Newborn Service Readiness of Primary Level Health Facilities of Eastern Mountain Region of Nepal

Background: Newborn service readiness is facility’s observed capacity to provide newborn services and a pre-requisite for quality. Newborn services are priority program of government and efforts are focused on infrastructure and supplies at peripheral health facilities. Study describes health facility readiness for newborn services in four domains of general requirements, equipment, medicines and commodities, and staffing and guidelines.Methods: Convergent parallel mixed method using concurrent triangulation was done in public health facilities providing institutional deliveries of two randomly selected districts- Taplejung and Solukhumbu of Eastern Mountain Region of Nepal. Face to face interview and observation of facilities were done using structured questionnaire and checklist; in-depth interviews were done using interview guideline from November 2016 to January 2017. Ethical clearance was taken. Descriptive analysis and deductive thematic analysis were done.Results: Mean score of newborn service readiness was 68.7±7.1 with range from 53.3 to 81.4 out of 100. Domains of general requirement, equipment, medicine and commodity, supervision, staffing and guideline were assessed. The gaps identified in general requirements were availability of uninterrupted power supply, means of communication and referral vehicle. Clean wrappers and heater for room temperature maintenance were identified during interviews to be part of the readiness. All health facilities had trained staff while retention of skill was of concern. There was felt need of enforcing adequate training coverage to suffice the need of human resources in remote. Conclusions: Efforts of improving transportation, heater for room temperature maintenance, trainings with skill retention strategy, utilization of guidelines, availability of skilled birth attendance could result increased and improved newborn service readiness.Keywords: Eastern mountain region of Nepal; health facility readiness; newborn service readiness.

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Availability and readiness to provide sexually transmitted infections and HIV testing and counselling services in Nepal: evidence from comprehensive health facility survey

BMJ Open ◽

10.1136/bmjopen-2020-040918 ◽

2020 ◽

Vol 10 (12) ◽

pp. e040918

Author(s):

Kiran Acharya ◽

Rajshree Thapa ◽

Navaraj Bhattarai ◽

Kiran Bam ◽

Bhagawan Shrestha

Keyword(s):

Quality Assurance ◽

Sexually Transmitted Infections ◽

Health Facility ◽

Health Facilities ◽

Sexually Transmitted ◽

Health Facility Survey ◽

Service Readiness ◽

Hiv Testing And Counselling ◽

Facility Survey ◽

Facility Readiness

ObjectiveWe assessed the availability and readiness of health facilities to provide sexually transmitted infections (STI) and HIV testing and counselling (HTC) services in Nepal.DesignThis was a cross-sectional study.SettingWe used data from the most recent nationally representative Nepal Health Facility Survey (NHFS) 2015. A total of 963 health facilities were surveyed with 97% response rate.Primary and secondary outcome measuresThe primary outcome of this study was to assess the availability and readiness of health facilities to provide STI and HTC services using the WHO Service Availability and Readiness Assessment (SARA) manual.ResultsNearly three-fourths (73.8%) and less than one-tenth (5.9%) of health facilities reported providing STI and HTC services, respectively. The mean readiness score of STI and HTC services was 26.2% and 68.9%, respectively. The readiness scores varied significantly according to the managing authority (private vs public) for both STI and HTC services. Interestingly, health facilities with external supervision had better service readiness scores for STI services that were almost four points higher than compared with those facilities with no external supervision. Regarding HTC services, service readiness was lower at private hospitals (32.9 points lower) compared to government hospitals. Unlike STI services, the readiness of facilities to provide HTC services was higher (4.8 point higher) at facilities which performed quality assurance.ConclusionThe facility readiness for HTC service is higher than that for STI services. There are persistent gaps in staff, guidelines and medicine and commodities across both services. Government of Nepal should focus on ensuring constant supervision and quality assurance, as these were among the determining factors for facility readiness.

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Measuring facility readiness to provide childbirth care: a comparison of indices using data from a health facility survey in Ethiopia

BMJ Global Health ◽

10.1136/bmjgh-2021-006698 ◽

2021 ◽

Vol 6 (10) ◽

pp. e006698

Author(s):

Elizabeth K Stierman ◽

Saifuddin Ahmed ◽

Solomon Shiferaw ◽

Linnea A Zimmerman ◽

Andreea A Creanga

Keyword(s):

Quality Improvement ◽

Health Facility ◽

Performance Monitoring ◽

Newborn Care ◽

Health Facilities ◽

Cross Sectional ◽

Who Standards ◽

Service Readiness ◽

Facility Readiness ◽

Childbirth Care

BackgroundActionable information about the readiness of health facilities is needed to inform quality improvement efforts in maternity care, but there is no consensus on the best approach to measure readiness. Many countries use the WHO’s Service Availability and Readiness Assessment (SARA) or the Demographic and Health Survey (DHS) Programme’s Service Provision Assessment to measure facility readiness. This study compares measures of childbirth service readiness based on SARA and DHS guidance to an index based on WHO’s quality of maternal and newborn care standards.MethodsWe used cross-sectional data from Performance Monitoring for Action Ethiopia’s 2019 survey of 406 health facilities providing childbirth services. We calculated childbirth service readiness scores using items based on SARA, DHS and WHO standards. For each, we used three aggregation methods for generating indices: simple addition, domain-weighted addition and principal components analysis. We compared central tendency, spread and item variation between the readiness indices; concordance between health facility scores and rankings; and correlations between readiness scores and delivery volume.ResultsIndices showed moderate agreement with one another, and all had a small but significant positive correlation with monthly delivery volume. Ties were more frequent for indices with fewer items. More than two-thirds of items in the relatively shorter SARA and DHS indices were widely (>90%) available in hospitals, and half of the SARA items were widely (>90%) available in health centres/clinics. Items based on the WHO standards showed greater variation and captured unique aspects of readiness (eg, quality improvement processes, actionable information systems) not included in either the SARA or DHS indices.ConclusionSARA and DHS indices rely on a small set of widely available items to assess facility readiness to provide childbirth care. Expanded selection of items based on the WHO standards can better differentiate between levels of service readiness.

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Magnitude and determinants of self-referrals among women seeking skilled birth attendance services: a cross-sectional hospital-based study in Marsabit County, Kenya

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20211728 ◽

2021 ◽

Vol 8 (5) ◽

pp. 2124

Author(s):

Joseph O. Adoyo ◽

Eliphas G. Makunyi ◽

George O. Otieno ◽

Alison Yoos

Keyword(s):

Multiple Logistic Regression Analysis ◽

Skilled Birth Attendance ◽

Health Facilities ◽

Public Hospitals ◽

Systematic Sampling ◽

P Value ◽

Cross Sectional ◽

Factors Associated ◽

Birth Attendance ◽

Referral Hospitals

Background: Self-referral to higher-level hospitals by women seeking skilled birth attendance services reflects in part their non-adherence to established referral pathways. This choice results in an inappropriate utilization of resources within health system. The Kenya Health Sector Referral Strategy aims at optimising the utilization and access of facilities. The aim of this study was to determine the prevalence and factors associated with self-referral among women seeking skilled birth attendance services in Marsabit County between 1st and 31st Oct 2019.Methods: A cross-sectional study was adopted at the maternity department in the selected public hospitals in Marsabit County, by use of interviewer-administered questionnaires to collect information from 161 women, through systematic sampling between 1st and 31st Oct 2019. Chi-square and multiple logistic regression analysis were used to test for factors associated with self-referral at 95% confidence interval.Results: Of the 161 women interviewed, 47.2% (n=76) were self-referrals. The odds of self-referral to the higher level health facilities were more likely among women: - aged 25-29 (AOR 5.174, CI 1.015-26.365, p-value 0.048); those referred for other ANC services (AOR 4.057, CI 1.405-11.720, p-value 0.010); and those, - who visited the referral facility before for delivery (AOR 5.395, CI 1.411 – 20.628, p-value 0.014). However, self-referral were less likely among women who perceived privacy and confidentiality of services at the referral hospitals (AOR 0.370, CI 0.138-0.990, p-value 0.048).Conclusions: Almost half of women seeking skilled birth attendance were self-referrals, relates to a possible implication on an unprecedented increased workload at referral hospitals and underutilization of primary health facilities.

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Measuring health facility readiness and its effects on severe malaria outcomes in Uganda

Scientific Reports ◽

10.1038/s41598-018-36249-8 ◽

2018 ◽

Vol 8 (1) ◽

Cited By ~ 7

Author(s):

Julius Ssempiira ◽

Ibrahim Kasirye ◽

John Kissa ◽

Betty Nambuusi ◽

Eddie Mukooyo ◽

...

Keyword(s):

Severe Malaria ◽

Health Facility ◽

Facility Readiness ◽

Health Facility Readiness

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The Prevalence of Skilled Birth Attendant Utilization and Its Correlates in North West Ethiopia

BioMed Research International ◽

10.1155/2015/436938 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 14

Author(s):

Mulunesh Alemayehu ◽

Wubegzier Mekonnen

Keyword(s):

Skilled Birth Attendant ◽

Skilled Birth Attendance ◽

Northwest Ethiopia ◽

Health Facilities ◽

Health Centers ◽

Skilled Birth Attendants ◽

Urban Residence ◽

North West ◽

Birth Attendants ◽

Birth Attendance

The low utilization of skilled birth attendants sustained high maternal mortality. The aim of this study was to assess its magnitude and correlates in Northwest Ethiopia. A study was conducted on 373 randomly selected women who gave birth in the 12 months preceding the survey. Correlates were identified using binary logistic regression. Skilled birth attendance was 18.8%. Inability to perform cultural practices in health facilities (65.5%), expecting smooth delivery (63.4%), and far distance (62%) were the main barriers. Women with urban residence (AOR = 5.46: 95% CI[2.21–13.49]), primary (AOR = 2.10: 95% CI[0.71–6.16]) and secondary-plus (AOR = 6.12:[1.39–26.92]) educational level, four-plus ANC visits (AOR = 17.33: 95% CI[4.22–71.29]), and proximity to health centers (AOR = 5.67: 95% CI[1.47–25.67]) had higher odds of using skilled birth attendants though women with no labor complications had lower odds (AOR = 0.02: 95% CI[0.01–0.05]). Skilled birth attendance use was low. Urban residence, primary-plus level of education, frequent ANC visits, living nearby the health centers, and a problem during labor were positively correlated with skilled birth attendance utilization. Stakeholders should enhance girls’ education beyond primary level and ANC services and shorten distances to health facilities.

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Levels of and changes in socioeconomic inequality in delivery care service: A decomposition analysis using Bangladesh Demographic Health Surveys

PLoS ONE ◽

10.1371/journal.pone.0242325 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0242325

Author(s):

Mohammad Habibullah Pulok ◽

Gowokani Chijere Chirwa ◽

Jacob Novignon ◽

Toshiaki Aizawa ◽

Marshall Makate

Keyword(s):

Health Facility ◽

Socioeconomic Inequality ◽

Care Service ◽

Skilled Birth Attendance ◽

Household Wealth ◽

Facility Delivery ◽

Delivery Care ◽

Health Facility Delivery ◽

Care Services ◽

Birth Attendance

Background Socioeconomic inequality in maternity care is well-evident in many developing countries including Bangladesh, but there is a paucity of research to examine the determinants of inequality and the changes in the factors of inequality over time. This study examines the factors accounting for the levels of and changes in wealth-related inequality in three outcomes of delivery care service: health facility delivery, skilled birth attendance, and C-section delivery in Bangladesh. Methods This study uses from the Bangladesh Demographic and Health Survey of 2011 and 2014. We apply logistic regression models to examine the association between household wealth status and delivery care measures, controlling for a wide range of sociodemographic variables. The Erreygers normalised concentration index is used to measure the level of inequalities and decomposition method is applied to disentangle the determinants contributing to the levels of and changes in the observed inequalities. Results We find a substantial inequality in delivery care service utilisation favouring woman from wealthier households. The extent of inequality increased in health facility delivery and C-section delivery in 2014 while increase in skilled birth attendance was not statistically significant. Wealth and education were the main factors explaining both the extent of and the increase in the degree of inequality between 2011 and 2014. Four or more antenatal care (ANC4+) visits accounted for about 8% to 14% of the observed inequality, but the contribution of ANC4+ visits declined in 2014. Conclusion This study reveals no progress in equity gain in the use of delivery care services in this decade compared to a declining trend in inequity in the last decade in Bangladesh. Policies need to focus on improving the provision of delivery care services among women from poorer socioeconomic groups. In addition, policy initiatives for promoting the completion of quality education are important to address the stalemate of equity gain in delivery care services in Bangladesh.

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Health system’s readiness to provide cardiovascular, diabetes and chronic respiratory disease related services in Nepal: analysis using 2015 health facility survey

10.21203/rs.3.rs-15600/v2 ◽

2020 ◽

Author(s):

Umesh Ghimire ◽

Nipun Shrestha ◽

Bipin Adhikari ◽

Suresh Meheta ◽

Yashashwi Pokharel ◽

...

Keyword(s):

Health Facility ◽

Health Facilities ◽

Public Hospitals ◽

World Health ◽

Related Services ◽

The Public ◽

Public Facilities ◽

Health Facility Survey ◽

Service Readiness ◽

Facility Survey

Abstract Background: The burgeoning rise of non-communicable diseases (NCDs) is posing serious challenges in resource constrained health facilities of Nepal. The main objective of this study was to assess the readiness of health facilities for cardiovascular diseases (CVDs), diabetes and chronic respiratory diseases (CRDs) services in Nepal. Methods: This study utilized data from the Nepal Health Facility Survey 2015. General readiness of 940 health facilities along with disease specific readiness for CVDs, diabetes and CRDs were assessed using service availability and readiness assessment manual of the World Health Organization (WHO). Health facilities were categorized into public and private facilities. Results: Out of a total of 940 health facilities assessed, private facilities showed higher availability of items of general service readiness, except for standard precautions for infection prevention, compared to public facilities. The multivariable adjusted regression coefficients for CVDs (β=2.87, 95%CI: 2.42-3.39), diabetes (β =3.02, 95%CI: 2.03-4.49) and CRDs (β=15.95, 95%CI: 4.61-55.13) at private facilities were higher than the public hospitals. Health facilities located in hills had higher readiness index for CVDs (β=1.99, 95%CI: 1.02 - 1.39). Service readiness for CVDs (β=1.13, 95%CI: 1.04-1.23) and diabetes (β=1.78, 95%CI: 1.23-2.59) were higher in the urban municipalities than in rural municipalities. Finally, disease related services readiness index was sub-optimal with some degree of variation at the province level in Nepal. Compared to province 1, Province 2 (β=0.83, 95%CI: 0.73-0.95), and province 4 (β =1.24, 95%CI: 1.07-1.43) and province 5 (β =1.17, 95%CI: 1.02-1.34) had higher readiness index for CVDs.Conclusions: This study found sub-optimal readiness of services related to three NCDs at the public facilities in Nepal. Compared to public facilities, private facilities showed higher readiness score for CVDs, diabetes and CRDs. To cope up with the growing burden of NCDs, urgent improvement in health services, particularly in public facilities are critical to manage common NCDs.

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Health system's readiness to provide cardiovascular, diabetes and chronic respiratory disease related services in Nepal: analysis using 2015 health facility survey

10.21203/rs.3.rs-15600/v1 ◽

2020 ◽

Author(s):

Umesh Ghimire ◽

Nipun Shrestha ◽

Bipin Adhikari ◽

Suresh Meheta ◽

Yashashwi Pokharel ◽

...

Keyword(s):

Health Facility ◽

Respiratory Disease ◽

Chronic Respiratory Disease ◽

Health Facilities ◽

World Health ◽

Related Services ◽

Public Facilities ◽

Health Facility Survey ◽

Service Readiness ◽

Facility Survey

Abstract Background: The burgeoning rise of non-communicable diseases is posing a serious challenge in resource constrained health facilities of Nepal. The main objective of this study was to assess the readiness of health facilities for cardiovascular, diabetes and chronic respiratory disease services in Nepal. Methods: This study utilized data from the Nepal Health Facility Survey 2015. General readiness of 940 health facilities along with disease specific readiness for cardiovascular diseases (CVDs), diabetes and cardiorespiratory diseases (CRDs) were assessed using service availability and readiness assessment manual of the World Health Organization (WHO). Health facilities were categorized into public and private facilities.Results: Out of a total of 940 health facilities assessed, private facilities showed higher availability of items of general service readiness, except for standard precautions for infection prevention, compared to public facilities. The multivariable adjusted regression coefficients for CVDs (β=2.87, 95%CI: 2.42-3.39), diabetes (β =3.02, 95%CI: 2.03-4.49) and CRDs (β=15.95, 95%CI: 4.61-55.13) at private facilities were higher than public hospitals. Health facilities located in hills had higher readiness index for CVDs (β=1.99, 95%CI: 1.02 - 1.39). Service readiness for CVDs (β=1.13, 95%CI: 1.04-1.23) and diabetes (β=1.78, 95%CI: 1.23-2.59) were higher in the urban municipalities than in rural municipalities. Finally, disease related services readiness index was sub-optimal with some degree of variation at the province level in Nepal. Province 2 for CVDs (β=0.83, 95%CI: 0.73-0.95), and province 4 (β =1.24, 95%CI: 1.07-1.43) and province 5 (β =1.17, 95%CI: 1.02-1.34) had higher readiness index compared to province 1.Conclusions: This study found a sub-optimal readiness of services related to three NCDs at the public facilities in Nepal. Compared to public facilities, private facilities showed higher readiness score for CVDs, diabetes and CRDs. To cope up with the growing burden of NCDs, urgent improvement in health services, particularly in public facilities are critical to manage common NCDs.

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Predictors of health facility readiness for diabetes service delivery in low- and middle-income countries: The case of Bangladesh

Diabetes Research and Clinical Practice ◽

10.1016/j.diabres.2020.108417 ◽

2020 ◽

Vol 169 ◽

pp. 108417

Author(s):

Jacqueline A. Seiglie ◽

Edson Serván-Mori ◽

Tahmina Begum ◽

James B. Meigs ◽

Deborah J. Wexler ◽

...

Keyword(s):

Service Delivery ◽

Health Facility ◽

Middle Income ◽

Middle Income Countries ◽

Facility Readiness ◽

Health Facility Readiness ◽

Low And Middle Income

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Normative Beliefs and Values Shape Mother’s Care Seeking Behaviours for Skilled Birth Attendance (Sba) During Birthing in Africa: A Scoping Review Protocol

10.21203/rs.3.rs-32893/v1 ◽

2020 ◽

Author(s):

Choolwe Jacobs ◽

Adnan Hyder

Keyword(s):

Scoping Review ◽

Grey Literature ◽

Skilled Birth Attendance ◽

Health Facilities ◽

Barriers And Facilitators ◽

Care Seeking ◽

Normative Beliefs ◽

Birth Attendance ◽

Beliefs And Values ◽

Scoping Reviews

Abstract Background: Skilled birth attendance (SBA) during delivery has been associated with improved maternal health outcome. However, low utilisation of SBA during childbirth has continued in many developing countries including Zambia. An understanding of the beliefs and values and how mothers are influenced by relational normative motivations is critical in understanding some “hidden” barriers and facilitators to utilisation of SBA in health facilities.Methods: A scoping review of normative beliefs and values shaping care seeking behaviours for Skilled Birth Attendance by mothers in Africa will be conducted. Google scholar, PubMed, EBSCOhost, SCOPUS, Embase and WEB of Science will be searched for articles that meet the eligibility criteria. The primary search will include peer-reviewed articles. Further searches will be made on Research gate, including grey literature from university websites for dissertations and theses. We will also search reference lists for relevant articles and studies. Keyword searches will be used to identify articles. Two independent reviewers will begin screening for eligible titles, abstracts and full articles with a third reviewer to help resolve any disputes. During title and abstract screening, duplicates will be removed. Study selection will conform to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines, and the Mixed Method Appraisal Tool will determine the quality of included studies. Content analysis will be used to present the narrative Discussion: Understanding how individual mother’s health seeking behaviours for SBA and those close to them are influenced by their beliefs and values is critical to informing health systems on the possible “hidden” barriers and facilitators to utilisation of SBA in public health facilities. The review will complement evidence base on normative beliefs and values shaping care seeking behaviours for Skilled Birth Attendance by mothers in Africa.

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