scholarly journals Improving maternal health services through social accountability interventions in Nepal:  An analytical review of existing literature

2019 ◽  
Author(s):  
Adweeti Nepal ◽  
Santa Kumar Dangol ◽  
Anke van der Kwaak
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Health System ◽  
Grey Literature ◽  
Maternal Health Services ◽  
Social Accountability ◽  
The Social ◽  
The Government ◽  
The Impact

Abstract Background: The persistent equity and quality gap in maternal health services in Nepal has resulted in poor maternal health outcomes. The Government of Nepal has emphasized on responsive and accountable maternal health services since 2005, while social accountability interventions have been commenced as a strategical approach. This review is an attempt to critically explore the social accountability interventions in maternal health services in Nepal and its outcomes by analyzing existing evidence to contribute informed policy. Methods: A literature review and desk study were done between December 2018 to May 2019. An adapted framework of social accountability by Lodenstein et al. 2013 was used for critical analysis and synthesis of the existing literature from Nepal and other low- and middle-income countries (LMICs). The literature was searched and extracted from the search engines i.e. google and google scholar using keywords. The searched includes both published and grey literature. Results: The review found different social accountability interventions initiated by the government and external development partners in maternal health services in Nepal. The evidence from Nepal and other LMICs showed that the social accountability interventions improve the quality of maternal health services through improving health system responsiveness, enhancing community ownership, addressing inequalities and enabling the community to influence the policy decision-making process. The strong gender norms, caste-hierarchy system, socio-political and economic context and weak enforceability mechanism in the health system are major contextual factors influencing community engagement in social accountability interventions in Nepal. Conclusions: The evidence show that social accountability interventions have the potential to improve the quality of maternal health services in Nepal. Critical factors of successful outcomes in maternal health services include quality implementation of the interventions. Similarly, continuous effort is needed from policymaker to strengthen monitoring and regulatory mechanism of the health system and decentralization, improve access to the information and establishment of proper channels to capture complaints and feedback from the community to ensure the effectiveness of the interventions for the long run. Furthermore, research is needed to evaluate the impact of the existing social accountability interventions in the reduction of maternal mortality in Nepal.

scholarly journals Improving maternal health services through social accountability interventions in Nepal: an analytical review of existing literature

2020 ◽  
Vol 41 (1) ◽  
Author(s):  
Adweeti Nepal ◽  
Santa Kumar Dangol ◽  
Anke van der Kwaak
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Health System ◽  
Maternal Health Services ◽  
Policy Formulation ◽  
Social Accountability ◽  
The Social ◽  
The Government ◽  
The Impact

Abstract Background The persistent quality gap in maternal health services in Nepal has resulted in poor maternal health outcomes. Accordingly, the Government of Nepal (GoN) has placed emphasis on responsive and accountable maternal health services and initiated social accountability interventions as a strategical approach simultaneously. This review critically explores the social accountability interventions in maternal health services in Nepal and its outcomes by analyzing existing evidence to contribute to the informed policy formulation process. Methods A literature review and desk study undertaken between December 2018 and May 2019. An adapted framework of social accountability by Lodenstein et al. was used for critical analysis of the existing literature between January 2000 and May 2019 from Nepal and other low-and-middle-income countries (LMICs) that have similar operational context to Nepal. The literature was searched and extracted from database such as PubMed and ScienceDirect, and web search engines such as Google Scholar using defined keywords. Results The study found various social accountability interventions that have been initiated by GoN and external development partners in maternal health services in Nepal. Evidence from Nepal and other LMICs showed that the social accountability interventions improved the quality of maternal health services by improving health system responsiveness, enhancing community ownership, addressing inequalities and enabling the community to influence the policy decision-making process. Strong gender norms, caste-hierarchy system, socio-political and economic context and weak enforceability mechanism in the health system are found to be the major contextual factors influencing community engagement in social accountability interventions in Nepal. Conclusions Social accountability interventions have potential to improve the quality of maternal health services in Nepal. The critical factor for successful outcomes in maternal health services is quality implementation of interventions. Similarly, continuous effort is needed from policymakers to strengthen monitoring and regulatory mechanism of the health system and decentralization process, to improve access to the information and to establish proper complaints and feedback system from the community to ensure the effectiveness and sustainability of the interventions. Furthermore, more study needs to be conducted to evaluate the impact of the existing social accountability interventions in improving maternal health services in Nepal.

Looking at the bigger picture: effect of performance-based contracting of district health services on equity of access to maternal health services in Zambia

2019 ◽  
Author(s):  
Collins Chansa ◽  
Mulenga Mary Mukanu ◽  
Chitalu Miriam Chama-Chiliba ◽  
Mpuma Kamanga ◽  
Nicholas Chikwenya ◽  
...  
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Health System ◽  
Health Expenditure ◽  
Maternal Health Services ◽  
Health Facilities ◽  
District Level ◽  
Health Service Provision ◽  
Equity Of Access ◽  
The Impact

Abstract Zambia has been using output-based approaches for over two decades to finance whole or part of the public health system. Between 1996 and 2006, performance-based contracting (PBC) was implemented countrywide with the Central Board of Health (CBoH) as the provider of health services. This study reviews the association between PBC and equity of access to maternal health services in Zambia between 1996 and 2006. A comprehensive document review was undertaken to evaluate the implementation process, followed by a trend analysis of health expenditure at district level, and a segmented regression analysis of data on antenatal care (ANC) and deliveries at health facilities that was obtained from five demographic and health survey datasets (1992, 1996, 2002, 2007 and 2014). The results show that PBC was anchored by high-level political support, an overarching policy and legal framework, and collective planning and implementation with all key stakeholders. Decentralization of health service provision was also an enabling factor. ANC coverage increased in both the lower and upper wealth quintiles during the PBC era, followed by a declining trend after the PBC era in both quintiles. Further, the percentage of women delivering at health facilities increased during the PBC era, particularly in rural areas and among the poor. The positive trend continued after the PBC era with similar patterns in both lower and upper wealth quintiles. Despite these gains, per capita health expenditure at district level declined during the PBC era, with the situation worsening after the PBC era. The study concludes that a nationwide PBC approach can contribute to improved equity of access to maternal health services and that PBC is a cost-efficient and sustainable policy reform. The study calls for policymakers to comprehensively evaluate the impact of health system reforms before terminating them.

scholarly journals Barriers to maternal health services during the Ebola outbreak in three West African countries: a literature review

2020 ◽  
Vol 5 (9) ◽  
pp. e002974
Author(s):  
Piper Yerger ◽  
Mohamed Jalloh ◽  
Cordelia E M Coltart ◽  
Carina King
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
West Africa ◽  
Health System ◽  
Virus Disease ◽  
Grey Literature ◽  
Care Facility ◽  
Maternal Health Services ◽  
Health Crisis ◽  
Relevant Stakeholder

IntroductionThe Ebola virus disease (EVD) outbreak in West Africa, affecting Guinea, Liberia and Sierra Leone from 2014 to 2016, was a substantial public health crisis with health impacts extending past EVD itself. Access to maternal health services (MHS) was disrupted during the epidemic, with reductions in antenatal care, facility-based deliveries and postnatal care. We aimed to identify and describe barriers related to the uptake and provision of MHS during the 2014–2016 EVD outbreak in West Africa.MethodsIn June 2020, we conducted a scoping review of peer-reviewed publications and grey literature from relevant stakeholder organisations. Search terms were generated to identify literature that explained underlying access barriers to MHS. Published literature in scientific journals was first searched and extracted from PubMed and Web of Science databases for the period between 1 January 2014 and 27 June 2020. We hand-searched relevant stakeholder websites. A ‘snowball’ approach was used to identify relevant sources uncaptured in the systematic search. The identified literature was examined to synthesise themes using an existing framework.ResultsNineteen papers were included, with 26 barriers to MHS uptake and provision identified. Three themes emerged: (1) fear and mistrust, (2) health system and service constraints, and (3) poor communication. Our analysis of the literature indicates that fear, experienced by both service users and providers, was the most recurring barrier to MHS. Constrained health systems negatively impacted MHS on the supply side. Poor communication and inadequately coordinated training efforts disallowed competent provision of MHS.ConclusionsBarriers to accessing MHS during the EVD outbreak in West Africa were influenced by complex but inter-related factors at the individual, interpersonal, health system and international level. Future responses to EVD outbreaks need to address underlying reasons for fear and mistrust between patients and providers, and ensure MHS are adequately equipped both routinely and during crises.

scholarly journals Clients’ Perspectives on Quality of Delivery Services in a Rural Setting in Tanzania: Findings from a Qualitative Action-Oriented Research

2017 ◽  
Vol 6 (1) ◽  
pp. 60 ◽  
Author(s):  
Gerald J. Makuka, MD ◽  
Moses M. Sango, MD ◽  
Ayubu E. Mashambo, MD ◽  
Abednego E. Mashambo, MD ◽  
Sia E Msuya, MD, PhD ◽  
...  
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Maternal Health Services ◽  
Rural Setting ◽  
Health Staff ◽  
Creative Commons ◽  
Quality Of Delivery ◽  
The Government ◽  
Oriented Research

Objective: To know and understand the perspectives of women on the quality of maternal health services provided at their health facility (HF) and to incite community self-propelled problem identification and way forward.Methods: A qualitative action- oriented research was conducted in a rural setting in Tanzania from 2011 to 2014. Twenty In-Depth Interviews (IDIs) and two Focus Group Discussions were held. The IDIs were conducted with mothers who had attended antenatal care at the HF and delivered there. The recordings transformed into English texts were used for analysis to get themes and possible explanations that were compared and reflected.Results: More than half 60% of the respondents reported to have experienced abuse by the health staff, 80% reported lack of amenities and all agreed to unavailability of health services at odd hours or weekends.Conclusion and Global Health Implications: This study reveals that the quality of maternal health services provided at the HF is not up to standard. The study demonstrates the importance of self-diagnosis in a community and to propel self-community interventions towards improving rural health services. The government, researchers and other stakeholders have key roles in the elimination of health disparities and unhealthy political mingling in health care.Key words: Quality • Maternal Health • Qualitative • Action-Oriented Research • Rural Setting • TanzaniaCopyright © 2017 Makuka et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the originalwork is properly cited.

scholarly journals Evaluating the impact of a maternal health voucher programme on service use before and after the introduction of free maternity services in Kenya: a quasi-experimental study

2018 ◽  
Vol 3 (2) ◽  
pp. e000726 ◽  
Author(s):  
Mardieh L Dennis ◽  
Timothy Abuya ◽  
Oona Maeve Renee Campbell ◽  
Lenka Benova ◽  
Angela Baschieri ◽  
...  
Keyword(s):  
Maternal Health ◽  
Private Sector ◽  
Maternal Health Services ◽  
Facility Delivery ◽  
Absolute Increase ◽  
Maternity Services ◽  
Poor Women ◽  
The Government ◽  
The Impact ◽  
The Continuum

IntroductionFrom 2006 to 2016, the Government of Kenya implemented a reproductive health voucher programme in select counties, providing poor women subsidised access to public and private sector care. In June 2013, the government introduced a policy calling for free maternity services to be provided in all public facilities. The concurrent implementation of these interventions presents an opportunity to provide new insights into how users adapt to a changing health financing and service provision landscape.MethodsWe used data from three cross-sectional surveys to assess changes over time in use of 4+ antenatal care visits, facility delivery, postnatal care and maternal healthcare across the continuum among a sample of predominantly poor women in six counties. We conducted a difference-in-differences analysis to estimate the impact of the voucher programme on these outcomes, and whether programme impact changed after free maternity services were introduced.ResultsBetween the preintervention/roll-out phase and full implementation, the voucher programme was associated with a 5.5% greater absolute increase in use of facility delivery and substantial increases in use of the private sector for all services. After free maternity services were introduced, the voucher programme was associated with a 5.7% higher absolute increase in use of the recommended package of maternal health services; however, disparities in access to facility births between voucher and comparison counties declined. Increased use of private sector services by women in voucher counties accounts for their greater access to care across the continuum.ConclusionsOur findings show that the voucher programme is associated with a modest increase in women’s use of the full continuum of maternal health services at the recommended timings after free maternity services were introduced. The greater use of private sector services in voucher counties also suggests that there is need to expand women’s access to acceptable and affordable providers.

scholarly journals A review of the impact of financing mechanisms on maternal health care in Australia

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Haylee Fox ◽  
Stephanie M. Topp ◽  
Emily Callander ◽  
Daniel Lindsay
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health System ◽  
Search Engine ◽  
Grey Literature ◽  
Maternal Health Care ◽  
World Health ◽  
Google Search ◽  
The Impact ◽  
Out Of Pocket Costs

Abstract Background The World Health Organization states there are three interrelated domains that are fundamental to achieving and maintaining universal access to care - raising sufficient funds for health care, reducing financial barriers to access by pooling funds in a way that prevents out-of-pocket costs, and allocating funds in a way that promotes quality, efficiency and equity. In Australia, a comprehensive account of the mechanisms for financing the health system have not been synthesised elsewhere. Therefore, to understand how the maternal health system is financed, this review aims to examine the mechanisms for funding, pooling and purchasing maternal health care and the influence these financing mechanisms have on the delivery of maternal health services in Australia. Methods We conducted a scoping review and interpretative synthesis of the financing mechanisms and their impact on Australia’s maternal health system. Due to the nature of the study question, the review had a major focus on grey literature. The search was undertaken in three stages including; searching (1) Google search engine (2) targeted websites and (3) academic databases. Executive summaries and table of contents were screened for grey literature documents and Titles and Abstracts were screened for journal articles. Screening of publications’ full-text followed. Data relating to either funding, pooling, or purchasing of maternal health care were extracted for synthesis. Results A total of 69 manuscripts were included in the synthesis, with 52 of those from the Google search engine and targeted website (grey literature) search. A total of 17 articles we included in the synthesis from the database search. Conclusion Our study provides a critical review of the mechanisms by which revenues are raised, funds are pooled and their impact on the way health care services are purchased for mothers and babies in Australia. Australia’s maternal health system is financed via both public and private sources, which consequentially creates a two-tiered system. Mothers who can afford private health insurance – typically wealthier, urban and non-First Nations women - therefore receive additional benefits of private care, which further exacerbates inequity between these groups of mothers and babies. The increasing out of pocket costs associated with obstetric care may create a financial burden for women to access necessary care or it may cause them to skip care altogether if the costs are too great.

scholarly journals Compromised quality of maternal healthcare in a market economy: Medellín, Colombia 2008-2009

2011 ◽  
pp. 294-302 ◽  
Author(s):  
Gloria Molina ◽  
Gilma Vargas ◽  
Alina Shaw
Keyword(s):  
Health Services ◽  
Maternal Care ◽  
Maternal Health Services ◽  
Labor Costs ◽  
Individual Interviews ◽  
The Social ◽  
Municipal Policies ◽  
Obstetric Services ◽  
Health Institutions

Objective: To analyze the quality of the maternal health services in Medellín city, Colombia within the context of the Social Security System in Health from the perspective of the mothers, physicians and nurses involved in the provision of these services. Methodology: A qualitative study was carried out, during which 24 individual interviews were conducted to key doctors and nurses, who work in health institutions that providing maternal care. Also three focus groups with mothers were conducted. The data analysis was carried out using a systematic and carefully coding and categorization process. Findings: In spite of the fact that municipal policies have been put in place to improve maternity care, mother and pregnant women face problems with health services. Findings suggests that the strategies put in place by these health institutions to decrease labor costs, the administrative barriers, the low tariffs of the obstetric services paid by the health insurers within and competitive market, and the focus on getting financial profitability, are aspects that affecting quality of maternal care.

scholarly journals Health Workers’ Perspectives on Infrastructure to Support Maternal Health Services in Rural Areas of Vietnam

2017 ◽  
Vol 12 (2) ◽  
pp. 55-61
Author(s):  
Thi Hoai Thu Nguyen ◽  
Fiona McDonald ◽  
Andrew Wilson
Keyword(s):  
Primary Care ◽  
Developing Countries ◽  
Maternal Health ◽  
Health Services ◽  
Rural Areas ◽  
Health Workers ◽  
Maternal Health Services ◽  
District Health ◽  
Health Centres ◽  
The Impact

Background: One common governance issue faced by developing countries is the establishment and maintenance of infrastructure to support the delivery of primary health services. This qualitative study explores the perspective of maternal health workers on how infrastructure impacts the provision of maternity services in rural areas in Vietnam. Methods: Forty-one health workers and health managers at the commune, district and provincial levels of the Vietnamese public health system were interviewed. Questions focused on the impact of various organisational factors, including the impact of infrastructure on the performance of the health workforce, which provides publicly funded primary care. All interviews were recorded, transcribed and coded for thematic analysis. Findings: Participants noted that infrastructure directly affected their ability to perform certain tasks and could both directly and indirectly negatively impact their motivation. In general, participants noted a lack of investment in infrastructure for the provision of primary care services in rural areas. They identified that there were deficits in the availability of utilities and the adequacy of facilities. Conclusion: This research contributes to understanding the barriers to the provision of primary care in developing countries and in particular. The current inadequacy of facility buildings and inadequacy of clean water supply are issues for health workers in meeting the technical requirements of the standards as set out in the National Guidelines on reproductive health, and lead to safety concerns for the quality of maternal health services provided in commune health centres and District Health Centres. Abbreviations: CHC – Commune Health Centres; DHC – District Health Centre; HW – Health Worker.

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