Problem ◽  
Pregnancy And Childbirth ◽  
Birth Attendance ◽  
In Pregnancy

The maternal mortality rate (MMR) in developing countries is still a major health problem, including in Indonesia. Antenatal Care (ANC), delivery with skilled birth attendance (SBA) at the time of delivery and delivery in institutional are universally considered important for reducing maternal mortality. Husbands can play a crucial role in pregnancy and childbirth. Therefore, the aim of this study was analyze the indicators of husband's role in pregnancy and maternity care which were suspected as one of the determinants of   ANC and SBA use in Polewali Mandar Regency. The population of this prospective cohort study was all married and pregnant woman, before using contraceptives and contraceptive failure or not using contraception and pregnancy is planned, unplanned pregnancy or mistimed pregnancy in Polewali Mandar 2015 (Size of sample = 100). Samples were randomly selected from participants of screening in 12 sub-districts in Polewali Mandar. Data about husband's role in pregnancy and maternity care was obtained through interviews using a structured questionnaire data processing by using SMART-PLS.  The result of data analysis suggested that the coefficient value that has been standardized from each indicator were as follows: accessibility = 0.944 and engagement = 0.954, dan responsibility = 0.968. Indicators of organizational support in implementing Maternal and Child Health Information System at Polewali Mandar Regency, respectively from the most important are: responsibility, engagement, and accessibility.

scholarly journals Status of Home Delivery and Its Associated Factors among Women Who Gave Birth within the Last 12 Months in East Badawacho District, Hadiya Zone, Southern Ethiopia

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Deneke Delibo ◽  
Melake Damena ◽  
Tesfaye Gobena ◽  
Bahailu Balcha
Keyword(s):  
Maternal Education ◽  
Skilled Birth Attendance ◽  
Home Delivery ◽  
Southern Ethiopia ◽  
Systematic Sampling ◽  
Birth Preparedness ◽  
Cross Sectional ◽  
Place Of Delivery ◽  
Birth Plan ◽  
Birth Attendance

Background. Home delivery is responsible to maternal mortality due to obstetric complication like hemorrhage, hypertensive disorders, and sepsis. The prevalence of home delivery is remained very high both nationally (73%) and regionally (SNNPR) with 74.5%. Efforts were made to increase institutional delivery through skilled birth attendance. But women still prefer home as a place of delivery. This study was done to determine whether home preference has association with home delivery or not and the reason why they prefer home delivery Method. A community-based cross-sectional study was conducted in East Badawacho District from January 26 to February 25/2018. A total of 552 participants were selected by systematic sampling. Data were collected using both quantitative and qualitative methods. Bivariate and multivariable analyses were carried out to identify factors associated with home delivery. Qualitative data was analyzed thematically, and results were triangulated with the data. Associations were determined by using OR at 95% CI and p value at 0.05. Result. Home delivery is found to be 73.6% (95% CI, 69.9%-77.2%). Lack of written birth plan for birth preparedness and readiness (AOR=14.965, 95% CI: 4.488-49.899), incomplete number of ANC visits (1-3)(AOR=4.455, 95% CI: 1.942-10.221), and home preference as a place of delivery (AOR=4.039, 95% CI: 1.545-10.558) were independent predictors of home delivery. Conclusion. Home delivery was high in the district. The independent factors significantly associated with home were lack of written birth plan for preparedness and readiness, incomplete number of ANC visits (1-3), and home preference as place of delivery. Actions targeting maternal education, encouraging number of ANC visits, and avoiding barriers for ID utilization were the crucial areas to tackle the problem.

Haste or Waste? Peer Pressure and Productivity in the Emergency Department

2020 ◽  
Author(s):  
David Silver
Keyword(s):  
Quality Of Care ◽  
Peer Group ◽  
Healthcare Providers ◽  
Peer Groups ◽  
Peer Pressure ◽  
Cross Sectional ◽  
Discharge Data ◽  
Intensity Of Care ◽  
Group Environments

Abstract Motivated by wide cross-sectional variations in intensity of care that are unrelated to quality of care, researchers and policymakers commonly claim that healthcare providers waste considerable resources, engaging in so-called “flat-of-the-curve” medicine. A key yet elusive prediction of this hypothesis is that providers ought to be able to cut back on care without sacrificing quality. This article examines the effects of a particular form of provider cutbacks—those generated by physicians working in high-pressure peer group environments. Using expansive, time-stamped discharge data from 137 hospital-based emergency departments, I document that physicians systematically alter their pace and intensity of care across frequently shuffled peer groups. Peer groups that induce a physician to work faster also induce her to order fewer tests and spend less money. Contrary to the flat-of-the-curve hypothesis, these cutbacks lead to large reductions in quality of care. This evidence, paired with the fact that slower physicians do not produce better average outcomes, suggests that cross-physician differences in resource utilization reflect substantial differences in physician productivity within a hospital.

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