scholarly journals Health system capacity for post-abortion care in Java, Indonesia: a signal functions analysis

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Jesse Philbin ◽  
Nugroho Soeharno ◽  
Margaret Giorgio ◽  
Rico Kurniawan ◽  
Meghan Ingerick ◽  
...  
Keyword(s):  
Health System ◽  
First Trimester ◽  
Health Centers ◽  
Signal Functions ◽  
Abortion Care ◽  
Post Abortion Care ◽  
Maternity Hospitals ◽  
Referral Hospitals ◽  
Post Abortion

Abstract Background The quality of obstetric care has been identified as a contributing factor in Indonesia’s persistently high level of maternal mortality, and the country’s restrictive abortion laws merit special attention to the quality of post-abortion care (PAC). Due to unique health policies and guidelines, in Indonesia, uterine evacuation for PAC is typically administered only by Ob/Gyns practicing in hospitals. Methods Using data from a survey of 657 hospitals and emergency obstetric-registered public health centers in Java, Indonesia’s most populous island, we applied a signal functions analysis to measure the health system’s capacity to offer PAC. We then used this framework to simulate the potential impact of the following hypothetical reforms on PAC capacity: allowing first-trimester uterine evacuation for PAC to take place at the primary care level, and allowing provision by clinicians other than Ob/Gyns. Finally, we calculated the proportion of PAC patients treated using four different uterine evacuation procedures. Results Forty-six percent of hospitals in Java have the full set of services needed to provide PAC, and PAC capacity is concentrated at the highest-level referral hospitals: 86% of referral hospitals have the full set of services, staffing, and equipment compared to 53% of maternity hospitals and 34% of local hospitals. No health centers are adequately staffed or authorized to offer basic PAC services under Indonesia’s current guidelines. PAC capacity at all levels of the health system increases substantially in hypothetical scenarios under which authorization to perform first-trimester uterine evacuation for PAC is expanded to midwives and general physicians practicing in health centers. In 2018, 88% percent of PAC patients were treated using dilation and curettage (D&C). Conclusions Offering first-trimester uterine evacuation for PAC in PONEDs and allowing clinicians other than Ob/Gyns to perform this procedure would greatly improve the capacity of Java’s health system to serve PAC patients. Increasing the use of vacuum aspiration and misoprostol for PAC-related uterine evacuation would lower the burden of treatment for patients and facilitate the task-shifting efforts needed to expand access to this life-saving service.

scholarly journals Health System Capacity for Post-Abortion Care in Java, Indonesia: A Signal Functions Analysis

2020 ◽  
Author(s):  
Jesse Philbin ◽  
Nugroho Soeharno ◽  
Margaret Giorgio ◽  
Rico Kurniawan ◽  
Meghan Ingerick ◽  
...  
Keyword(s):  
Health System ◽  
First Trimester ◽  
Health Centers ◽  
Signal Functions ◽  
Abortion Care ◽  
Post Abortion Care ◽  
Maternity Hospitals ◽  
Referral Hospitals ◽  
Post Abortion

Abstract Background: The quality of obstetric care has been identified as a contributing factor in Indonesia’s persistently high level of maternal mortality, and the country’s restrictive abortion laws merit special attention to the quality of post-abortion care (PAC). Due to unique health policies and guidelines, in Indonesia, uterine evacuation for PAC is typically administered only by Ob/Gyns practicing in hospitals. Methods: Using data from a survey of 657 hospitals and emergency obstetric-registered public health centers in Java, Indonesia’s most populous island, we applied a signal functions analysis to measure the health system’s capacity to offer PAC. We then used this framework to simulate the potential impact of the following hypothetical reforms on PAC capacity: allowing first-trimester uterine evacuation for PAC to take place at the primary care level, and allowing provision by clinicians other than Ob/Gyns. Finally, we calculated the proportion of PAC patients treated using four different uterine evacuation procedures. Results: Forty-six percent of hospitals in Java have the full set of services needed to provide PAC, and PAC capacity is concentrated at the highest-level referral hospitals: 86% of referral hospitals have the full set of services, staffing, and equipment compared to 53% of maternity hospitals and 34% of local hospitals. No health centers are adequately staffed or authorized to offer basic PAC services under Indonesia’s current guidelines. PAC capacity at all levels of the health system increases substantially in hypothetical scenarios under which authorization to perform first-trimester uterine evacuation for PAC is expanded to midwives and general physicians practicing in health centers. In 2018, 88% percent of PAC patients were treated using dilation and curettage (D&C). Conclusions: Offering first-trimester uterine evacuation for PAC in PONEDs and allowing clinicians other than Ob/Gyns to perform this procedure would greatly improve the capacity of Java’s health system to serve PAC patients. Increasing the use of vacuum aspiration and misoprostol for PAC-related uterine evacuation would lower the burden of treatment for patients and facilitate the task-shifting efforts needed to expand access to this life-saving service.

scholarly journals Quality Of Post-Abortion Care In Java, Indonesia: An Essential Services Analysis 

2020 ◽  
Author(s):  
Jesse Philbin ◽  
Nugroho Soeharno ◽  
Margaret Giorgio ◽  
Rico Kurniawan ◽  
Meghan Ingerick ◽  
...  
Keyword(s):  
Health System ◽  
First Trimester ◽  
Health Centers ◽  
Abortion Care ◽  
Vacuum Aspiration ◽  
Post Abortion Care ◽  
Dilation And Curettage ◽  
Essential Services ◽  
Post Abortion

Abstract Background High maternal mortality in Indonesia persists despite economic growth and a reform that extended health insurance to all Indonesians. Quality of obstetric health services, in general, has been identified as a factor for this; in addition, the country’s restrictive abortion laws merit special attention to the quality of post-abortion care (PAC) services. Methods Using data from a survey of 657 hospitals and emergency obstetric-registered public health centers in Java, Indonesia’s most populous island, we used the essential services framework to measure the health system’s capacity to offer PAC. We then used this framework to explore how Java’s capacity to offer PAC could change given two hypothetical reforms. Finally, we calculated the proportion of PAC patients treated using each of four different procedures. Results No emergency obstetric health centers (PONEDs) are adequately staffed or authorized to offer basic PAC services, while 46% of all hospitals in Java have the full set of services needed. These proportions increase in hypothetical scenarios in which PAC authorization is expanded to midwives, general physicians, and PONED facilities. Eighty-eight percent of PAC patients were treated using dilation and curettage (D&C). Conclusions Allowing clinicians other than Ob/Gyns to perform uterine evacuation and offering first-trimester PAC service in PONEDs would greatly improve the capacity of Java’s health system to serve PAC patients. Increasing the use of vacuum aspiration and misoprostol would lower the burden of treatment for patients, reduce costs to the health system, and facilitate the task-shifting efforts needed to expand access to this life-saving service.

scholarly journals Health System Cost of Post-Abortion Care (PAC): A Systematic Review

2021 ◽  
Author(s):  
Estro Dariatno Sihaloho ◽  
Ibnu Habibie ◽  
Fariza Zahra Kamilah ◽  
Yodi Christiani
Keyword(s):  
Systematic Review ◽  
Health System ◽  
Direct Cost ◽  
Medical Cost ◽  
Cochrane Library ◽  
System Cost ◽  
Abortion Care ◽  
Post Abortion Care ◽  
Health System Cost ◽  
Post Abortion

Abstract Background: Despite the increasing trend of Post Abortion Care (PAC) needs and provision, the evidence related to its health system cost is lacking. The study aims to review the health system costs of Post-Abortion Care (PAC) per patient at a national level.Methods: A systematic review of literatures related to PAC cost published in 1994 – October 2020 was performed. Electronic databases such as PubMed, Medline, The Cochrane Library, CINAHL, and PsycINFO were used to search the literature. Following the title and abstract screening, reporting quality was appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. PAC costs were extrapolated into, US dollars ($US) and international dollars ($I), both in 2019. Content analysis was also conducted to synthesize the qualitative findings.Results: Twelve studies met the inclusion criteria. All studies reported direct medical cost per patient in accessing PAC, but only three of them included indirect medical cost. All studies reported either average or range of cost. In terms of range, The highest direct cost of PAC with MVA (Medical Vacuum Aspiration) services can be found in Colombia, between $US50.58-212.47, while the lowest is in Malawi ($US15.2-139.19). The highest direct cost of PAC with D&C (Dilatation and Curettage), services was in El Salvador ($US65.22-240.75), while the lowest is in Bangladesh ($US15.71-103.85). Among two studies providing average indirect cost data, Uganda with $US105.04 is the highest average indirect medical cost, while Rwanda with $US51.44 is the lowest on the cost of indirect medical.Conclusions: Our review shows variability in cost of PAC across countries. This study depicts a clearer picture of how costly it is for women to access PAC service, although it is still seemingly underestimated. When a study compared the use of UE method between MVA and D&C, it is confirmed that MVA treatments tend to have lower costs and potentially reduce a significant cost. Therefore, by looking at both clinical and economic perspective, improving and strengthening the quality and accessibility of PAC with MVA is a priority.

DELIVERING POST-ABORTION CARE THROUGH A COMMUNITY-BASED REPRODUCTIVE HEALTH VOLUNTEER PROGRAMME IN PAKISTAN

2012 ◽  
Vol 44 (6) ◽  
pp. 719-731 ◽  
Author(s):  
SYED KHURRAM AZMAT ◽  
BABAR T SHAIKH ◽  
GHULAM MUSTAFA ◽  
WAQAS HAMEED ◽  
MOHSINA BILGRAMI
Keyword(s):  
Reproductive Health ◽  
Group Discussions ◽  
Community Based ◽  
Family Planning Services ◽  
Abortion Care ◽  
Care Services ◽  
Post Abortion Care ◽  
Post Abortion ◽  
Depth Interviews

SummaryThis qualitative study was conducted in May–June 2010 with women using post-abortion care (PAC) services provided by the Marie Stopes Society in Pakistan during the six month period preceding the study, more than 70% of whom had been referred to the clinics by reproductive health volunteers (RHVs). The aim of the study was to establish the socio-demographic profile of clients, determine their preferred method of treatment, explore their perceptions of the barriers to accessing post-abortion services and to understand the challenges faced by RHVs. The sample women were selected from six randomly selected districts of Sindh and Punjab. Eight focus group discussions were conducted with PAC clients and fifteen in-depth interviews with RHVs. In addition, a quantitative exit interview questionnaire was administered to 76 clients. Medical, rather than surgical, treatment for incomplete and unsafe abortions was preferred because it was perceived to ‘cause less pain’, was ‘easy to employ’ and ‘having fewer complications’. Household economics influence women's decision-making on seeking post-abortion care. Other restraining factors include objection by husbands and in-laws, restrictions on female mobility, the views of religious clerics and a lack of transport. The involvement of all stakeholders could secure social approval and acceptance of the provision of safe post-abortion care services in Pakistan, and improve the quality of family planning services to the women who want to space their pregnancies.

scholarly journals The infrastructural capacity of Ghanaian health facilities to provide safe abortion and post-abortion care: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Onikepe Owolabi ◽  
Taylor Riley ◽  
Easmon Otupiri ◽  
Chelsea B. Polis ◽  
Roderick Larsen-Reindorf
Keyword(s):  
Scale Up ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
Safe Abortion ◽  
Signal Functions ◽  
Rural Location ◽  
Abortion Care ◽  
Post Abortion Care ◽  
Comprehensive Abortion Care ◽  
Post Abortion

Abstract Background Ghana is one of few countries in sub-Saharan Africa with relatively liberal abortion laws, but little is known about the availability and quality of abortion services nationally. The aim of this study was to describe the availability and capacity of health facilities to deliver essential PAC and SAC services in Ghana. Methods We utilized data from a nationally representative survey of Ghanaian health facilities capable of providing post-abortion care (PAC) and/or safe abortion care (SAC) (n = 539). We included 326 facilities that reported providing PAC (57%) or SAC (19%) in the preceding year. We utilized a signal functions approach to evaluate the infrastructural capacity of facilities to provide high quality basic and comprehensive care. We conducted descriptive analysis to estimate the proportion of primary and referral facilities with capacity to provide SAC and PAC and the proportion of SAC and PAC that took place in facilities with greater capacity, and fractional regression to explore factors associated with higher structural capacity for provision. Results Less than 20% of PAC and/or SAC providing facilities met all signal function criteria for basic or comprehensive PAC or for comprehensive SAC. Higher PAC caseloads and staff trained in vacuum aspiration was associated with higher capacity to provide PAC in primary and referral facilities, and private/faith-based ownership and rural location was associated with higher capacity to provide PAC in referral facilities. Primary facilities with a rural location were associated with lower basic SAC capacity. Discussion Overall very few public facilities have the infrastructural capacity to deliver all the signal functions for comprehensive abortion care in Ghana. There is potential to scale-up the delivery of safe abortion care by facilitating service provision all health facilities currently providing postabortion care. Conclusions SAC provision is much lower than PAC provision overall, yet there are persistent gaps in capacity to deliver basic PAC at primary facilities. These results highlight a need for the Ghana Ministry of Health to improve the infrastructural capability of health facilities to provide comprehensive abortion care.

scholarly journals The health system cost of post-abortion care in Rwanda

2014 ◽  
Vol 30 (2) ◽  
pp. 223-233 ◽  
Author(s):  
Michael Vlassoff ◽  
Sabine F Musange ◽  
Ina R Kalisa ◽  
Fidele Ngabo ◽  
Felix Sayinzoga ◽  
...  
Keyword(s):  
Health System ◽  
System Cost ◽  
Abortion Care ◽  
Post Abortion Care ◽  
Health System Cost ◽  
Post Abortion

scholarly journals Health System Cost of Post-Abortion Care (PAC): A Systematic Review

2021 ◽  
Author(s):  
Estro Dariatno Sihaloho ◽  
Ibnu Habibie ◽  
Fariza Zahra Kamilah ◽  
Yodi Christiani
Keyword(s):  
Systematic Review ◽  
Health System ◽  
Direct Cost ◽  
Medical Cost ◽  
Cochrane Library ◽  
System Cost ◽  
Abortion Care ◽  
Post Abortion Care ◽  
Health System Cost ◽  
Post Abortion

Abstract Background: Despite the increasing trend of Post Abortion Care (PAC) needs and provision, the evidence related to its health system cost is lacking. The study aims to review the health system costs of Post-Abortion Care (PAC) per patient at a national level.Methods: A systematic review of literatures related to PAC cost published in 1994 – October 2020 was performed. Electronic databases such as PubMed, Medline, The Cochrane Library, CINAHL, and PsycINFO were used to search the literature. Following the title and abstract screening, reporting quality was appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. PAC costs were extrapolated into, US dollars ($US) and international dollars ($I), both in 2019. Content analysis was also conducted to synthesize the qualitative findings.Results: Twelve studies met the inclusion criteria. All studies reported direct medical cost per patient in accessing PAC, but only three of them included indirect medical cost. All studies reported either average or range of cost. In terms of range, The highest direct cost of PAC with MVA (Medical Vacuum Aspiration) services can be found in Colombia, between $US50.58-212.47, while the lowest is in Malawi ($US15.2-139.19). The highest direct cost of PAC with D&C (Dilatation and Curettage), services was in El Salvador ($US65.22-240.75), while the lowest is in Bangladesh ($US15.71-103.85). Among two studies providing average indirect cost data, Uganda with $US105.04 is the highest average indirect medical cost, while Rwanda with $US51.44 is the lowest on the cost of indirect medical.Conclusions: Our review shows variability in cost of PAC across countries. This study depicts a clearer picture of how costly it is for women to access PAC service, although it is still seemingly underestimated. When a study compared the use of UE method between MVA and D&C, it is confirmed that MVA treatments tend to have lower costs and potentially reduce a significant cost. Therefore, by looking at both clinical and economic perspective, improving and strengthening the quality and accessibility of PAC with MVA is a priority.

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