Public Health and Project Management: Do Projects Deliver?

Maternal, newborn, and child health (MNCH) has remained an ever-concerning area for hospital management and researchers throughout the world. Nevertheless, in the literature, less attention is paid to developing countries. The current study identifies the problems faced by maternal newborn and child health projects at each phase. We obtained data on MNCH projects via interviews from district project managers and extracted various themes for each phase of the MNCH project. The results indicated the most significant problems faced by the MNCH project emanate from the inefficient bureaucratic structure, lack of realistic planning, weak working environment, political interference, and inefficient knowledge acquisition. The current study found that project managers experience various problems from the initiation stage of the project to its closure. Additionally, they find themselves to be poorly equipped to manage such problems. We proposed various strategies such as implementing a bottom-up management approach, more decentralization, establishing patient feedback systems, giving more authority to the project managers, and so forth.

Equity in Essential Maternal, Newborn, and Child Health Interventions in Northeastern China, 2008 to 2018

Objectives: We aim to analyze equity in maternal, newborn, and child health (MNCH) interventions in Jilin, a northeastern province of China, 2008–2018.

Study design: Cross-sectional study.

Methods: We used provincially representative survey data from 2008, 2013, and 2018. We included 18 essential MNCH interventions, analyzed equity, and calculated the composite coverage score. We used logistic and multiple linear regressions to adjust sampling clusters and covariates.

Results: Coverage of hospital-based interventions, such as hospital delivery and antenatal B-ultrasound tests, was nearly universal in Jilin province. Cesarean sections persisted at alarmingly high rates (57.6%). Enormous unmet needs and rural–urban inequalities existed for community-based interventions, such as improved drinking water sources (85.4 vs. 97.9%, p < 0.01), improved sanitation facilities (52.5 vs. 94.2%, p < 0.01), four government-funded antenatal care services (55.8 vs. 84.1%, p < 0.01), and at least eight antenatal care sessions (26.8 vs. 46.3%, p < 0.05). Compared to rural–urban inequity, individual-level disparities across income and education were either small in scale or statistically insignificant. The inequity in coverage of maternal and newborn care shrank during 2008–2018.

Conclusions: Despite its success in reducing mortality, China's unique obstetrician-led safe motherhood strategy may come at the cost of over-medicalization and health inequity. Jilin province's recent efforts to revitalize primary health care show the potential to make a change. An integrated system that links families, communities, and all levels of health care organizations seems to be the most effective and efficient model to offer continuing MNCH care.

Armed conflicts and national trends in reproductive, maternal, newborn and child health in sub-Saharan Africa: what can national health surveys tell us?

Armed conflicts are widespread in sub-Saharan Africa and considered to be an important factor in slowing down national progress in reproductive, maternal, newborn and child health (RMNCH). The measurement of the impact of conflicts on national levels and trends in RMNCH is difficult. National surveys conducted before and sometimes during and after conflicts are a major source of information on the national and local effects of conflicts on RMNCH. We examined data from national surveys in 13 countries in sub-Saharan Africa with major conflicts during 1990–2016 to assess the levels and trends in RMNCH intervention coverage, nutritional status and mortality in children under 5 years in comparison with subregional trends. The surveys provide substantive evidence of a negative association between levels and trends in national indicators of RMNCH service coverage, child growth and under-5 mortality with armed conflict, with some notable exceptions. National surveys are an important source of data to assess the longer term national consequences of conflicts for RMNCH in most countries, despite limitations due to sampling and timing of the surveys.