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Odendaal W, Chetty T, Tomlinson M, Goga A, Singh Y, Kauchali S, Marshall C, Hunt X. "If you work alone on this project, you can't reach your target": unpacking the leader's role in well-performing teams in a maternal and neonatal quality improvement programme in South Africa, before and during COVID-19. BMC Health Serv Res 2023; 23:1382. [PMID: 38066525 PMCID: PMC10709890 DOI: 10.1186/s12913-023-10378-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
The South African National Department of Health developed a quality improvement (QI) programme to reduce maternal and neonatal mortality and still births. The programme was implemented between 2018 and 2022 in 21 purposively selected public health facilities. We conducted a process evaluation to describe the characteristics and skills of the QI team leaders of well-performing teams. The evaluation was conducted in 15 of the 21 facilities. Facilities were purposively selected and comprised semi-structured interviews with leaders at three time points; reviewing of QI documentation; and 37 intermittently conducted semi-structured interviews with the QI advisors, being QI technical experts who supported the teams. These interviews focused on participants' experiences and perceptions of how the teams performed, and performance barriers and enablers. Thematic data analysis was conducted using Atlas.ti. Variation in team performance was associated with leaders' attributes and skills. However, the COVID-19 pandemic also affected team functioning. Well-performing teams had leaders who effectively navigated COVID-19 and other challenges, who embraced QI and had sound QI skills. These leaders cultivated trust by taking responsibility for failures, correcting members' mistakes in encouraging ways, and setting high standards of care. Moreover, they promoted programme ownership among members by delegating tasks. Given the critical role leaders play in team performance and thus in the outcomes of QI programmes, efforts should focus on leader selection, training, and support.
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Affiliation(s)
- Willem Odendaal
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, Cape Town, Western Cape, South Africa.
- Department of Psychiatry, Stellenbosch University, Francie Van Zijl Drive, Tygerberg, Cape Town, Western Cape, South Africa.
| | - Terusha Chetty
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, Cape Town, Western Cape, South Africa
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Stellenbosch University, Franzi Van Zijl Drive, Tygerberg, Cape Town, Western Cape, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Ameena Goga
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, Cape Town, Western Cape, South Africa
- Department of Paediatrics and Child Health, University of Pretoria, Steve Biko Academic Hospital, Pretoria, Gauteng, South Africa
| | - Yages Singh
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, Cape Town, Western Cape, South Africa
| | - Shuaib Kauchali
- Department of Paediatrics and Child Health, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Carol Marshall
- South African National Department of Health, Voortrekker Road, Pretoria, Gauteng, South Africa
| | - Xanthe Hunt
- Institute for Life Course Health Research, Stellenbosch University, Franzi Van Zijl Drive, Tygerberg, Cape Town, Western Cape, South Africa
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Odendaal W, Chetty T, Goga A, Tomlinson M, Singh Y, Marshall C, Kauchali S, Pillay Y, Makua M, Hunt X. From purists to pragmatists: a qualitative evaluation of how implementation processes and contexts shaped the uptake and methodological adaptations of a maternal and neonatal quality improvement programme in South Africa prior to, and during COVID-19. BMC Health Serv Res 2023; 23:819. [PMID: 37525226 PMCID: PMC10391767 DOI: 10.1186/s12913-023-09826-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Despite progress, maternal and neonatal mortality and still births remain high in South Africa. The South African National Department of Health implemented a quality improvement (QI) programme, called Mphatlalatsane, to reduce maternal and neonatal mortality and still births. It was implemented in 21 public health facilities, seven per participating province, between 2018 and 2022. METHODS We conducted a qualitative process evaluation of the contextual and implementation process factors' influence on implementation uptake amongst the QI teams in 15 purposively selected facilities. Data collection included three interview rounds with the leaders and members of the QI teams in each facility; intermittent interviews with the QI advisors; programme documentation review; observation of programme management meetings; and keeping a fieldwork journal. All data were thematically analysed in Atlas.ti. Implementation uptake varied across the three provinces and between facilities within provinces. RESULTS Between March and August 2020, the COVID-19 pandemic disrupted uptake in all provinces but affected QI teams in one province more severely than others, because they received limited pre-pandemic training. Better uptake among other sites was attributed to receiving more QI training pre-COVID-19, having an experienced QI advisor, and good teamwork. Uptake was more challenging amongst hospital teams which had more staff and more complicated MNH services, versus the primary healthcare facilities. We also attributed better uptake to greater district management support. A key factor shaping uptake was leaders' intrinsic motivation to apply QI methodology. We found that, across sites, organic adaptations to the QI methodology were made by teams, started during COVID-19. Teams did away with rapid testing of change ideas and keeping a paper trail of the steps followed. Though still using data to identify service problems, they used self-developed audit tools to record intervention effectiveness, and not the prescribed tools. CONCLUSIONS Our study underscores the critical role of intrinsic motivation of team leaders, support from experienced technical QI advisors, and context-sensitive adaptations to maximise QI uptake when traditionally recognised QI steps cannot be followed.
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Affiliation(s)
- Willem Odendaal
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, Western Cape, South Africa / 491 Peter Mokaba Ridge Road, Durban, KwaZulu-Natal, South Africa.
- Department of Psychiatry, Stellenbosch University, Franzi van Zijl drive, Tygerberg, Cape Town, Western Cape, South Africa.
| | - Terusha Chetty
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, Western Cape, South Africa / 491 Peter Mokaba Ridge Road, Durban, KwaZulu-Natal, South Africa
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Umbilo Road, Durban, KwaZulu-Natal, South Africa
| | - Ameena Goga
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, Western Cape, South Africa / 491 Peter Mokaba Ridge Road, Durban, KwaZulu-Natal, South Africa
- Department of Paediatrics and Child Health, University of Pretoria, Steve Biko Academic Hospital, Pretoria, Gauteng, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Stellenbosch University, Franzi van Zijl Drive, Tygerberg, Cape Town, Western Cape, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Yages Singh
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, Western Cape, South Africa / 491 Peter Mokaba Ridge Road, Durban, KwaZulu-Natal, South Africa
| | - Carol Marshall
- South African National Department of Health, Voortrekker Road, Pretoria, Gauteng, South Africa
| | - Shuaib Kauchali
- Maternal, Adolescent and Child Health Institute (MatCH), Avondale Street, Durban, KwaZulu-Natal, South Africa
- Department of Paediatrics and Child Health, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Yogan Pillay
- Clinton Health Access Initiative, Francis Baard Street, Pretoria, Gauteng, South Africa
- Division of Public Health and Health Systems, Department of Global Health, Stellenbosch University, Franzi van Zijl Drive, Tygerberg, Cape Town, Western Cape, South Africa
| | - Manala Makua
- South African National Department of Health, Voortrekker Road, Pretoria, Gauteng, South Africa
- University of South Africa, Preller Street, Pretoria, Gauteng, South Africa
| | - Xanthe Hunt
- Institute for Life Course Health Research, Stellenbosch University, Franzi van Zijl Drive, Tygerberg, Cape Town, Western Cape, South Africa
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Millimouno TM, Dioubaté N, Niane H, Diallo MC, Maomou C, Sy T, Diallo IS, Semaan A, Delvaux T, Beňová L, Delamou A. Effect of the COVID-19 pandemic on maternal and neonatal health services in three referral hospitals in Guinea: an interrupted time-series analysis. Reprod Health 2023; 20:50. [PMID: 36966343 PMCID: PMC10039677 DOI: 10.1186/s12978-023-01599-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/21/2023] [Indexed: 03/27/2023] Open
Abstract
INTRODUCTION In sub-Saharan Africa, there is limited evidence on the COVID-19 health-related effect from front-line health provision settings. Therefore, this study aimed to analyse the effect of the COVID-19 pandemic on routine maternal and neonatal health services in three referral hospitals. MATERIALS AND METHODS We conducted an observational study using aggregate monthly maternal and neonatal health services routine data for two years (March 2019-February 2021) in three referral hospitals including two maternities: Hôpital National Ignace Deen (HNID) in Conakry and Hôpital Regional de Mamou (HRM) in Mamou and one neonatology ward: Institut de Nutrition et de Santé de l'Enfant (INSE) in Conakry. We compared indicators of health service utilisation, provision and health outcomes before and during the COVID-19 pandemic periods. An interrupted time-series analysis (ITSA) was performed to assess the relationship between changes in maternal and neonatal health indicators and COVID-19 through cross-correlation. RESULTS During COVID-19, the mean monthly number (MMN) of deliveries decreased significantly in HNID (p = 0.039) and slightly increased in HRM. In the two maternities, the change in the MMN of deliveries were significantly associated with COVID-19. The ITSA confirmed the association between the increase in the MMN of deliveries and COVID-19 in HRM (bootstrapped F-value = 1.46, 95%CI [0.036-8.047], p < 0.01). We observed an increasing trend in obstetric complications in HNID, while the trend declined in HRM. The MMN of maternal deaths increased significantly (p = 0.011) in HNID, while it slightly increased in HRM. In INSE, the MMN of neonatal admissions significantly declined (p < 0.001) and this decline was associated with COVID-19. The MMN of neonatal deaths significantly decreased (p = 0.009) in INSE and this decrease was related to COVID-19. CONCLUSION The pandemic negatively affected the maternal and neonatal care provision, health service utilisation and health outcomes in two referral hospitals located in Conakry, the COVID-19 most-affected region.
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Affiliation(s)
- Tamba Mina Millimouno
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea.
- Centre d'Excellence d'Afrique pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Faculté des Sciences et Techniques de la Santé, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea.
| | - Nafissatou Dioubaté
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Harissatou Niane
- Institut de Nutrition et de Santé de l'Enfant, Hôpital National Donka, Conakry, Guinea
| | | | - Cécé Maomou
- Service de Maternité de l'Hôpital Régional de Mamou, Mamou, Guinea
| | - Telly Sy
- Service de Maternité de l'Hôpital National Ignace Deen, Conakry, Guinea
| | - Ibrahima Sory Diallo
- Institut de Nutrition et de Santé de l'Enfant, Hôpital National Donka, Conakry, Guinea
| | - Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Alexandre Delamou
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
- Centre d'Excellence d'Afrique pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Faculté des Sciences et Techniques de la Santé, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea
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Aninanya GA, Williams JE, Williams A, Otupiri E, Howard N. Effects of computerized decision support on maternal and neonatal health-worker performance in the context of combined implementation with performance-based incentivisation in Upper East Region, Ghana: a qualitative study of professional perspectives. BMC Health Serv Res 2022; 22:1581. [PMID: 36567357 PMCID: PMC9791727 DOI: 10.1186/s12913-022-08940-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 12/07/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Computerized decision support systems (CDSS) and performance-based incentives (PBIs) can improve health-worker performance. However, there is minimal evidence on the combined effects of these interventions or perceived effects among maternal and child healthcare providers in low-resource settings. We thus aimed to explore the perceptions of maternal and child healthcare providers of CDSS support in the context of a combined CDSS-PBI intervention on performance in twelve primary care facilities in Ghana's Upper East Region. METHODS We conducted a qualitative study drawing on semi-structured key informant interviews with 24 nurses and midwives, 12 health facility managers, and 6 district-level staff familiar with the intervention. We analysed data thematically using deductive and inductive coding in NVivo 10 software. RESULTS Interviewees suggested the combined CDSS-PBI intervention improved their performance, through enhancing knowledge of maternal health issues, facilitating diagnoses and prescribing, prompting actions for complications, and improving management. Some interviewees reported improved morbidity and mortality. However, challenges described in patient care included CDSS software inflexibility (e.g. requiring administration of only one intermittent preventive malaria treatment to pregnant women), faulty electronic partograph leading to unnecessary referrals, increased workload for nurses and midwives who still had to complete facility forms, and power fluctuations affecting software. CONCLUSION Combining CDSS and PBI interventions has potential to improve maternal and child healthcare provision in low-income settings. However, user perspectives and context must be considered, along with allowance for revisions, when designing and implementing CDSS and PBIs interventions.
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Affiliation(s)
- Gifty Apiung Aninanya
- grid.442305.40000 0004 0441 5393Department of Health Services Policy, Planning, Management and Economics, School of Public Health, University for Development Studies, Box TL 1350, Tamale, Ghana
| | - John E Williams
- grid.462788.7Dodowa Health Research Centre, PO Box DD1, Dodowa, Ghana
| | - Afua Williams
- grid.434994.70000 0001 0582 2706Ga North Municipal Hospital, Ghana Health Service, Accra, Ghana
| | - Easmon Otupiri
- grid.9829.a0000000109466120Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Natasha Howard
- grid.4280.e0000 0001 2180 6431Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore , 117549 Singapore ,grid.8991.90000 0004 0425 469XDepartment of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
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Breddels EM, Simin J, Fornes R, Lilja Engstrand H, Engstrand L, Bruyndonckx R, Brusselaers N. Population-based cohort study: proton pump inhibitor use during pregnancy in Sweden and the risk of maternal and neonatal adverse events. BMC Med 2022; 20:492. [PMID: 36539798 PMCID: PMC9768950 DOI: 10.1186/s12916-022-02673-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Approximately half of all women suffer from heartburn at some stage during pregnancy. The most effective treatment is proton pump inhibitors, but the safety of use during pregnancy cannot be guaranteed. This study aimed to elucidate the effect of proton pump inhibitors on the risk of pre-eclampsia, gestational diabetes mellitus, preterm birth, an Apgar score at 5 min below 7, and a child being small or large for its gestational age. METHODS This Swedish population-based study included 1,089,514 live singleton deliveries between July 2006 and December 2016 in Sweden. Multiple logistic regression was used to model the outcomes as a function of the covariates. Results were presented as odds ratios with 95% confidence intervals. RESULTS In 1.4% of all pregnancies, the mother used proton pump inhibitors in the period from 3 months before the last menstrual period up to delivery. The use of proton pump inhibitors was associated with higher odds of pre-eclampsia (odds ratio = 1.19, 1.10-1.29), gestational diabetes mellitus (odds ratio = 1.29, 1.16-1.43), preterm birth (odds ratio = 1.23, 1.14-1.32), and small for gestational age (odds ratio = 1.27, 1.16-1.40) and lower odds of large for gestational age (odds ratio = 0.84, 0.77-0.91). No significant association was found with a low Apgar score 5 min after birth. CONCLUSIONS Proton pump inhibitor use was associated with a higher risk of pre-eclampsia, gestational diabetes, preterm birth, and being born small for gestational age.
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Affiliation(s)
- Esmee M Breddels
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium.,Centre for Translational Microbiome Research, Department of Microbiology Tumor and Cell Biology, Karolinska Institutet, Biomedicum A8, Solnavägen 9, 17165, Stockholm, Sweden
| | - Johanna Simin
- Centre for Translational Microbiome Research, Department of Microbiology Tumor and Cell Biology, Karolinska Institutet, Biomedicum A8, Solnavägen 9, 17165, Stockholm, Sweden
| | - Romina Fornes
- Centre for Translational Microbiome Research, Department of Microbiology Tumor and Cell Biology, Karolinska Institutet, Biomedicum A8, Solnavägen 9, 17165, Stockholm, Sweden
| | - Helene Lilja Engstrand
- Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Engstrand
- Centre for Translational Microbiome Research, Department of Microbiology Tumor and Cell Biology, Karolinska Institutet, Biomedicum A8, Solnavägen 9, 17165, Stockholm, Sweden
| | - Robin Bruyndonckx
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium
| | - Nele Brusselaers
- Centre for Translational Microbiome Research, Department of Microbiology Tumor and Cell Biology, Karolinska Institutet, Biomedicum A8, Solnavägen 9, 17165, Stockholm, Sweden. .,Global Health Institute, Antwerp University, Antwerp, Belgium.
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Sumankuuro J, Baatiema L, Crockett J, Young J. Women's use of non-conventional herbal uterotonic in pregnancy and labour: evidence from birth attendants. BMC Pregnancy Childbirth 2022; 22:600. [PMID: 35896986 PMCID: PMC9327204 DOI: 10.1186/s12884-022-04934-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/19/2022] [Indexed: 11/14/2022] Open
Abstract
Background Over the years, governments and stakeholders have implemented various policies/programmes to improve maternal health outcomes in low-middle-income countries. In Ghana, Community Health Officers were trained as midwives to increase access to skilled maternal healthcare. The government subsequently banned traditional birth attendants from providing direct maternal healthcare in 2000. Despite these, there is an unprecedented utilisation of TBAs’ services, including herbal uterotonics. This has attempted to defeat stakeholders’ campaigns to improve maternal health outcomes. Thus, we explored and highlighted herbal uterotonic consumption in pregnancy and birth and the implications on maternal and newborn health outcomes in North-Western Ghana. Methods This was an exploratory qualitative study that investigated traditional birth attendants (n = 17) and healthcare providers' (n = 26) perspectives on the intake of herbal uterotonics in pregnancy and childbirth in rural Ghana, using in-depth interviews. A combination of convenience, purposive and snowball sampling procedures were employed in selecting participants. Results Findings were captured in two domains: (1) perceived rationale for herbal uterotonic intake, and (2) potential adverse impacts of herbal uterotonic intake in pregnancy and labour, and nine topics: (i) confidence in unskilled attendance at birth, (ii) cost and a shortage of essential medicines, (iii) herbal uterotonics as a remedy for obstetric problems, (iv) herbal uterotonics facilitate birth, (v) attraction of home birth for cultural reasons, (vi) affordability of herbal uterotonics, (vii) unintended consequences and adverse outcomes, (viii) risks using herbal uterotonics to manage fertility and (ix) risks using herbal uterotonics to facilitate home birth. Conclusion The findings have suggested that the intake of non-conventional herbal uterotonic is widespread in the study area, although the constituents of the herb are unknown. However, complex and multiple factors of healthcare cost, desire for homebirth, unawareness of the negative effects of such substances, perceived way of addressing obstetric problems and cultural undertones, among others, accounted for herbal uterotonics consumption. We also encourage research into the constituents of ‘mansugo’ and the potential benefits and adverse effects. We recommend qualitative studies involving previous users of this herbal uterotonic to inform policy and healthcare provision.
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Affiliation(s)
- Joshua Sumankuuro
- Faculty of Public Policy and Governance, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Ghana. .,Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. .,School of Community Health, Faculty of Science, Charles Sturt University, Orange, New South Wales, Australia. .,School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa.
| | - Leonard Baatiema
- Department of Health Policy and Management, University of Ghana, Accra, Ghana.,Department of Global Health and Population, Harvard T.H Chan School of Public Health, Harvard University, Boston, USA
| | - Judith Crockett
- School of Community Health, Faculty of Science, Charles Sturt University, Orange, New South Wales, Australia
| | - Jeanine Young
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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Jafree SR, Momina A, Muazzam A, Wajid R, Calib G. Factors Affecting Delivery Health Service Satisfaction of Women and Fear of COVID- 19: Implications for Maternal and Child Health in Pakistan. Matern Child Health J 2021; 25:881-891. [PMID: 33900516 PMCID: PMC8072320 DOI: 10.1007/s10995-021-03140-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 11/28/2022]
Abstract
Objective High maternal and neonatal mortality rates in developing regions like Pakistan are linked to low rates of institutional deliveries. One way to improve rates of institutional deliveries is through improving institutional delivery service satisfaction in women. The aim of this research is to identify which factors influence delivery service satisfaction during the period of COVID-19 and which socio-demographic characteristics of women are associated with greater fear of catching COVID-19 during institutional deliveries. Methods A total of 190 women who had given birth between May to June, 2020, were sampled from two private and two public sector hospitals in Lahore, Pakistan. A standardized tool was modified for use and a combination of descriptive statistics and multivariate regression was applied. Results The results reveal that a majority of women, at 74.7%, are afraid of contracting COVID-19; specifically, women delivering at public hospitals, those who are illiterate or semi-literate, with more than four children, with low household income, and who are unemployed. Regression models are used to identify factors related to higher satisfaction, including the following: (i) pre-delivery care (explanatory power of R2 = 0.651); (ii) during delivery care (R2 = 0.716); (iii) after delivery care for women (R2 = 0.525); and (iv) after delivery care for newborn (R2 = 0.780). The main areas which influence satisfaction include the following: service quality of staff and administration; maintenance of hygiene and sanitation; involvement in decision-making; provision of necessary information; and advice for breastfeeding, immunization and family planning. Conclusions for Practice Based on our findings, we recommend improved regulation of delivery services in both public and private hospitals and increased protection for disadvantaged women groups to maintain service quality during the pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s10995-021-03140-4.
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Affiliation(s)
- Sara Rizvi Jafree
- Department of Sociology, Forman Christian College University, Ferozepur Road, Lahore, 54600, Pakistan.
| | - Ainul Momina
- Institute of Public Health, King Edward Medical University, Lahore, Pakistan
| | | | - Rabia Wajid
- Lady Willingdon Hospital and King Edward Medical University, Lahore, Pakistan
| | - Gloria Calib
- Forman Christian College, Chartered University, Dhaka, 1209, Bangladesh
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Sarin E, Bajpayee D, Kumar A, Dastidar SG, Chandra S, Panda R, Taneja G, Gupta S, Kumar H. Intrapartum Fetal Heart Monitoring Practices in Selected Facilities in Aspirational Districts of Jharkhand, Odisha and Uttarakhand. J Obstet Gynaecol India 2021; 71:143-149. [PMID: 34149216 PMCID: PMC8166967 DOI: 10.1007/s13224-020-01403-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 11/20/2020] [Indexed: 11/30/2022] Open
Abstract
Background The risk of mortality for the mother and the newborn is aggravated during birth in low- and middle-income countries due to preventable causes, which can be addressed with increased quality of care practices. One such practice is intrapartum fetal heart rate (FHR) monitoring, which is crucial for the early detection of fetal ischemia, but is inadequately monitored in low- and middle-income countries. In India, there is currently a lack of sufficient data on FHR monitoring.
Methods An assessment using facility records, interviews and observation was conducted in seven facilities providing tertiary, secondary or primary level care in aspirational districts of three states. The study sought to investigate the frequency of monitoring, devices used for monitoring and challenges in usage.
Results FHR was not monitored as per standard protocol. Case sheets revealed 70% of labor was monitored at least once. Only 33% of observed cases were monitored every half hour during active labor, and none were monitored every 5 min during the second stage of labor. More time was observed for monitoring with a Doppler compared with a stethoscope, as providers reported fluctuation in readings. Reportedly, low audibility and a perceived need of expertise were associated with using a stethoscope. High case load and the time required for monitoring were reported as challenges in adhering to standard monitoring protocols. Conclusion The introduction of a standardized device and a short refresher training on the World Health Organization and skilled birth attendant protocols for FHR monitoring will improve usage and compliance.
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Affiliation(s)
- Enisha Sarin
- Monitoring Evaluation and Learning, USAID-VRIDDHI/IPE Global, B-84, Defence Colony, New Delhi, 110024 India
| | - Devina Bajpayee
- Maternal and Newborn Health, USAID-VRIDDHI/IPE Global, B-84, Defence Colony, New Delhi, 110024 India
| | - Arvind Kumar
- USAID-VRIDDHI/IPE Global, B-84, Defence Colony, New Delhi, 110024 India
| | | | - Subodh Chandra
- Office of Director General Medical, Health and Family Welfare, Danda Lakhond, Post- Gujrada, Shasrdhara Road, Dehradun, Uttarakhand 248001 India
| | - Ranjan Panda
- USAID-VRIDDHI/IPE Global, Bhubaneswar, India.,Bhubaneswar, India
| | - Gunjan Taneja
- USAID-VRIDDHI/IPE Global, B-84, Defence Colony, New Delhi, 110024 India
| | - Sachin Gupta
- USAID-VRIDDHI/IPE Global, B-84, Defence Colony, New Delhi, 110024 India.,USAID, American Embassy, Shantipath, Chanakyapuri, New Delhi, 110021 India
| | - Harish Kumar
- USAID-VRIDDHI/IPE Global, B-84, Defence Colony, New Delhi, 110024 India
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Xia W, Li WHC, Cai W, Song P, Ho LLK, Cheung AT, Luo YH, Zeng C, He L, Gao C, Ho KY. Association of smoking behavior among Chinese expectant fathers and smoking abstinence after their partner becomes pregnant: a cross-sectional study. BMC Pregnancy Childbirth 2020; 20:449. [PMID: 32758182 PMCID: PMC7405418 DOI: 10.1186/s12884-020-03148-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/31/2020] [Indexed: 11/29/2022] Open
Abstract
Background Exposure to secondhand smoke (SHS) during pregnancy can cause pregnancy complications and adverse birth outcomes. About 40% of Chinese expectant fathers are smokers and they rarely attempt to quit smoking. There is a paucity of effective smoking cessation services targeting this population. In this study, we assessed the smoking behavior of Chinese expectant fathers and examined its association with smoking abstinence after their partner became pregnant, which is an essential prerequisite for designing effective smoking cessation interventions. Methods We conducted a cross-sectional survey in the obstetrics and gynecology clinic of three tertiary hospitals in China. Expectant fathers who smoked at least one cigarette per day for 1 month within the past 12 months were invited to participate in this study. The participants were asked to complete a structured questionnaire that assessed their smoking behaviors before and after their partner became pregnant. Results From December 2017 to March 2018, we recruited a total of 466 eligible expectant fathers, among whom 323 (69.3%) were identified as current smokers and 143 (30.7%) were ex-smokers. Using lasso regression, 19 features were selected from among 27 independent variables. The results of the selected multivariable logistic regression model showed that knowledge about the health hazards of smoking among smokers (odds ratio (OR) 1.39; 95% confidence interval (CI) 1.24 to 1.58; p < 0.001), knowledge about the health hazards of SHS to pregnant women (OR 1.46; 95% CI 1.09 to 1.97; p < 0.001), knowledge about harm to the fetus and newborn (OR 1.58; 95% CI 1.25 to 2.03; p < 0.001), and being a first-time expectant father (OR 2.08; 95% CI 1.02 to 3.85; p = 0.046) were significantly positively associated with smoking abstinence among expectant fathers after their partner became pregnant. Significantly negative associations were found for severe dysfunctionality in terms of family support (OR 0.48; 95% CI 0.24 to 0.95; p = 0.036) and smoking only outside the home (OR 0.81; 95% CI 0.26 to 0.98; p < 0.001). Conclusions In this study, we identified several factors associated with smoking abstinence among expectant fathers after their partner became pregnant. These findings can guide the development of effective interventions targeting expectant fathers, to help them quit smoking.
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Affiliation(s)
- Wei Xia
- School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road,Pokfulam, Hong Kong SAR, China
| | - William Ho Cheung Li
- School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road,Pokfulam, Hong Kong SAR, China.
| | - Wenzhi Cai
- Shenzhen hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Peige Song
- School of Public Health, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Laurie Long Kwan Ho
- School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road,Pokfulam, Hong Kong SAR, China
| | - Ankie Tan Cheung
- School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road,Pokfulam, Hong Kong SAR, China
| | - Yuan Hui Luo
- School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road,Pokfulam, Hong Kong SAR, China
| | - Chunxian Zeng
- Shenzhen hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Li He
- The People's Hospital Of Wenshan Prefecture, Wenshan, Yunnan, China
| | - Chao Gao
- The Third People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Ka Yan Ho
- School of Nursing, The Hong Kong Polytechnic University, Hung Ho, Kowloon, Hong Kong SAR, China
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Memirie ST, Tolla MT, Desalegn D, Hailemariam M, Norheim OF, Verguet S, Johansson KA. A cost-effectiveness analysis of maternal and neonatal health interventions in Ethiopia. Health Policy Plan 2019; 34:289-297. [PMID: 31106346 PMCID: PMC6661540 DOI: 10.1093/heapol/czz034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2019] [Indexed: 12/11/2022] Open
Abstract
Ethiopia is one of the sub-Saharan African countries contributing to the highest number of maternal and neonatal deaths. Coverage of maternal and neonatal health (MNH) interventions has remained very low in Ethiopia. We examined the cost-effectiveness of selected MNH interventions in an Ethiopian setting. We analysed 13 case management and preventive MNH interventions. For all interventions, we used an ingredients-based approach for cost estimation. We employed a static life table model to estimate the health impact of a 20% increase in intervention coverage relative to the baseline. We used disability-adjusted life years (DALYs) as the health outcome measure while costs were expressed in 2018 US$. Analyses were based on local epidemiological, demographic and cost data when available. Our finding shows that 12 out of the 13 interventions included in our analysis were highly cost-effective. Interventions targeting newborns such as neonatal resuscitation (institutional), kangaroo mother care and management of newborn sepsis with injectable antibiotics were the most cost-effective interventions with incremental cost-effectiveness ratios of US$7, US$8 and US$17 per DALY averted, respectively. Obstetric interventions (induction of labour, active management of third stage of labour, management of pre-eclampsia/eclampsia and maternal sepsis, syphilis treatment and tetanus toxoid during pregnancy) and safe abortion cost between US$100 and US$300 per DALY averted. Calcium supplementation for pre-eclampsia and eclampsia prevention was the least cost-effective, with a cost per DALY of about US$3100. Many of the MNH interventions analysed were highly cost-effective, and this evidence can inform the ongoing essential health services package revision in Ethiopia. Our analysis also shows that calcium supplementation does not appear to be cost-effective in our setting.
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Affiliation(s)
- Solomon Tessema Memirie
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Global Public Health and Primary Care, University of Bergen, N Bergen, Norway
| | - Mieraf Taddesse Tolla
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Dawit Desalegn
- Department of Gynecology and Obstetrics, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Ole Frithjof Norheim
- Department of Global Public Health and Primary Care, University of Bergen, N Bergen, Norway
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kjell Arne Johansson
- Department of Global Public Health and Primary Care, University of Bergen, N Bergen, Norway
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Gopalan SS, Das A, Howard N. Maternal and neonatal service usage and determinants in fragile and conflict-affected situations: a systematic review of Asia and the Middle-East. BMC Womens Health 2017; 17:20. [PMID: 28298198 PMCID: PMC5353776 DOI: 10.1186/s12905-017-0379-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 03/07/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Fragile and conflict-affected situations (FCS) in Asia and the Middle-East contribute significantly to global maternal and neonatal deaths. This systematic review explored maternal and neonatal health (MNH) services usage and determinants in FCS in Asia and the Middle-East to inform policy on health service provision in these challenging settings. METHODS This systematic review was conducted using a standardised protocol. Pubmed, Embase, Web of Science, and selected development agency websites were searched for studies meeting inclusion criteria. Studies were assessed for methodological quality using an adapted evaluation tool. Qualitative and quantitative data were synthesized and pooled odds ratios generated for meta-analysis of service-usage determinants. RESULTS Of 18 eligible peer-reviewed studies, eight were from Nepal, four from Afghanistan, and two each from Iraq, Yemen, and the Palestinian Territories. Fragile situations provide limited evidence on emergency obstetric care, postnatal care, and newborn services. Usage of MNH services was low in all FCS, irrespective of economic growth level. Demand-side determinants of service-usage were transportation, female education, autonomy, health awareness, and ability-to-pay. Supply-side determinants included service availability and quality, existence of community health-workers, costs, and informal payments in health facilities. Evidence is particularly sparse on MNH in acute crises, and remains limited in fragile situations generally. CONCLUSIONS Findings emphasize that poor MNH status in FCS is a leading contributor to the burden of maternal and neonatal ill-health in Asia and the Middle-East. Essential services for skilled birth attendance and emergency obstetric, newborn, and postnatal care require improvement in FCS. FCS require additional resources and policy attention to address the barriers to appropriate MNH care. Authors discuss the 'targeted policy approach for vulnerable groups' as a means of addressing MNH service usage inequities.
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Affiliation(s)
- Saji S Gopalan
- London School of Hygiene and Tropical Medicine (LSHTM), London, UK.
| | | | - Natasha Howard
- London School of Hygiene and Tropical Medicine (LSHTM), London, UK
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Biswas A, Halim A, Rahman F, Eriksson C, Dalal K. The Economic Cost of Implementing Maternal and Neonatal Death Review in a District of Bangladesh. J Public Health Res 2016; 5:729. [PMID: 28090477 PMCID: PMC5228161 DOI: 10.4081/jphr.2016.729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 11/04/2016] [Indexed: 11/23/2022] Open
Abstract
Introduction Maternal and neonatal death review (MNDR) introduced in Bangladesh and initially piloted in a district during 2010. MNDR is able to capture each of the maternal, neonatal deaths and stillbirths from the community and government facilities (hospitals). This study aimed to estimate the cost required to implement MNDR in a district of Bangladesh during 2010-2012. Materials and methods MNDR was implemented in Thakurgaon district in 2010 and later gradually extended until 2015. MNDR implementation framework, guidelines, tools and manual were developed at the national level with national level stakeholders including government health and family planning staff at different cadre for piloting at Thakurgaon. Programme implementation costs were calculated by year of costing and costing as per component of MNDR in 2013. The purchasing power parity conversion rate was 1 $INT = 24.46 BDT, as of 31st Dec 2012. Results Overall programme implementation costs required to run MNDR were 109,02,754 BDT (445,738 $INT $INT) in the first year (2010). In the following years cost reduced to 8,208,995 BDT (335,609 $INT, during 2011) and 6,622,166 BDT (270,735 $INT, during 2012). The average cost per activity required was 3070 BDT in 2010, 1887 BDT and 2207 BDT required in 2011 and 2012 respectively. Each death notification cost 4.09 $INT, verbal autopsy cost 8.18 $INT, and social autopsy cost 16.35 $INT. Facility death notification cost 2.04 $INT and facility death review meetings cost 20.44 $INT. One death saved by MNDR costs 53,654 BDT (2193 $INT). Conclusions Programmatic implementation cost of conducting MPDR give an idea on how much cost will be required to run a death review system for a low income country settings using government health system. Significance for public health Maternal and neonatal death review (MNDR) system in a low income county is one of the key indicators to improve quality of health care services. The MNDR also support in the reduction of maternal and newborn deaths. However, to run a comprehensive death review system need to know costs associated with the system. This is crucial in low income countries for planning and designing a public health intervention. Very few studies yet perform to look at the costs to run a death review system. This paper describes health economic cost of death review system in Bangladesh for future public health research in low income countries
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Affiliation(s)
- Animesh Biswas
- Department of Public Health Science, School of Health Sciences, Örebro University, Sweden; Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh
| | - Abdul Halim
- Centre for Injury Prevention and Research (CIPRB) , Dhaka, Bangladesh
| | - Fazlur Rahman
- Centre for Injury Prevention and Research (CIPRB) , Dhaka, Bangladesh
| | - Charli Eriksson
- Department of Public Health Science, School of Health Sciences, Örebro University , Sweden
| | - Koustuv Dalal
- Department of Public Health Science, School of Health Sciences, Örebro University , Sweden
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Lassi ZS, Aftab W, Ariff S, Kumar R, Hussain I, Musavi NB, Memon Z, Soofi SB, Bhutta ZA. Impact of service provision platforms on maternal and newborn health in conflict areas and their acceptability in Pakistan: a systematic review. Confl Health 2015; 9:25. [PMID: 26300959 PMCID: PMC4546286 DOI: 10.1186/s13031-015-0054-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 08/12/2015] [Indexed: 11/10/2022] Open
Abstract
Various models and strategies have been implemented over the years in different parts of the world to improve maternal and newborn health (MNH) in conflict affected areas. These strategies are based on specific needs and acceptability of local communities. This paper has undertaken a systematic review of global and local (Pakistan) information from conflict areas on platforms of health service provision in the last 10 years and information on acceptability from local stakeholders on effective models of service delivery; and drafted key recommendations for improving coverage of health services in conflict affected areas. The literature search revealed ten studies that described MNH service delivery platforms. The results from the systematic review showed that with utilisation of community outreach services, the greatest impacts were observed in skilled birth attendance and antenatal consultation rates. Facility level services, on the other hand, showed that labour room services for an internally displaced population (IDP) improved antenatal care coverage, contraceptive prevalence rate and maternal mortality. Consultative meetings and discussions conducted in Quetta and Peshawar (capitals of conflict affected provinces) with relevant stakeholders revealed that no systematic models of MNH service delivery, especially tailored for conflict areas, are available. During conflict, even previously available services and infrastructure suffered due to various barriers specific to times of conflict and unrest. A number of barriers that hinder MNH services were discussed. Suggestions for improving MNH services in conflict areas were also laid down by participants. The review identified some important steps that can be undertaken to mitigate the effects of conflict on MNH services, which include: improve provision and access to infrastructure and equipment; development and training of healthcare providers; and advocacy at different levels for free access to healthcare services and for the introduction of the programme model in existing healthcare system. The obligation is enormous, however, for a sustainable programme, it is important to work closely with both the IDP and host community, and collaborating with the government and non-government organisations.
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Affiliation(s)
- Zohra S Lassi
- Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan ; Australian Research Centre for Health of Women and Babies, Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia
| | - Wafa Aftab
- Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Shabina Ariff
- Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Rohail Kumar
- Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Imtiaz Hussain
- Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Nabiha B Musavi
- Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Zahid Memon
- Head of Research and M&E, Greenstar Social Marketing, Karachi, Pakistan
| | - Sajid B Soofi
- Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada ; Program for Global Paediatric Research, Hospital for Sick Children, Toronto, ON Canada
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Abstract
PURPOSE The purpose of this paper is to explore the readiness of contracted and non-contracted first-level healthcare facilities in Pakistan to deliver quality maternal and neonatal health (MNH) care. A balanced scorecard (BSC) was used as the assessment framework. DESIGN/METHODOLOGY/APPROACH Using a cross-sectional study design, two rural health centers (RHCs) contracted out to Aga Khan Health Service, Pakistan were compared with four government managed RHCs. A BSC was designed to assess RHC readiness to deliver good quality MNH care. In total 20 indicators were developed, representing five BSC domains: health facility functionality, service provision, staff capacity, staff and patient satisfaction. Validated data collection tools were used to collect information. Pearson χ2, Fisher's Exact and the Mann-Whitney tests were applied as appropriate to detect significant service quality differences among the two facilities. FINDINGS Contracted facilities were generally found to be better than non-contracted facilities in all five BSC domains. Patients' inclination for facility-based delivery at contracted facilities was, however, significantly higher than non-contracted facilities (80 percent contracted vs 43 percent non-contracted, p=0.006). PRACTICAL IMPLICATIONS The study shows that contracting out initiatives have the potential to improve MNH care. ORIGINALITY/VALUE This is the first study to compare MNH service delivery quality across contracted and non-contracted facilities using BSC as the assessment framework.
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Affiliation(s)
- Fauziah Rabbani
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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