Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 6. strategies used by effective projects

Nearly 80% of the world’s population lives in low- and middle-income countries (LMICs) and these regions bear the greatest burden of maternal, neonatal, and child mortality, with most of the deaths occurring at home. Much of global maternal and child mortality is attributable to easily preventable and treatable conditions. However, the challenge lies in reaching the most vulnerable communities, especially the rural populations, making it imperative that maternal, newborn, and child health (MNCH) interventions focus on communities in tandem with facility-based strategies. There is widespread consensus that delivering effective primary health care (PHC) interventions through the continuum of care, starting from pregnancy to delivery and then to the newborn, infant, and the young child, is an integral component of health strategies in high-, middle- and low-income settings. Despite gaps in research, several effective community-based PHC approaches have been proven to impact MNCH positively. Implementation of these strategies is needed at scale in LMICs and in partnership with all stakeholders including the public and private sector. Community-based PHC, operating on the principles of community engagement and community mobilization, is now more critical than ever. Further robust studies are needed to evaluate certain strategies of community-based PHC and their impact on maternal and child health outcomes, such as the use of mobile technology and social franchises. Recognition of community health workers (CHWs) as a formal cadre and the integration of community-based health services within PHC are vital in strengthening efforts to impact maternal, neonatal, and child health outcomes positively. However, despite the importance of community-based PHC for MNCH in LMICs, the existence of a strong health system and skilled workforce is central to achieving positive health outcomes in these regions.

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A qualitative appraisal of stakeholders’ perspectives of a community-based primary health care program in rural Ghana

BMC Health Services Research ◽

10.1186/s12913-019-4506-2 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 5

Author(s):

Mawuli K. Kushitor ◽

Adriana A. Biney ◽

Kalifa Wright ◽

James F Phillips ◽

John Koku Awoonor-Williams ◽

...

Keyword(s):

Health Care ◽

Primary Health Care ◽

Child Health ◽

Maternal And Child Health ◽

Scale Up ◽

Care Providers ◽

Community Members ◽

Community Based ◽

Primary Health ◽

And Child Health

Abstract Background The Ghana Community-based Health Planning and Services (CHPS) initiative is a national strategy for improving access to primary health care services for underserved communities. Following a successful trial in the North Eastern part of the country, CHPS was adopted as Ghana’s flagship programme for achieving the Universal Health Coverage. Recent empirical evidence suggests, however, that scale-up of CHPS has not necessarily replicated the successes of the pilot study. This study examines the community’s perspective of the performance of CHPS and how the scale up could potentially align with the original experimental study. Method Applying a qualitative research methodology, this study analysed transcripts from 20 focus group discussions (FGDs) in four functional CHPS zones in separate districts of the Northern and Volta Regions of Ghana to understand the community’s assessment of CHPS. The study employed the thematic analysis to explore the content of the CHPS service provision, delivery and how community members feel about the service. In addition, ordinary least regression model was applied in interpreting 126 scores consigned to CHPS by the study respondents. Results Two broad areas of consensus were observed: general favourable and general unfavourable thematic areas. Favourable themes were informed by approval, appreciation, hard work and recognition of excellent services. The unfavourable thematic area was informed by rudeness, extortion, inappropriate and unprofessional behaviour, lack of basic equipment and disappointments. The findings show that mothers of children under the age of five, adolescent girls without children, and community leaders generally expressed favourable perceptions of CHPS while fathers of children under the age of five and adolescent boys without children had unfavourable expressions about the CHPS program. A narrow focus on maternal and child health explains the demographic divide on the perception of CHPS. The study revealed wide disparities in actual CHPS deliverables and community expectations. Conclusions A communication gap between health care providers and community members explains the high and unrealistic expectations of CHPS. Efforts to improve program acceptability and impact should address the need for more general outreach to social networks and men rather than a sole focus on facility-based maternal and child health care.

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Improving maternal and child health: a situational analysis of primary health care centres of Sokoto state, Nigeria

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20184777 ◽

2018 ◽

Vol 5 (12) ◽

pp. 5052

Author(s):

Aminu U. Kaoje ◽

Sani Labaran ◽

Aminu G. Magashi ◽

Jessica T. Ango

Keyword(s):

Health Care ◽

Primary Health Care ◽

Child Health ◽

Maternal And Child Health ◽

The State ◽

Current Form ◽

Primary Health ◽

Nurse Midwife ◽

Care Facilities ◽

And Child Health

Background: Primary health care facilities constitute the first point of contacts of public with healthcare and form integral part of the country’s health system.Methods: A descriptive cross sectional study was conducted among 88 primary care facilities in the State. A simple random sampling technique was used to select the facilities. Federal Ministry of Health integrated supportive supervision tool was adapted for data collection and analysis done using SPSS Version 20.0. The variables were summarised with frequency and percentage and results presented in tables.Results: Almost two-thirds (65%) of the facilities provide 24 hours service coverage for both maternal and child care services. Only 16% of the facilities had medical officers, 12.5% had required number of nurse/midwife while 27% had no single nurse/midwife. With respect to trainings, one third of the facilities had personnel trained on medium and extended lifesaving skills, 20% had a trained staff on emergency obstetrics and newborn care while 61% had no single trained personnel on integrated management of childhood illnesses. A large proportion of the facilities provide maternal services such as focused ANC and delivery but none use partograph to monitor labour. A good number of facilities were lacking basic equipment and medicine supply with about two third of facilities lacking misoprostol and magnesium sulphate, and only 15% had functional DRF.Conclusions: Health resources and the level of service provision in its current form may not lead to a significant improvement in maternal and child health in the state to guarantee universal coverage.

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