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Olivas ET, Valdez M, Muffoletto B, Wallace J, Stollak I, Perry HB. Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 6. Management of pregnancy complications at Community Birthing Centers (Casas Maternas Rurales). Int J Equity Health 2023; 21:204. [PMID: 36855147 PMCID: PMC9976365 DOI: 10.1186/s12939-022-01758-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND In Guatemala, Indigenous women have a maternal mortality ratio over twice that of non-Indigenous women. Long-standing marginalization of Indigenous groups and three decades of civil war have resulted in persistent linguistic, economic, cultural, and physical barriers to maternity care. Curamericas/Guatemala facilitated the development of three community-built, -owned, and -operated birthing centers, Casas Maternas Rurales (referred to here as Community Birthing Centers), where auxiliary nurses provided physically accessible and culturally acceptable clinical care. The objective of this paper is to assess the management of complications and the decision-making pathways of Birthing Center staff for complication management and referral. This is the sixth paper in the series of 10 articles. Birthing centers are part of the Expanded Census-based, Impact-oriented Approach, referred to as CBIO+. METHODS We undertook an explanatory, mixed-methods study on the handling of pregnancy complications at the Birthing Centers, including a chart review of pregnancy complications encountered among 1,378 women coming to a Birthing Center between 2009 and 2016 and inductively coded interviews with Birthing Center staff. RESULTS During the study period, 1378 women presented to a Birthing Center for delivery-related care. Of the 211 peripartum complications encountered, 42.2% were successfully resolved at a Birthing Center and 57.8% were referred to higher-level care. Only one maternal death occurred, yielding a maternal mortality ratio of 72.6 maternal deaths per 100,000 live births. The qualitative study found that staff attribute their successful management of complications to frequent, high-quality trainings, task-shifting, a network of consultative support, and a collaborative atmosphere. CONCLUSION The Birthing Centers were able to resolve almost one-half of the peripartum complications and to promptly refer almost all of the others to a higher level of care, resulting in a maternal mortality ratio less than half that for all Indigenous Guatemalan women. This is the first study we are aware of that analyzes the management of obstetrical complications in such a setting. Barriers to providing high-quality maternity care, including obtaining care for complications, need to be addressed to ensure that all pregnant women in such settings have access to a level of care that is their fundamental human right.
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Affiliation(s)
- Elijah T Olivas
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mario Valdez
- Curamericas/Guatemala, Calhuitz, San Sebastián Coatán, Huehuetenango, Guatemala
| | | | | | - Ira Stollak
- Curamericas Global, Raleigh, North Carolina, USA
| | - Henry B Perry
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Hernandez A, Hurtig AK, San Sebastian M, Jerez F, Flores W. 'History obligates us to do it': political capabilities of Indigenous grassroots leaders of health accountability initiatives in rural Guatemala. BMJ Glob Health 2022; 7:e008530. [PMID: 35508334 PMCID: PMC9073391 DOI: 10.1136/bmjgh-2022-008530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/13/2022] [Indexed: 11/23/2022] Open
Abstract
Growing interest in how marginalised citizens can leverage countervailing power to make health systems more inclusive and equitable points to the need for politicised frameworks for examining bottom-up accountability initiatives. This study explores how political capabilities are manifested in the actions and strategies of Indigenous grassroots leaders of health accountability initiatives in rural Guatemala. Qualitative data were gathered through group discussions and interviews with initiative leaders (called defenders of the right to health) and initiative collaborators in three municipalities. Analysis was oriented by three dimensions of political capabilities proposed for evaluating the longer-term value of participatory development initiatives: political learning, reshaping networks and patterns of representation. Our findings indicated that the defenders' political learning began with actionable knowledge about defending the right to health and citizen participation. The defenders used their understanding of local norms to build trust with remote Indigenous communities and influence them to participate in monitoring to attempt to hold the state accountable for the discriminatory and deficient healthcare they received. Network reshaping was focused on broadening their base of support. Their leadership strategies enabled them to work with other grassroots leaders and access resources that would expand their reach in collective action and lend them more influence representing their problems beyond the local level. Patterns of representing their interests with a range of local and regional authorities indicated they had gained confidence and credibility through their evolving capability to navigate the political landscape and seek the right authority based on the situation. Our results affirm the critical importance of sustained, long-term processes of engagement with marginalised communities and representatives of the state to enable grassroots leaders of accountability initiatives to develop the capabilities needed to mobilise collective action, shift the terms of interaction with the state and build more equitable health systems.
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Affiliation(s)
- Alison Hernandez
- Center for the Study of Equity and Governance in Health Systems (CEGSS), Ciudad de Guatemala, Guatemala
- Epidemiology and Global Health, Umea University, Umea, Sweden
| | | | | | - Fernando Jerez
- Center for the Study of Equity and Governance in Health Systems (CEGSS), Ciudad de Guatemala, Guatemala
| | - Walter Flores
- Center for the Study of Equity and Governance in Health Systems (CEGSS), Ciudad de Guatemala, Guatemala
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Petiwala A, Lanford D, Landers G, Minyard K. Community voice in cross-sector alignment: concepts and strategies from a scoping review of the health collaboration literature. BMC Public Health 2021; 21:712. [PMID: 33849498 PMCID: PMC8042631 DOI: 10.1186/s12889-021-10741-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/30/2021] [Indexed: 11/19/2022] Open
Abstract
Background Health care access is an important driver of population health, and factors beyond health care also drive health outcomes. Recognizing the importance of the social determinants of health (SDOH), different actors in the health care, public health, and social service sectors are increasingly collaborating to improve health outcomes in communities. To support such collaboration, the Robert Wood Johnson Foundation developed a cross-sector alignment theory of change. According to the cross-sector alignment theory of change, community voice is critical for helping collaboratives address community health needs. Yet research on health collaboratives offers mixed guidance on how community voice should be understood and which community voice strategies are most effective. Methods This study addresses a gap in the literature with a systematic scoping review of research on health-oriented cross-sector collaboration and community voice. By scanning key academic journals, searching three academic databases, and obtaining documents from across our professional networks, we identified 36 documents that address community voice in health collaboratives. Results The review reveals several conceptions of community voice and a range of community voice strategies. We find that community voice strategies fall on a spectrum between two broad types of approaches: active and passive. These vary not only in the level of power shared between communities and collaborators, but also in the level of involvement required from the community, and this in turn has important implications for community collaboration strategies. We also find that while most strategies are discussed in the context of short-term collaboration, many also lend themselves to adoption in the context of sustainable collaboration and, ultimately, cross-sector alignment. Conclusion This review provides a characterization and conceptualization of community voice in health-oriented collaborations that provides a new theoretical basis for future research. Passive and active community voice strategies can be studied in more detail for their expected impact on health outcomes and disparities. Increased attention to active community voice and the resources it requires can help practitioners achieve improved health outcomes and researchers understand the pathways to health improvement through collaboration.
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Affiliation(s)
- Aliza Petiwala
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, 55 Park Place 8th Floor, Atlanta, GA, 30303, USA.
| | - Daniel Lanford
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, 55 Park Place 8th Floor, Atlanta, GA, 30303, USA
| | - Glenn Landers
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, 55 Park Place 8th Floor, Atlanta, GA, 30303, USA
| | - Karen Minyard
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, 55 Park Place 8th Floor, Atlanta, GA, 30303, USA
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Abstract
Walter Flores and Jeannie Samuel argue that grassroots organisations are essential to ensure improvements in the health of marginalised populations
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Affiliation(s)
- Walter Flores
- Centro de Estudios para la Equidad y Gobernanza en los Sistemas de Salud-CEGSS, Guatemala
| | - Jeannie Samuel
- Health and Society Program, York University, Toronto, Canada
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Kuruvilla S, Hinton R, Boerma T, Bunney R, Casamitjana N, Cortez R, Fracassi P, Franz-Vasdeki J, Helldén D, McManus J, Papp S, Rasanathan K, Requejo J, Silver KL, Tenhoope-Bender P, Velleman Y, Wegner MN, Armstrong CE, Barnett S, Blauvelt C, Buang SN, Bury L, Callahan EA, Das JK, Gurnani V, Kaba MW, Milman HM, Murray J, Renner I, Roche ML, Saint V, Simpson S, Subedar H, Ukhova D, Velásquez CN, Young P, Graham W. Business not as usual: how multisectoral collaboration can promote transformative change for health and sustainable development. BMJ 2018; 363:k4771. [PMID: 30530519 PMCID: PMC6282730 DOI: 10.1136/bmj.k4771] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - Rachael Hinton
- Partnership for Maternal, Newborn, and Child Health, Geneva, Switzerland
| | - Ties Boerma
- Countdown to 2030, and University of Manitoba, Manitoba, Canada
| | | | - Nuria Casamitjana
- ISGlobal, Barcelona Institute for Global Health, University of Barcelona, Spain
| | | | | | | | - Daniel Helldén
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | | | | | | | - Mary Nell Wegner
- Maternal Health Task Force, Harvard University TH Chan School of Public Health, Boston, Massachusetts, USA
| | | | | | | | | | | | | | - Jai K Das
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Vandana Gurnani
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | | | | | | | - Ilona Renner
- National Centre for Early Prevention, Federal Centre for Health Education, Cologne, Germany
| | - Marion Leslie Roche
- Nutrition International, Adolescents' and Women's Health and Nutrition, Ottawa, Ontario, Canada
| | - Victoria Saint
- Berlin, Germany, Council on International Educational Exchange (CIEE), Berlin, Germany
| | | | | | | | | | | | - Wendy Graham
- London School of Hygiene and Tropical Medicine, London, UK
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