Understanding variation in health service coverage and maternal health outcomes among districts in Rwanda – A qualitative study of local health workers’ perceptions

AbstractObjectiveTo identify factors that explain variations between districts in maternal health service coverage and maternal health outcomes.MethodsIndividual key informant interviews and focus group discussions using structured topic lists were conducted in May 2015 in four purposively selected districts.ResultsThe solidarity support for poor people and the interconnectedness between local leaders and heads of health facilities were identified as enablers of health service utilization. Geographical factors, in particular location close to borders with mobile populations and migrants, and large populations with sparsely distributed health infrastructure, exacerbated by hilly topography and muddy roads were identified as barriers. Shortages of skilled health providers at the level of district hospitals were cited as contributing to poor maternal health outcomes.ConclusionThere is a need to take into account disparities between districts when allocating staff and financial resources in order to achieve universal coverage for high-quality maternal health services and better outcomes. Local innovations such as the use of SMS and WhatsApp text messages by health workers and financial protection schemes for poor patients improve solidarity and are worth to be scaled up.

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Multistakeholder Perspectives on Maternal Text Messaging Intervention in Uganda: Qualitative Study (Preprint)

10.2196/preprints.9565 ◽

2017 ◽

Author(s):

Onaedo Ilozumba ◽

Marjolein Dieleman ◽

Sara Van Belle ◽

Moses Mukuru ◽

Azucena Bardají ◽

...

Keyword(s):

Maternal Health ◽

Qualitative Study ◽

Health Outcomes ◽

Text Messaging ◽

Program Theory ◽

Team Members ◽

Health Team ◽

Village Health Team ◽

Maternal Health Outcomes ◽

Village Health

BACKGROUND Despite continued interest in the use of mobile health for improving maternal health outcomes, there have been limited attempts to identify relevant program theories. OBJECTIVES This study had two aims: first, to explicate the assumptions of program designers, which we call the program theory and second, to contrast this program theory with empirical data to gain a better understanding of mechanisms, facilitators, and barriers related to the program outcomes. METHODS To achieve the aforementioned objectives, we conducted a retrospective qualitative study of a text messaging (short message service) platform geared at improving individual maternal health outcomes in Uganda. Through interviews with program designers (n=3), we elicited 3 main designers’ assumptions and explored these against data from qualitative interviews with primary beneficiaries (n=26; 15 women and 11 men) and health service providers (n=6), as well as 6 focus group discussions with village health team members (n=50) who were all involved in the program. RESULTS Our study results highlighted that while the program designers’ assumptions were appropriate, additional mechanisms and contextual factors, such as the importance of incentives for village health team members, mobile phone ownership, and health system factors should have been considered. CONCLUSIONS Our results indicate that text messages could be an effective part of a more comprehensive maternal health program when context and system barriers are identified and addressed in the program theories.

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How does social accountability contribute to better maternal health outcomes? A qualitative study on perceived changes with government and civil society actors in Gujarat, India

BMC Health Services Research ◽

10.1186/s12913-018-3453-7 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 11

Author(s):

Mukesh Hamal ◽

Tjard de Cock Buning ◽

Vincent De Brouwere ◽

Azucena Bardají ◽

Marjolein Dieleman

Keyword(s):

Civil Society ◽

Maternal Health ◽

Qualitative Study ◽

Health Outcomes ◽

Social Accountability ◽

Maternal Health Outcomes

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Remuneration systems of community health workers in India and promoted maternal health outcomes: a cross-sectional study

BMC Health Services Research ◽

10.1186/s12913-019-4883-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Hannah J. Koehn ◽

Shenglin Zheng ◽

Robert F. Houser ◽

Corey O’Hara ◽

Beatrice Lorge Rogers

Keyword(s):

Maternal Health ◽

Health Outcomes ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Maternal Health Outcomes

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Pro-poor policies and improvements in maternal health outcomes in India

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03839-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

M. Bhatia ◽

L. K. Dwivedi ◽

K. Banerjee ◽

A. Bansal ◽

M. Ranjan ◽

...

Keyword(s):

Maternal Health ◽

Maternal Mortality ◽

Health Outcomes ◽

Health Workers ◽

Household Wealth ◽

Supply Side ◽

Wealth Status ◽

Financial Barriers ◽

Maternal Health Outcomes ◽

Eag States

Abstract Background Since 2005, India has experienced an impressive 77% reduction in maternal mortality compared to the global average of 43%. What explains this impressive performance in terms of reduction in maternal mortality and improvement in maternal health outcomes? This paper evaluates the effect of household wealth status on maternal mortality in India, and also separates out the performance of the Empowered Action Group (EAG) states and the Southern states of India. The results are discussed in the light of various pro-poor programmes and policies designed to reduce maternal mortality and the existing supply side gaps in the healthcare system of India. Using multiple sources of data, this study aims to understand the trends in maternal mortality (1997–2017) between EAG and non EAG states in India and explore various household, economic and policy factors that may explain reduction in maternal mortality and improvement in maternal health outcomes in India. Methods This study triangulates data from different rounds of Sample Registration Systems to assess the trend in maternal mortality in India. It further analysed the National Family Health Surveys (NFHS). NFHS-4, 2015–16 has gathered information on maternal mortality and pregnancy-related deaths from 601,509 households. Using logistic regression, we estimate the association of various socio-economic variables on maternal deaths in the various states of India. Results On an average, wealth status of the households did not have a statistically significant association with maternal mortality in India. However, our disaggregate analysis reveals, the gains in terms of maternal mortality have been unevenly distributed. Although the rich-poor gap in maternal mortality has reduced in EAG states such as Bihar, Odisha, Assam, Rajasthan, the maternal mortality has remained above the national average for many of these states. The EAG states also experience supply side shortfalls in terms of availability of PHC and PHC doctors; and availability of specialist doctors. Conclusions The novel contribution of the present paper is that the association of household wealth status and place of residence with maternal mortality is statistically not significant implying financial barriers to access maternal health services have been minimised. This result, and India’s impressive performance with respect to maternal health outcomes, can be attributed to the various pro-poor policies and cash incentive schemes successfully launched in recent years. Community-level involvement with pivotal role played by community health workers has been one of the major reasons for the success of many ongoing policies. Policy makers need to prioritise the underperforming states and socio-economic groups within the states by addressing both demand-side and supply-side measures simultaneously mediated by contextual factors.

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More Than Shelter: Housing for Urban Maternal and Infant Health

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18073331 ◽

2021 ◽

Vol 18 (7) ◽

pp. 3331

Author(s):

Jason Reece

Keyword(s):

Public Health ◽

Maternal Health ◽

Health Outcomes ◽

City Planning ◽

Infant Health ◽

The United States ◽

Housing Quality ◽

Housing Discrimination ◽

Maternal Health Outcomes ◽

The Impact

Housing quality, stability, and affordability have a direct relationship to socioemotional and physical health. Both city planning and public health have long recognized the role of housing in health, but the complexity of this relationship in regard to infant and maternal health is less understood. Focusing on literature specifically relevant to U.S. metropolitan areas, I conduct a multidisciplinary literature review to understand the influence of housing factors and interventions that impact infant and maternal health. The paper seeks to achieve three primary goals. First, to identify the primary “pathways” by which housing influences infant and maternal health. Second, the review focuses on the role and influence of historical housing discrimination on maternal health outcomes. Third, the review identifies emergent practice-based housing interventions in planning and public health practice to support infant and maternal health. The literature suggests that the impact of housing on infant health is complex, multifaceted, and intergenerational. Historical housing discrimination also directly impacts contemporary infant and maternal health outcomes. Policy interventions to support infant health through housing are just emerging but demonstrate promising outcomes. Structural barriers to housing affordability in the United States will require new resources to foster greater collaboration between the housing and the health sectors.

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