Perceptions and Experiences of Inequity in The Provision and Utilization of Maternal, Newborn, and Child Health Services in Tigray, Ethiopia: A Qualitative Exploratory Study

Background In earlier studies, we could show that rural Ethiopian maternal health services were distributed pro-rich, while child immunization coverage was equitably distributed. Hence, this study aimed at exploring rural Ethiopian mothers’ and primary healthcare workers’ perceptions of inequities and their causes in the provision and utilization of maternal, newborn, and child health services. Methods The study was conducted from August to December 2019 in two rural districts in Tigray, Ethiopia. We performed 22 in-depth interviews and three focus group discussions with mothers who had given birth the last year before the survey. We also interviewed women’s development group leaders, health extension workers at health posts, and health workers at health centers. The final sample was determined based on the concept of saturation. The interviews and focus group discussions were audiotaped, transcribed, translated, coded, and analyzed using thematic analysis. Results Mothers perceived the provision and utilization of antenatal care, facility-based delivery, and care-seeking for sick children inequitably distributed, while immunization was seen as an equitable service. The inequity in providing and utilizing maternal and child health services was linked to the economy, distance, social and cultural norms, health systems, maternal age, and education. Poor implementation of the Government’s equity-oriented policies, such as community-based health insurance, was perceived to result in health inequities. Conclusions Mothers and primary health care providers in rural Ethiopia indicated weaknesses in delivering equitable services and reasons for inequitable utilization. The narratives could inform efforts to provide universal health coverage for mothers, newborns, and children. These problems require multisectoral actions to address the identified sources of inequities.

Level of completion along continuum of care for maternal, newborn and child health services and factors associated with it among women in India: a population-based cross-sectional study

Background India, being a developing country, presents a disquiet picture of maternal and neonatal mortality and morbidity. The majority of maternal and neonatal mortality could be avoided if the continuum of care (CoC) is provided in a structured pathway from pregnancy to the postpartum period. Therefore, this article attempted to address the following research questions: What is the level of completion along CoC for MNCH services? At which stage of care do women discontinue taking services? and what are the factors affecting the continuation in receiving maternal, newborn and child health (MNCH) services among women in India? Methods The study utilized the data from the National Family Health Survey (NFHS-4) conducted during 2015–16 in India. The analysis was limited to 107,016 women aged 15–49 who had given a live birth in the last 5 years preceding the survey and whose children had completed 1 year. Four sequential fixed effect logit regression models were fitted to identify the predictors of completion of CoC. Results Nearly 39% of women in India had completed CoC for maternal and child health by receiving all four types of service (antenatal care, institutional delivery, post-natal care and full immunization of their child), with substantial regional variation ranging from 12 to 81%. The highest number of dropouts in CoC were observed at the first stage with a loss of nearly 38%. Further, education, wealth index, and health insurance coverage emerged as significant factors associated with CoC completion. Conclusion The major barrier in achieving CoC for maternal and child health is the low utilization of ANC services in the first stage of the continuum and hence should be addressed for increasing CoC completion rate in the country. The gaps across all the levels of CoC indicate a need for increased focus on the CoC approach in India. A strategy should be developed that will connect all the components of MNCH avoiding dropouts and the MNCH provision should be standardized to provide services to every woman and child.

Determinants of Evidence Use by Frontline Maternal, Newborn and Child Health Staff in Selected Health Facilities in Ghana

Background The current paper examines the level of use of evidence and factors affecting the use of evidence by frontline maternal, newborn and child health (MNCH) and reproductive and child health (RCH) staff in practice decisions in selected health facilities in Ghana. Methods Data was collected from 509 respondents drawn from 44 health facilities in three regions in Ghana. Means were used to examine the level of use of evidence, whiles cross-tabulations and Partial least Squares-based regression were used to examine factors that influence the use of evidence in practice decisions by frontline MNCH/RCH staff. Conclusion We argue that any effort to improve the use of evidence by frontline MNCH/RC staff in practice decisions should focus on improving attitudes and knowledge of staff as well as challenges related to the structure of the organisation. Given however that the score for attitude was relatively high, emphases should be on knowledge and organizational structure in particular, which had the lowest score even though it has the single most important effect on the use of evidence.

Local Dynamics of Collaboration for Maternal, Newborn and Child Health: A Social Network Analysis of Healthcare Providers and Their Managers in Gert Sibande District, South Africa

Background: Accountability for maternal, newborn and child health (MNCH) is a collaborative endeavour and documenting collaboration dynamics may be key to understanding variations in the performance of MNCH services. This study explored the dynamics of collaboration among frontline health professionals participating in two MNCH coordination structures in a rural South African district. It examined the role and position of actors, the nature of their relationships, and the overall structure of the collaborative network in two sub-districts. Methods: Cross-sectional survey using a social network analysis (SNA) methodology of 42 district and sub district actors involved in MNCH coordination structures. Different domains of collaboration (eg, communication, professional support, innovation) were surveyed at key interfaces (district-sub-district, across service delivery levels, and within teams). Results: The overall network structure reflected a predominantly hierarchical mode of clustering of organisational relationships around hospitals and their referring primary healthcare (PHC) facilities. Clusters were linked through (and dependent on) a combination of district MNCH programme and line managers, identified as central connectors or boundary spanners. Overall network density remained low suggesting potential for strengthening collaborative relationships. Within cluster collaborative patterns (inter-professional and across levels) varied, highlighting the significance of small units in district functioning. Conclusion: SNA provides a mechanism to uncover the nature of relationships and key actors in collaborative dynamics which could point to system strengths and weaknesses. It offers insights on the level of fragmentation within and across small units, and the need to strengthen cohesion and improve collaborative relationships, and ultimately, the delivery of health services.