scholarly journals Review of health and non-health sector indicators for monitoring service provision along the continuum of care for maternal health

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Mamothena Carol Mothupi ◽  
Lucia Knight ◽  
Hanani Tabana
Keyword(s):  
Maternal Health ◽  
Service Provision ◽  
Health Sector ◽  
Continuum Of Care ◽  
Monitoring Service ◽  
The Continuum

scholarly journals Review of health and non-health sector indicators for monitoring service provision along the continuum of care for maternal health

2020 ◽  
Author(s):  
Mamothena Mothupi ◽  
Lucia Knight ◽  
Hanani Tabana
Keyword(s):  
Quality Of Care ◽  
Maternal Health ◽  
Health System ◽  
Service Provision ◽  
Health Sector ◽  
Continuum Of Care ◽  
Care Utilization ◽  
District Health ◽  
The Continuum

Abstract Objective : This study uses health and non-health sector data sources to select and assess available indicators for service provision along the continuum of care for maternal health at subnational levels in South Africa. It applies the adequacy approach established in another study to assess the multi-dimensionality of available indicators. Using adequacy and the process of assessment in the study, the comprehensiveness of the continuum of care for improving maternal health outcomes can be assessed. Results: We found 27 indicators of care utilization and access, linkages of care, and quality of care from the routine district health information system. The General Household Survey contained 11 indicators for the social determinants of health on the continuum of care framework. Indicator gaps include health promotion during and after pregnancy, maternal nutrition, empowerment and quality of care. At present, the available indicators measure about 74% of the interventions on the continuum of care framework. We make recommendations regarding improvements needed to better measure and monitor the continuum of care for maternal health. These involve actions within the health system and include integration of non-health system indicators.

scholarly journals Review of health and non-health sector indicators for monitoring service provision along the continuum of care for maternal health

2020 ◽  
Author(s):  
Mamothena Mothupi ◽  
Lucia Knight ◽  
Hanani Tabana
Keyword(s):  
Quality Of Care ◽  
Maternal Health ◽  
Health System ◽  
Service Provision ◽  
Health Sector ◽  
Continuum Of Care ◽  
Care Utilization ◽  
District Health ◽  
The Continuum

Abstract Objective : This study uses health and non-health sector data sources to select and assess available indicators for service provision along the continuum of care for maternal health at subnational levels in South Africa. It applies the adequacy approach established in another study to assess the multi-dimensionality of available indicators. Using adequacy and the process of assessment in the study, the comprehensiveness of the continuum of care for improving maternal health outcomes can be assessed. Results: We found 27 indicators of care utilization and access, linkages of care, and quality of care from the routine district health information system. The General Household Survey contained 11 indicators for the social determinants of health on the continuum of care framework. Indicator gaps include health promotion during and after pregnancy, maternal nutrition, empowerment and quality of care. At present, the available indicators measure about 74% of the interventions on the continuum of care framework. We make recommendations regarding improvements needed to better measure and monitor the continuum of care for maternal health. These involve actions within the health system and include integration of non-health system indicators.

Indicators and gaps for monitoring service provision along the continuum of care for maternal health in South Africa

2020 ◽  
Author(s):  
Mamothena Mothupi ◽  
Lucia Knight ◽  
Hanani Tabana
Keyword(s):  
South Africa ◽  
Quality Of Care ◽  
Maternal Health ◽  
Health System ◽  
Service Provision ◽  
Continuum Of Care ◽  
Care Utilization ◽  
District Health ◽  
The Continuum

Abstract Objective This study assesses indicators for service provision along the continuum of care for maternal health at subnational levels in South Africa. It applies the emerging construct of adequacy of the continuum of care to assess multi-dimensionality of available indicators. Using adequacy and the process of assessment in the study, the comprehensiveness of the continuum of care for improving maternal health outcomes can be assessed. Results We found indicators along the adequacy dimensions of care utilization and access, linkages of care, and quality of care in the routine district health information system. The General Household Survey contained indicators for the social determinants of health on the continuum of care framework. Indicator gaps include health promotion during and after pregnancy, maternal nutrition, empowerment and quality of care. At present, the available indicators measure about 74% of the interventions on the continuum of care framework. We make recommendations regarding improvements needed to better measure and monitor the continuum of care for maternal health. These involve actions within the health system and include integration of non-health system indicators.

scholarly journals Women’s retention on the Continuum of Maternal Care Pathway in West Gojjam Zone, Ethiopia: Multilevel Analysis

2020 ◽  
Author(s):  
Amanu Aragaw Emiru ◽  
Getu Degu Alene ◽  
Gurmesa Tura Debelew
Keyword(s):  
Maternal Health ◽  
Health Service ◽  
Antenatal Care ◽  
Service Utilization ◽  
Maternal Care ◽  
Health Service Utilization ◽  
Continuum Of Care ◽  
Maternal Health Service ◽  
West Gojjam ◽  
The Continuum

Abstract Background: The continuum of maternal care has been one of the effective approaches for improving the health of mothers and newborns. Although large numbers of Ethiopian women do not use maternal health services, points of drop out along the continuum are not understood well. Understanding of a particular point of maternal care dropout on the continuum, however, helps governments make effective interventions. This study aimed to assess the extent of women’s service utilization and the factors affecting retention on the continuum of care in West Gojjam Zone, Ethiopia. Methods: A community-based study linked to health facility data was conducted in June 2018. Data were obtained from 1281 mothers who gave birth to their last baby within the preceding 12 months from a two-stage cluster sampling. Data were collected via face-to-face interviews using a pretested questionnaire. Multilevel logistic regression models were used to examine the effects of individual and cluster-level factors on key elements of the continuum of care. The measure of fixed effects was expressed as Odds Ratio with 95 % confidence interval. Results: The study revealed that only 12.1% of women completed the continuum of care (ANC4+, SBA, PNC within 48 hours after birth); while 25.1% reported not having care at any stage for their most recent birth. There were commonalities and differences in the predictors of the three indicators of maternal health service utilization. Variables related to services received during antenatal care such as early initiation of ANC (AOR=7.53, 95%CI, 2.94, 19.29) and receiving proper contents (AOR=3.31, 95%CI, 1.08, 10.16) were among the predictors significantly associated with the completion of the continuum of care. Conclusions: The continuum of maternal care completion rate was extremely low, indicating that women were not getting the maximum possible health benefit from existing health services. The results also revealed that maternal health service utilization was influenced by factors operating at various levels-individual, household, community, and health facility. Since antenatal care is considered an entry point for the subsequent use of maternal services, strategies that aimed to improve maternal health service utilization should target early initiation and antenatal care quality

Continuum of maternal health care services and its impact on child immunization in India: an application of the propensity score matching approach

2020 ◽  
pp. 1-20
Author(s):  
Mohd Usman ◽  
Enu Anand ◽  
Laeek Siddiqui ◽  
Sayeed Unisa
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health Care Services ◽  
Continuum Of Care ◽  
Maternal Health Care ◽  
Child Immunization ◽  
Care Services ◽  
Care Approach ◽  
Maternal Health Care Services ◽  
The Continuum

Abstract Continuum of care throughout pregnancy, delivery and post-delivery has proved to be a critical health intervention for improving the health of mothers and their newborn children. Using data from the fourth wave of the National Family Health Survey (NFHS-4) conducted in 2015–16, this study examined the correlates of utilization of maternal health care services and child immunization following the continuum of care approach in India. The study also assessed whether the continuity in utilizing maternal health care services affects the immunization of children. A total of 33,422 survey women aged 15–49 were included in the analysis of maternal health care indicators, and 8246 children aged 12–23 months for the analysis of child immunization. The results indicated that about 19% of the women had completed the maternal health continuum, i.e. received full antenatal care, had an institutional delivery and received postnatal care. Women with a higher level of education and of higher economic status were more likely to have complete continuum of care. Continuity of maternal health care was found to be associated with an increase in the immunization level of children. It was observed that 76% of the children whose mothers had complete continuum of care were fully immunized. Furthermore, the results from propensity score matching revealed that if mothers received continuum of care, the chance of their child being fully immunized increased by 17 percentage points. The results suggest that promotion of the continuum of maternal health care approach could help reduce not only the burden of maternal deaths in India, but also that of child deaths by increasing the immunization level of children.

scholarly journals Community’s experience and perceptions of maternal health services across the continuum of care in Ethiopia: A qualitative study

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255404
Author(s):  
Gizachew Tadele Tiruneh ◽  
Meaza Demissie ◽  
Alemayehu Worku ◽  
Yemane Berhane
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Postnatal Care ◽  
Continuum Of Care ◽  
Maternal Health Services ◽  
Opportunity Costs ◽  
Community Perceptions ◽  
Negative Experiences ◽  
Multiple Challenges ◽  
The Continuum

Background Continuum of care is an effective strategy to ensure that every woman receives a series of maternal health services continuously from early pregnancy to postpartum stages. The community perceptions regarding the use of maternal services across the continuum of care are essential for utilization of care in low-income settings but information in that regard is scanty. This study explored the community perceptions on the continuum of care for maternal health services in Ethiopia. Methods This study employed a phenomenological qualitative research approach. Four focus group discussions involving 26 participants and eight in-depth interviews were conducted with women who recently delivered, community health workers, and community leaders that were purposively selected for the study in West Gojjam zone, Amhara region. All the interviews and discussions were audio-taped; the records were transcribed verbatim. Data were coded and analyzed thematically using ATLAS.ti software. Results We identified three primary themes: practice of maternal health services; factors influencing the decision to use maternal health services; and reasons for discontinuation across the continuum of maternal health services. The study showed that women faced multiple challenges to continuously uptake maternal health services. Late antenatal care booking was the main reasons for discontinuation of maternal health services across the continuum at the antepartum stage. Women’s negative experiences during care including poor quality of care, incompetent and unfriendly health providers, disrespectful care, high opportunity costs, difficulties in getting transportation, and timely referrals at healthcare facilities, particularly at health centers affect utilization of maternal health services across the continuum of care. In addition to the reverberation effect of the intrapartum care factors, the major reasons mentioned for discontinuation at the postpartum stage were lack of awareness about postnatal care and service delivery modality where women are not scheduled for postpartum consultations. Conclusion This study showed that rural mothers still face multiple challenges to utilize maternal health services as recommended by the national guidelines. Negative experiences women encountered in health facilities, community perceptions about postnatal care services as well as challenges related to service access and opportunity costs remained fundamental to be reasons for discontinuation across the continuum pathways.

scholarly journals Development and testing of a composite index to monitor the continuum of maternal health service delivery at provincial and district level in South Africa

2020 ◽  
Author(s):  
Mamothena Carol Mothupi ◽  
Jeroen De Man ◽  
Hanani Tabana ◽  
Lucia Knight
Keyword(s):  
South Africa ◽  
Maternal Health ◽  
Service Delivery ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Composite Index ◽  
Health Service Delivery ◽  
Continuum Of Care ◽  
Determinants Of Health ◽  
The Continuum

Abstract Introduction: The continuum of care is a recommended framework for comprehensive health service delivery for maternal health, and it integrates health system and social determinants of health. There is a current lack of knowledge on a measurement approach to monitor performance on the framework. In this study we aim to develop and test a composite index for assessing the maternal health continuum in South Africa. Materials and Methods: The composite index was computed as a geometric mean of four dimensions of adequacy of the continuum of care. Data was sourced from the district health information system, household surveys and the census. The index formula was tested for robustness when alternative inputs for indicators and standardization methods were used. The index was used to assess performance in service delivery in the North West province of South Africa, as well as its four districts over a five-year period (2013-2017). The index was validated by assessing associations with maternal health and other outcomes. And factor analysis was used to assess the statistical dimensions of the index. Results: The provincial level index score increased from 62.3 in 2013 to 74 in 2017, showing general improvement in service delivery over time. The district level scores also improved over time, and our analysis identified areas for performance improvement. These include social determinants of health in some districts, and access and linkages to care in others. The provincial index was correlated with institutional maternal mortality rates (rs=-0.90, 90% CI = (-1.00, -0.25)) and the Human Development Index (r=0.97, 95% CI = (0.63, 0.99). It was robust to alternative approaches including z-score standardization of indicators. Factor analysis showed three groupings of indicators for the health system and social determinants of health. Conclusions: This study demonstrated the development and testing of a composite index to monitor and assess service delivery on the continuum of care for maternal health. The index was shown to be robust and valid, and identified potential areas for service improvement. A contextualised version can be tested in other settings within and outside of South Africa.

scholarly journals Assessing Contact, Coverage, and Quality of continuum of care in Uttar Pradesh, India

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Gupta ◽  
K S ◽  
K Yonzon ◽  
P Kumar ◽  
V Choudhry
Keyword(s):  
Service Delivery ◽  
Health System ◽  
Neonatal Mortality ◽  
Service Provision ◽  
Clinical Care ◽  
Uttar Pradesh ◽  
Continuum Of Care ◽  
Multilevel Regression ◽  
The Continuum

Abstract Background Given the high neonatal mortality in LMIC, strategies suggest a continuum of care (COC) as an effective framework to ensure timely and appropriate service provision throughout the MNCH continuum. However, the measurement approaches traditionally focus on assessing continuum of care from the lenses of time-based coverage and missing out on the quality of coverage and service delivery. This paper aims to assess the continuum of care based on these three parameters and the factors affecting its achievement. Methods Multistage sampling design identified live births and stillbirths in the last calendar year (March 2018-February 2019) across the 50 districts of Uttar Pradesh(n = 16646).COC was assessed on three measurements 1) Contact: Any contact with the health system across the continuum, 2)Coverage: Adequate contacts of the health system through outreach services and clinical care, and 3)Quality: receiving adequate services along with these contacts. Further, a multilevel regression model was used to estimate the factors associated with the continuum of care. Results 64% (60.04-67.65) of the women and child received health system contact across the continuum while only 2.1% (1.57-2.78) and 2.8% (2.33-3.44) women and children achieved coverage and quality based COC, respectively. Achievement of COC coverage and COC quality is highly affected by the service delivery platform, with women at outreach platform being more likely to achieve adequate coverage while women at facilities are more likely to achieve quality services across ANC, delivery, and PNC. Conclusions Achievement of both coverage and quality based COC remains low in Uttar Pradesh, India. Even those who achieve contact(s) failed to receive quality services along with these contacts with health systems. Efforts should be focused on building quality service at the outreach and non-outreach platforms across the continuum of care for reducing the risk of neonatal mortality. Key messages Owing to the lack of an integrated approach for service delivery across outreach, clinical care and community care, continuum of care remains broken for most of the mothers and children. For targeting coverage and quality of COC, focus should be on improving the quality of service provision across the outreach platforms which are already in reach of the women.

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