Impact of Investment Case on Equitable Access on Maternal and Child Health Services in Nepal: Quasi-experimental study

2020 ◽  
Author(s):  
Janak Kumar Thapa ◽  
Doris Stöckl ◽  
Raj Kumar Sangroula ◽  
Dip Narayan Thakur ◽  
Suresh Mehata ◽  
...  
Keyword(s):  
Developing Countries ◽  
Child Health ◽  
Linear Regression ◽  
Health Services ◽  
Local Level ◽  
Child Health Services ◽  
P Value ◽  
Care Seeking ◽  
Equitable Access ◽  
And Child Health

Abstract Background Different areas of disparities remain a concern in developing countries like Nepal regarding the utilization of maternal, neonatal and child health services like disparities in education, income, administrative regions, ethnic groups, province-level etc. In order to support equitable outcomes for Maternal, Neonatal and Child Health (MNCH) and to scale-up quality services, an Investment case was launched by developmental partners in the Asia-Pacific region. Investment Case (IC) at the local level aims to develop a coherent plan with local level development plans, which is equitable and responsive to the bottlenecks and the local needs. The study aims to identify the factors affecting equitable access to maternal health services in Nepal. Methods The study focuses on the impact of the intervention package developed by applying the investment case (IC) approach in maternal and child health services in Nepal introduced in 2011. Complex sample analysis was carried out to adjust the weight of the sample. Cross tabulation with Confidence Interval (CI) was used to generate weighted disaggregated data. Difference in Difference (DiD) analysis was carried out using a linear regression model. Finally, multivariate linear regression was carried out to figure out the effect of the intervention. Results Based on the data, the improvements before and after the intervention were calculated in both the intervention and comparison districts; no variables showed a significant association. Changes were similar for intervention and comparison areas: four antenatal care seeking (DiD=-4.8, p = 0.547 CI= -0.041-0.022), Skill Birth Attendance (SBA) delivery (DiD = 6.6, p = 0.325, CI= -0.010-0.039). Multivariable regression analysis also did not reveal any significant improvement in aggregate outcomes. The intervention did not play a significant role in any variables, i.e., four antenatal care seeking (p-value 0.062), SBA delivery (p-value 0.939). Conclusion The IC approach is itself a successful approach in most of the developing countries. After the implementation of IC, some of the MNCH indicators like ANC, SBA delivery have shown improvements in the intervention as well as comparison districts but have not shown significant with the intervention.

scholarly journals Impact of measles supplementary immunisation activities on utilisation of maternal and child health services in low-income and middle-income countries

2018 ◽  
Vol 3 (3) ◽  
pp. e000466 ◽  
Author(s):  
Iryna Postolovska ◽  
Stéphane Helleringer ◽  
Margaret E Kruk ◽  
Stéphane Verguet
Keyword(s):  
Child Health ◽  
Health Services ◽  
Maternal And Child Health ◽  
Low Income ◽  
Child Health Services ◽  
Demographic And Health Surveys ◽  
Care Seeking ◽  
Middle Income ◽  
Middle Income Countries ◽  
And Child Health

BackgroundMeasles supplementary immunisation activities (SIAs) are an integral component of measles elimination in low-income and middle-income countries (LMICs). Despite their success in increasing vaccination coverage, there are concerns about their negative consequences on routine services. Few studies have conducted quantitative assessments of SIA impact on utilisation of health services.MethodsWe analysed the impact of SIAs on utilisation of selected maternal and child health services using Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 28 LMICs, where at least one SIA occurred over 2000–2014. Logistic regressions were conducted to investigate the association between SIAs and utilisation of the following services: facility delivery, postnatal care and outpatient sick child care (for fever, diarrhoea, cough).ResultsSIAs do not appear to significantly impact utilisation of maternal and child services. We find a reduction in care-seeking for treatment of child cough (OR 0.67; 95% CI 0.48 to 0.95); and a few significant effects at the country level, suggesting the need for further investigation of the idiosyncratic effects of SIAs in each country.ConclusionThe paper contributes to the debate on vertical versus horizontal programmes to ensure universal access to vaccination. Measles SIAs do not seem to affect care-seeking for critical conditions.

scholarly journals Barriers in utilization of maternal and child health services among Musahar in Dudhauli Municipality of Sindhuli district, Nepal

2020 ◽  
Vol 8 (1) ◽  
pp. 1
Author(s):  
Laxmi Gautam ◽  
Jwala Subedi
Keyword(s):  
Public Health ◽  
Child Health ◽  
Health Services ◽  
Maternal And Child Health ◽  
Quantitative Methods ◽  
Health Workers ◽  
Child Health Services ◽  
Health Concern ◽  
P Value ◽  
And Child Health

Background: Maternal and Child Health remains a public health challenge in Nepal. This study explored information regarding barriers in the utilization of Maternal and Child Health services among women of Musahar community.Methods: A cross-sectional study was carried out in Dudhauli Municipality, Sindhuli using qualitative and quantitative methods. Qualitative data were obtained from, In Depth Interview among health workers and a Focus Group Discussion among FCHVs of Musahar community. Interview was carried out using questionnaire for quantitative study among 121 mothers of under 5 children. The data was analyzed using SPSS software version 21. Chi Square test was applied to test the associations while p value <0.05 was considered significant.Results: The average age and age at marriage of respondents were 24.6±5.7 years and 16.22±2.8 respectively, 76% were illiterate, 93.2% lies below poverty line and 73.6% were home maker. Among them, 29.8 did not have ANC while 47.1 had 4 or more ANC visits, 64.5% institutional delivery and 29.8% PNC visit. Social barriers and lack of information are major barriers contributing to more than half of no ANC visit and which contribute to >60% in case of PNC. Home delivery for first child was 56.2% while for last child was 33.9%. Almost 1/5th of the children were not vaccinated. Qualitative study identified social factors like negligence, family pressure, shyness, and unhealthy financial decisions as important barriers.Conclusions: Utilization of maternal and child health services was poor among Musahar mothers and children which indicates a serious public health concern.

scholarly journals Assessment of Maternal and Child Health Care Services Performance in The Context of COVID-19 Pandemic in Addis Ababa, Ethiopia: Evidence From Routine Service Data

2021 ◽  
Author(s):  
Senedu Bekele Gebreegziabher ◽  
Solomon Sisay Marrye ◽  
Tsegaye Hailu Kumssa ◽  
Kassa Haile Merga ◽  
Alemu Kibret Feleke ◽  
...  
Keyword(s):  
Health Care ◽  
Child Health ◽  
Health Services ◽  
Maternal And Child Health ◽  
Addis Ababa ◽  
Child Health Services ◽  
P Value ◽  
Health Management Information System ◽  
Under Five ◽  
And Child Health

Abstract Background In many settings, health care service provision has been modified to managing COVID-19 cases, and this has been affecting the provision of maternal and child health services. The aim of this study was to assess trends in selected maternal and child health services performance in the context of COVID-19 pandemic. Methods A cross-sectional data review was conducted in Addis Ababa, Ethiopia from April to May 2021. Routine health management information system database was reviewed from Addis Ababa Health Bureau for the period from July 2019 to March 2021 across all quarters. Proportions and mean with standard deviations were computed. T-test was used to assess statistically significant differences in services mean performance. Results PNC visit, new contraceptives accepters, safe abortion care and number of under-five years old children treated for pneumonia significantly decreased by 9.3% (p-value 0.04), 20.3% (p-value 0.004), 23.7% (p-value 0.01) and 77.2% (P-value < 0.001), respectively during the first eight months of the COVID-19 pandemic compared to the previous eight months’ average performance. The trends in ANC first visit, new contraceptive accepters, pentavalent-3 vaccination and under-five children treated for pneumonia began to decline between January-March 2020 when the COVID-19 pandemic began; with accelerated declines between April-June 2020 following national lockdown. The trends for the stated services began to increase during July-September 2020, during the last quarter of national lockdown. Contraceptive accepters and pentavalent-1 vaccination continued to decline and showed no recovery until January-March 2021when this study was completed. Conclusions Most of the maternal and child health services performance declined following the onset of COVID-19 pandemic and national lockdown, and most of the services began recovering during July-September 2020, the last quarter of national lockdown. However, new and repeat contraceptive accepters and pentavalent-1 recipients continue to decline and show no recovery during end of the study period. Implementing COVID-19 prevention measures and assuring the community about the safety of service delivery is imperative to ensure continuity of the maternal and child health services. Regular monitoring and evaluation of services performance is required to identify slowly recovering services and respond to potentially volatile changes during the COVID-19 pandemic.

scholarly journals Short Term Effects of Performance-Based Financing on Maternal and Child Health Services in the MIFI Health District

2021 ◽  
pp. 1-11
Author(s):  
Djam Chefor Alain ◽  
Earnest Njih Tabah ◽  
Bekolo Calvin Epie ◽  
Lenwo Njonwo Leslie ◽  
Augustine Eyong Bate
Keyword(s):  
Child Health ◽  
Health Services ◽  
Maternal And Child Health ◽  
Health District ◽  
Child Health Services ◽  
P Value ◽  
Short Term ◽  
Performance Based Financing ◽  
The Mean ◽  
And Child Health

Background: Improving maternal, neonatal and child health are two of the most critical Sustainable Development Goals (MDGs). The Cameroon health system has consistently faced huge challenges to meet these objectives. As upshot; decision-makers identified the lack of a suitable health financing policy as an important issue that needed to be addressed. In response; the performance- based financing (PBF) scheme was implemented. Objective of Study: Assess the short term effects of PBF on both maternal and child health services. Methods: An analytical cross-sectional study was carried out in the Mifi Health District to compare the trend in some key child health indicators before and after PBF’s implementation across 41 randomly selected health facilities. A linear regression model and a paired sample T-test were used in the analysis, considering a p-value of <0.05 as significant and a confidence interval at 95%. Results: There was a significant decrease in the mean Pentavalent dropout rate (p-value=0.02) as well as in the mean number of child deaths (p-value=0.019), per facilities per year from 26.61 and 0.46 before, to -104.07 and 0.15. There was also a significant increase in the proportion of women per facility per year who came for first antenatal care visit (ANC) p=0.001 from 94.55 before to 229.71 during PBF. The mean number per facility per year of pregnant women who attended at least 4 ANCs (p=0.034) also increased significantly from 44.65 before to 119.05 during PBF. Equally, the mean number of women per facility per year attending post natal visits significantly increased (p=0.010) from 23.23 before to 75.29 during PBF. Conclusion: The findings of the assessment of the effect of PBF scheme on maternal and child health services in the Mifi Health District, demonstrates a significant improvement in key indicators of maternal and child health, following PBF implementation. This study highlights the essential need for policymakers to carefully examine the effect of the PBF strategy on maternal and child health with the perspective of further scaling up this reform to other regions. Therefore, PBF can be an effective strategy for improving maternal and child health by increasing the utilisation of MCH services.

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