1
|
Akila D, Akinola O, Omotoso O, Ohkubo S, Adefila A, Yohanna P, Kalu NI, Oyeyemi A, Ojelade O, Waziri A, Kwaknat W, Solanke O, Emonena B, Rotimi O, Mwaikambo L, Igharo V, Ajijola L, Bose K. Improving Contraceptive Service Quality and Accessibility for Adolescents and Youth Through Proprietary Patent Medicine Vendors in Four Nigerian States. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2200225. [PMID: 38508767 PMCID: PMC11111103 DOI: 10.9745/ghsp-d-22-00225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 02/21/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION In Nigeria, health care services and commodities have increasingly been accessed through private sector entities, including retail pharmacies and drug shops (also called proprietary patent medicine vendors [PPMVs]). However, PPMVs cannot provide long-acting or permanent methods, and concerns have been raised about their quality of services and their need to better comply with government regulations. This article describes how The Challenge Initiative's (TCI) family planning program supported 4 state governments in Nigeria to develop a model to strengthen public-private partnerships between PPMVs and primary health centers (PHCs) to leverage PPMVs to provide adolescents and youth with high-quality contraceptive information, services, and referrals to PHCs. PROGRAM DESCRIPTION The intervention implemented a hub-spoke model by strengthening the linkages between neighboring PPMVs and large PHCs for delivering contraceptive services to adolescents and youth. The steps in the implementation process included: (1) introducing the intervention to state governments, (2) selecting PPMVs as spokes and high-volume PHCs as hubs, (3) conducting whole-site orientations jointly with PPMV and PHC staff, (4) strengthening referral links between PPMVs and PHCs, (5) implementing supportive supervision and coaching, and (6) strengthening client data management. TCI worked with the state and local ministry of health to improve PPMV operators' knowledge, attitudes, and skills to deliver adolescent- and youth-friendly services. LESSONS LEARNED AND RECOMMENDATIONS Implementing the PPMV intervention with state governments and PHCs strengthened the public-private partnership. A functional referral system in Plateau State demonstrated significant success, enabling increased contraceptive choice and adherence to regulations for adolescents and youth. We recommend that the government strengthen the working relationship between PPMVs and PHCs, incorporate PPMVs into the routine supportive supervision of the state health system, and incorporate a referral linkage with PHCs into the design and implementation of PPMV programs.
Collapse
Affiliation(s)
- Dorcas Akila
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria.
| | - Oluwasegun Akinola
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Olukunle Omotoso
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Saori Ohkubo
- The Challenge Initiative, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Adewale Adefila
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Philemon Yohanna
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Nwanne Ikodiya Kalu
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Adebusola Oyeyemi
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Olubunmi Ojelade
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Aisha Waziri
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Winifred Kwaknat
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Olusola Solanke
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Bernard Emonena
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Oluwafemi Rotimi
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Lisa Mwaikambo
- The Challenge Initiative, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Victor Igharo
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Lekan Ajijola
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Krishna Bose
- The Challenge Initiative, Bill & Melinda Gates Institute for Population and Reproductive Health, Baltimore, MD, USA
| |
Collapse
|
2
|
Morris G, Maliqi B, Lattof SR, Strong J, Yaqub N. Private sector quality of care for maternal, new-born, and child health in low-and-middle-income countries: a secondary review. Front Glob Womens Health 2024; 5:1369792. [PMID: 38707636 PMCID: PMC11066217 DOI: 10.3389/fgwh.2024.1369792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/21/2024] [Indexed: 05/07/2024] Open
Abstract
The private sector has emerged as a crucial source of maternal, newborn, and child health (MNCH) care in many low- and middle-income countries (LMICs). Quality within the MNCH private sector varies and has not been established systematically. This study systematically reviews findings on private-sector delivery of quality MNCH care in LMICs through the six domains of quality care (QoC) (i.e., efficiency, equity, effectiveness, people-centered care, safety, and timeliness). We registered the systematic review with PROSPERO international prospective register of systematic reviews (registration number CRD42019143383) and followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Statement for clear and transparent reporting of systematic reviews and meta-analyses. Searches were conducted in eight electronic databases and two websites. For inclusion, studies in LMICs must have examined at least one of the following outcomes using qualitative, quantitative, and/or mixed-methods: maternal morbidity, maternal mortality, newborn morbidity, newborn mortality, child morbidity, child mortality, service utilization, quality of care, and/or experience of care including respectful care. Outcome data was extracted for descriptive statistics and thematic analysis. Of the 139 included studies, 110 studies reported data on QoC. Most studies reporting on QoC occurred in India (19.3%), Uganda (12.3%), and Bangladesh (8.8%). Effectiveness was the most widely measured quality domain with 55 data points, followed by people-centered care (n = 52), safety (n = 47), timeliness (n = 31), equity (n = 24), and efficiency (n = 4). The review showed inconsistencies in care quality across private and public facilities, with quality varying across the six domains. Factors such as training, guidelines, and technical competence influenced the quality. There were also variations in how domains like "people-centered care" have been understood and measured over time. The review underscores the need for clearer definitions of "quality" and practical QoC measures, central to the success of Sustainable Development Goals (SDGs) and equitable health outcomes. This research addresses how quality MNCH care has been defined and operationalized to understand how quality is delivered across the private health sector and the larger health system. Numerous variables and metrics under each QoC domain highlight the difficulty in systematizing QoC. These findings have practical significance to both researchers and policymakers. Systematic Review Registration https://bmjopen.bmj.com/content/10/2/e033141.long, Identifier [CRD42019143383].
Collapse
Affiliation(s)
- Georgina Morris
- Department of International Development, London School of Economics and Political Science, London, United Kingdom
| | - Blerta Maliqi
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Samantha R. Lattof
- Department of International Development, London School of Economics and Political Science, London, United Kingdom
| | - Joe Strong
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Nuhu Yaqub
- Regional Office for Africa, World Health Organization, Brazzaville, Congo
| |
Collapse
|
3
|
Babah OA, Akinajo OR, Beňová L, Hanson C, Abioye AI, Adaramoye VO, Adeyemo TA, Balogun MR, Banke-Thomas A, Galadanci HS, Sam-Agudu NA, Afolabi BB, Larsson EC. Prevalence of and risk factors for iron deficiency among pregnant women with moderate or severe anaemia in Nigeria: a cross-sectional study. BMC Pregnancy Childbirth 2024; 24:39. [PMID: 38182997 PMCID: PMC10768359 DOI: 10.1186/s12884-023-06169-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 12/03/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Anaemia during pregnancy causes adverse outcomes to the woman and the foetus, including anaemic heart failure, prematurity, and intrauterine growth restriction. Iron deficiency anaemia (IDA) is the leading cause of anaemia and oral iron supplementation during pregnancy is widely recommended. However, little focus is directed to dietary intake. This study estimates the contribution of IDA among pregnant women and examines its risk factors (including dietary) in those with moderate or severe IDA in Lagos and Kano states, Nigeria. METHODS In this cross-sectional study, 11,582 women were screened for anaemia at 20-32 weeks gestation. The 872 who had moderate or severe anaemia (haemoglobin concentration < 10 g/dL) were included in this study. Iron deficiency was defined as serum ferritin level < 30 ng/mL. We described the sociodemographic and obstetric characteristics of the sample and their self-report of consumption of common food items. We conducted bivariate and multivariable logistic regression analysis to identify risk factors associated with IDA. RESULTS Iron deficiency was observed among 41% (95%CI: 38 - 45) of women with moderate or severe anaemia and the prevalence increased with gestational age. The odds for IDA reduces from aOR: 0.36 (95%CI: 0.13 - 0.98) among pregnant women who consume green leafy vegetables every 2-3 weeks, to 0.26 (95%CI: 0.09 - 0.73) among daily consumers, compared to those who do not eat it. Daily consumption of edible kaolin clay was associated with increased odds of having IDA compared to non-consumption, aOR 9.13 (95%CI: 3.27 - 25.48). Consumption of soybeans three to four times a week was associated with higher odds of IDA compared to non-consumption, aOR: 1.78 (95%CI: 1.12 - 2.82). CONCLUSION About 4 in 10 women with moderate or severe anaemia during pregnancy had IDA. Our study provides evidence for the protective effect of green leafy vegetables against IDA while self-reported consumption of edible kaolin clay and soybeans appeared to increase the odds of having IDA during pregnancy. Health education on diet during pregnancy needs to be strengthened since this could potentially increase awareness and change behaviours that could reduce IDA among pregnant women with moderate or severe anaemia in Nigeria and other countries.
Collapse
Affiliation(s)
- Ochuwa Adiketu Babah
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.
- Centre for Clinical Trials and Implementation Science (CCTRIS), College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Opeyemi Rebecca Akinajo
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
- Centre for Clinical Trials and Implementation Science (CCTRIS), College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ajibola Ibraheem Abioye
- Centre for Clinical Trials and Implementation Science (CCTRIS), College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Victoria Olawunmi Adaramoye
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
- Centre for Clinical Trials and Implementation Science (CCTRIS), College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Titilope A Adeyemo
- Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
- Centre for Clinical Trials and Implementation Science (CCTRIS), College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
- Department of Haematology and Blood Transfusion, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Mobolanle Rasheedat Balogun
- Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
- Centre for Clinical Trials and Implementation Science (CCTRIS), College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
- Department of Community Health, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Aduragbemi Banke-Thomas
- Centre for Clinical Trials and Implementation Science (CCTRIS), College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
- Global Maternal and Newborn Health Hub, Institute of Lifecourse Development, University of Greenwich, London, UK
| | - Hadiza S Galadanci
- African Center of Excellence for Population Health and Policy, Bayero University, Kano, Nigeria
- Department of Obstetrics and Gynaecology, College of Health Sciences Bayero University Kano/ Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Bosede Bukola Afolabi
- Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
- Centre for Clinical Trials and Implementation Science (CCTRIS), College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Elin C Larsson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
4
|
Moucheraud C, McBride K, Heuveline P, Shah M. Preventing, but Not Caring for, Adolescent Pregnancies? Disparities in the Quality of Reproductive Health Care in Sub-Saharan Africa. J Adolesc Health 2022; 71:210-216. [PMID: 35437221 PMCID: PMC9995166 DOI: 10.1016/j.jadohealth.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE There is concern that adolescents experience worse quality of health care than older women. We compare quality of reproductive health services (family planning and antenatal care) for adolescents (<20 years) versus adult women (≥25 years), in four sub-Saharan African countries. METHODS In total, 2,342 family planning visits and 8,600 antenatal care visits were analyzed from Democratic Republic of the Congo, Malawi, Senegal, and Tanzania. Service Provision Assessment surveys include observation of care and client exit interviews. We compare visit content and care satisfaction for adolescents versus adult women aged ≥25. All models are multilevel, weighted to reflect survey design, and include client, provider, and facility covariates (pooled models also include survey fixed effects). RESULTS Adolescents receive more overall family planning care activities compared to adult women (2.31 activities in adjusted generalized linear models, standard error [SE] 1.29, p < .1), and 3.76 more discussion activities (e.g., counseling) on average (SE 1.94, p < .1), but significantly fewer discussion activities during antenatal care (-3.10 activities, SE .97, p < .01). However, adolescents' satisfaction with both care types was not significantly different than adult women. These relationships largely persist in country-stratified models, using different model specifications, and when comparing adolescents to women aged ≥20. CONCLUSIONS Adolescents' family planning visits are similar to, or even slightly more comprehensive than, adult women-but their antenatal visits include fewer recommended care components, with particular gaps for activities requiring provider-client dialog. This suggests opportunities for strengthening communication between providers and young women, and improving care across the reproductive health continuum.
Collapse
Affiliation(s)
- Corrina Moucheraud
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California; UCLA Center for Health Policy Research, Los Angeles, California.
| | - Kaitlyn McBride
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Patrick Heuveline
- Department of Sociology and California Center for Population Research, University of California Los Angeles, Los Angeles, California
| | - Manisha Shah
- Department of Public Policy, Luskin School of Public Affairs, University of California Los Angeles, Los Angeles, California
| |
Collapse
|
5
|
Hakim S, Chowdhury MAB, Ahmed Z, Uddin MJ. Are Bangladeshi healthcare facilities prepared to provide antenatal care services? Evidence from two nationally representative surveys. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000164. [PMID: 36962302 PMCID: PMC10021659 DOI: 10.1371/journal.pgph.0000164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 06/17/2022] [Indexed: 06/18/2023]
Abstract
Identifying high-risk pregnancies through antenatal care (ANC) is considered the cornerstone to eliminating child deaths and improving maternal health globally. Understanding the factors that influence a healthcare facility's (HCF) preparedness to provide ANC service is essential for assisting maternal and newborn health system progress. We aimed to evaluate the preparedness of HCFs to offer ANC services among childbearing women in Bangladesh and investigate the facility characteristics linked to the preparedness. The data for this study came from two waves of the Bangladesh Health Facilities Survey (BHFS), conducted in 2014 and 2017 using a stratified random sample of facilities. The study samples were 1,508 and 1,506 HCFs from the 2014 and 2017 BHFS, respectively. The outcome variable "ANC services preparedness" was calculated as an index score using a group of tracer indicators. Multinomial logistic regression models were used to identify the significant correlates of ANC service preparedness. We found that private hospitals had a lower chance of having high preparedness than district and upazila public facilities in 2014 (RRR = 0.04, 95% CI: 0.01-0.22, p-value = <0.001) and 2017 (RRR = 0.23, 95% CI: 0.07-0.74, p-value = 0.01), respectively. HCFs from the Khulna division had a 2.84 (RRR = 2.84, CI: 1.25-6.43, p-value = 0.01) and 3.51 (RRR = 3.51, CI: 1.49-8.27, p-value = <0.001) higher likelihood of having medium and high preparedness, respectively, for ANC service compared to the facilities in the Dhaka division in 2017. The facilities that had a medium infection prevention score were 3.10 times (RRR = 3.10, 95% CI: 1.65-5.82; p-value = <0.001) and 1.89 times (RRR = 1.89, 95% CI: 1.09-3.26, p-value = 0.02) more likely to have high preparedness compared to those facilities that had a low infection prevention score in 2014 and 2017 respectively. Facilities without visual aids for client education on pregnancy and ANC were less likely to have high (RRR = 0.29, 95% CI: 0.16-0.53, p-value = <0.001) and (RRR = 0.55, 95% CI: 0.30-0.99, p-value = 0.04) preparedness, respectively, than those with visual aids for client education on pregnancy and ANC in both the surveys. At all two survey time points, facilities that did not maintain individual client cards or records for ANC clients were less likely to have high (RRR = 0.53, 95% CI: 0.31-.92, p-value = 0.02) and (RRR = 0.41, 95% CI: 0.25-0.66, p-value = <0.001) preparedness, respectively, compared to their counterparts. We conclude that most facilities lack adequate indicators for ANC service preparedness. To improve the readiness of ANC services, government authorities could focus on union-level facilities, community clinics, private facilities, and administrative divisions. They could also make sure that infection control items are available, maintain individual client cards or records for ANC clients, and also ensure ANC clients have access to visual aids.
Collapse
Affiliation(s)
- Shariful Hakim
- Department of Statistics, Shahjalal University of Science & Technology, Sylhet, Bangladesh
- Chander Hat Degree College, Nilphamari, Bangladesh
| | | | - Zobayer Ahmed
- Department of Economics, Selcuk University, Selçuklu, Turkey
- Department of Economics & Banking, International Islamic University Chittagong, Kumira, Bangladesh
| | - Md Jamal Uddin
- Department of Statistics, Shahjalal University of Science & Technology, Sylhet, Bangladesh
- Department of General Educational and Development, Daffodil International University, Dhaka, Bangladesh
| |
Collapse
|
6
|
Bergh K, Bishu S, Taddese HB. Identifying the determinants of patient satisfaction in the context of antenatal care in Kenya, Tanzania, and Malawi using service provision assessment data. BMC Health Serv Res 2022; 22:746. [PMID: 35658949 PMCID: PMC9167501 DOI: 10.1186/s12913-022-08085-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Antenatal care (ANC) is a service that can reduce the incidence of maternal and neonatal deaths when provided by skilled healthcare workers. Patient satisfaction is an important health system responsiveness goal which has been shown to influence adherence to healthcare interventions. This study aims to assess the determinants of pregnant women’s satisfaction with ANC across Kenya, Tanzania, and Malawi using nationally representative Service Provision Assessment data.
Methods
Patient satisfaction was conceptualised mainly based on Donabedian’s theory of healthcare quality with patient characteristics, structure, and process as the major determinants. Bivariate and multivariate analyses were conducted to identify the potential determinants.
Results
Findings show that satisfaction was negatively associated with women’s age (AOR: 0.95; 95% CI: 0.92–0.99) and having a secondary (AOR: 0.39; 95% CI: 0.17–0.87) or tertiary education (AOR: 0.41; 95% CI: 0.17–0.99) in Kenya. Women on their first pregnancy were more likely to report satisfaction in Tanzania (AOR: 1.62; 95% CI: 1.00–2.62) while women were less likely to report being satisfied in their second trimester in Malawi (AOR: 0.31; 95% CI: 0.09–0.97). The important structural and process factors for patient satisfaction included: private versus public run facilities in Kenya (AOR: 2.05; 95% CI: 1.22–3.43) and Malawi (AOR: 1.85; 95% CI: 0.99–3.43); level of provider training, that is, specialist versus enrolled nurse in Tanzania (AOR: 0.35; 95% CI: 0.13–0.93) or clinical technician in Malawi (AOR: 0.08; 95% CI: 0.01–0.36); and shorter waiting times across all countries.
Conclusion
Findings highlight the importance of professional proficiency and efficient service delivery in determining pregnant women’s satisfaction with ANC. Future studies should incorporate both patient characteristics and institutional factors at health facilities into their conceptualisation of patient satisfaction.
Collapse
|
7
|
Stone B, Sambo J, Sawadogo-Lewis T, Roberton T. When it rains, it pours: detecting seasonal patterns in utilization of maternal healthcare in Mozambique using routine data. BMC Health Serv Res 2020; 20:950. [PMID: 33059682 PMCID: PMC7559485 DOI: 10.1186/s12913-020-05807-0] [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: 07/17/2020] [Accepted: 10/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Climatic conditions and seasonal trends can affect population health, but typically, we consider the effect of climate on the epidemiology of communicable diseases. However, climate can also have an effect on access to care, particularly in remote rural areas of low- and middle-income countries. In this study, we investigate associations between the rainy season and the utilization of maternal health services in Mozambique. METHODS We examined patterns in the number of women receiving antenatal care (ANC) and delivering at a health facility for 2012-2019, using data from Mozambique's Health Management Information Systems. We investigated the association between seasonality (rainfall) and maternal health service utilization (ANC and institutional delivery) at national and provincial level. We fit a negative binomial regression model for institutional delivery and used it to estimate the yearly reduction in institutional deliveries due to the rainy season, with other factors held constant. We used the Lives Saved Tool (LiST) to model increases in mortality due to this estimated decrease in institutional delivery associated with the rainy season. RESULTS In our national analysis, the rate of ANC visits was 1% lower during the rainy season, adjusting for year and province (IRR = 0.99, 95% CI: 0.96-1.03). The rate of institutional deliveries was 6% lower during the rainy season than the dry season, after adjusting for time and province (IRR = 0.94, 95% CI: 0.92-0.96). In provincial analyses, all provinces except for Maputo-Cidade, Maputo-Province, Nampula, and Niassa showed a statistically significantly lower rate of institutional deliveries in the rainy season. None were statistically significantly lower for ANC. We estimate that, due to reductions in institutional delivery attributable only to the rainy season, there were 74 additional maternal deaths and 726 additional deaths of children under the age of 1 month in 2021, that would not have died if the mothers had instead delivered at a facility. CONCLUSION Fewer women deliver at a health facility during the rainy season in Mozambique than during the dry season. Barriers to receiving care during pregnancy and childbirth must be addressed using a multisectoral approach, considering the impact of geographical inequities.
Collapse
Affiliation(s)
- Briana Stone
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Júlia Sambo
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | | | - Timothy Roberton
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
8
|
Defar A, Getachew T, Taye G, Tadele T, Getnet M, Shumet T, Molla G, Gonfa G, Teklie H, Tadesse A, Bekele A. Quality antenatal care services delivery at health facilities of Ethiopia, assessment of the structure/input of care setting. BMC Health Serv Res 2020; 20:485. [PMID: 32487097 PMCID: PMC7268345 DOI: 10.1186/s12913-020-05372-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 05/27/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND According to the Donabedian model, the assessment for the quality of care includes three dimensions. These are structure, process, and outcome. Therefore, the present study aimed at assessing the structural quality of Antenatal care (ANC) service provision in Ethiopian health facilities. METHODS Data were obtained from the 2018 Ethiopian Service Availability and Readiness Assessment (SARA) survey. The SARA was a cross-sectional facility-based assessment conducted to capture health facility service availability and readiness in Ethiopia. A total of 764 health facilities were sampled in the 9 regions and 2 city administrations of the country. The availability of equipment, supplies, medicine, health worker's training and availability of guidelines were assessed. Data were collected from October-December 2017. We run a multiple linear regression model to identify predictors of health facility readiness for Antenatal care service. The level of significance was determined at a p-value < 0.05. RESULT Among the selected health facilities, 80.5% of them offered Antenatal care service. However, the availability of specific services was very low. The availability of tetanus toxoid vaccination, folic acid, iron supplementation, and monitoring of hypertension disorder was, 67.7, 65.6, 68.6, and 75.1%, respectively. The overall mean availability among the ten tracer items that are necessary to provide quality Antenatal care services was 50%. In the multiple linear regression model, health centers, health posts and clinics scored lower Antenatal care service readiness compared to hospitals. The overall readiness index score was lower for private health facilities (β = - 0.047, 95% CI: (- 0.1, - 0.004). The readiness score had no association with the facility settings (Urban/Rural) (p-value > 0.05). Facilities in six regions except Dire Dawa had (β = 0.067, 95% CI: (0.004, 0.129) lower readiness score than facilities in Tigray region (p-value < 0.015). CONCLUSION This analysis provides evidence of the gaps in structural readiness of health facilities to provide quality Antenatal care services. Key and essential supplies for quality Antenatal care service provision were missed in many of the health facilities. Guaranteeing properly equipped and staffed facilities shall be a target to improve the quality of Antenatal care services provision.
Collapse
Affiliation(s)
- Atkure Defar
- Reproductive Health Research Team, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Department of Epidemiology and Biostatistics, University of Gondar, College of Medicine and Health Science, Institute of Public health, Gondar, Ethiopia
| | - Theodros Getachew
- Health System Research Team, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- College of Medicine and Health Science, Institute of Public health, University of Gondar, Gondar, Ethiopia
| | - Girum Taye
- Health System Research Team, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Tefera Tadele
- Reproductive Health Research Team, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Misrak Getnet
- Reproductive Health Research Team, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Tigist Shumet
- Health System Research Team, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Gebeyaw Molla
- Health System Research Team, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Geremew Gonfa
- Health System Research Team, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Habtamu Teklie
- Reproductive Health Research Team, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ambaye Tadesse
- Health System Research Team, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Abebe Bekele
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| |
Collapse
|
9
|
Dennis ML, Benova L, Abuya T, Quartagno M, Bellows B, Campbell OMR. Initiation and continuity of maternal healthcare: examining the role of vouchers and user-fee removal on maternal health service use in Kenya. Health Policy Plan 2019; 34:120-131. [PMID: 30843068 PMCID: PMC6481282 DOI: 10.1093/heapol/czz004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2019] [Indexed: 11/15/2022] Open
Abstract
This study explores the relationship between two health financing initiatives on women's progression through the maternal health continuum in Kenya: a subsidized reproductive health voucher programme (2006-16) and the introduction of free maternity services in all government facilities (2013). Using cross-sectional survey data, we ran three multivariable logistic regression models examining the effects of the voucher programme, free maternity policy, health insurance and other determinants on (1) early antenatal care (ANC) initiation (first visit within the first trimester of pregnancy), (2) receiving continuous care (1+ ANC, facility birth, 1+ post-natal care (PNC) check) and (3) completing the maternal health pathway as recommended (4+ ANC, facility birth, 1+ PNC, with first check occurring within 48 h of delivery). Full implementation of the voucher programme was positively associated with receiving continuous care among users of 1+ ANC [interaction term adjusted odds ratio (aOR): 1.33, P = 0.014]. Early ANC initiation (aOR: 1.32, P = 0.001) and use of private sector ANC (aOR: 1.93, P < 0.001) were also positively associated with use of continuous care among ANC users. Among continuous care users, early ANC was associated with increased odds of completing the maternal health pathway as recommended (aOR: 3.80, P < 0.001). Higher parity was negatively associated with all three outcomes, while having health insurance was positively associated with each outcome. The impact of other sociodemographic factors such as maternal age, education, wealth quintile, urban residence, and employment varied by outcome; however, the findings generally suggest that marginalized women faced greater barriers to early ANC initiation and continuity of care. Health financing and women's timing and source of ANC are strongly related to their subsequent progression through the maternal health pathway. To increase continuity of care and improve maternal health outcomes, policymakers must therefore focus on equitably reducing financial and other barriers to care seeking and improving quality of care throughout the continuum.
Collapse
Affiliation(s)
- Mardieh L Dennis
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, Keppel Street WC1E7HT, London, UK
| | - Lenka Benova
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, Keppel Street WC1E7HT, London, UK.,Department of Public Health, Institute of Tropical Medicine, Kronenburgstraat 43, Antwerpen, Belgium
| | - Timothy Abuya
- Population Council Kenya, Avenue 5, Rose Avenue, Nairobi, Kenya
| | - Matteo Quartagno
- Department of Medical Statistics, Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, Keppel Street WC1E7HT, London, UK.,MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, Gower Street, London, UK and
| | - Ben Bellows
- Population Council, 4301 Connecticut Avenue NW, Suite 280, Washington DC, USA
| | - Oona M R Campbell
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, Keppel Street WC1E7HT, London, UK
| |
Collapse
|
10
|
Pugliese-Garcia M, Radovich E, Hassanein N, Campbell OMR, Khalil K, Benova L. Temporal and regional variations in use, equity and quality of antenatal care in Egypt: a repeat cross-sectional analysis using Demographic and Health Surveys. BMC Pregnancy Childbirth 2019; 19:268. [PMID: 31349804 PMCID: PMC6660959 DOI: 10.1186/s12884-019-2409-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/12/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Egypt has seen substantial decreases in maternal mortality and reached near universal coverage for antenatal care (ANC). The objective of this paper is to describe the changes over time (1991-2014) in the use of ANC in Egypt, focusing on sector of provision (public versus private), and the content and equity of this care, to inform future policies for improving maternal and newborn health. METHODS We used Demographic and Health surveys (DHS) conducted in Egypt in 1995, 2000, 2005, 2008 and 2014 to explore national and regional trends in ANC. To assess content of care, we calculated the percentage of ANC users who reported receiving seven ANC components measured in DHS in 2014. RESULTS During the period under consideration, the percentage of women in need of ANC who received facility-based ANC increased from 42 to 90%, the majority of which was private-sector ANC. The mean number of ANC visits among ANC users increased over time from 7.5 (95% confidence interval [CI] = 7.1-7.9) in 1991-1995 to 9.7 (95%CI 9.6-9.9) in 2010-2014. In 2010-2014, 44% of women using public ANC reported eight or more visits compared to 71% in private ANC. In the same period, 24% of ANC users received all seven care components. This percentage ranged from 10% of women reporting fewer than four ANC visits to 29% of women reporting eight or more. The poorest ANC users received all seven measured components of care less often than the wealthiest (20% versus 28%, p-value< 0.001). CONCLUSIONS Egypt's improvements in ANC coverage were characterized by decreasing reliance on public services and a rising number of ANC visits. However, despite rising ANC coverage, less than a third of women received the seven essential ANC components measured at least once during pregnancy, with differences between poorer and wealthier women. Policymakers need to ensure that high ANC coverage translates into equity-focused interventions targeting ANC quality. Further research needs to support this effort by assessing the determinants behind poor quality of ANC and evaluating potential interventions.
Collapse
Affiliation(s)
- Miguel Pugliese-Garcia
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1H 9SH UK
| | - Emma Radovich
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Nevine Hassanein
- Gynuity Health Projects, Egypt team, 220 East 42nd, New York, NY 10017 USA
| | - Oona M. R. Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | | | - Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
11
|
Mourtada R, Bottomley C, Houben F, Bashour H, Campbell OMR. A mixed methods analysis of factors affecting antenatal care content: A Syrian case study. PLoS One 2019; 14:e0214375. [PMID: 30908532 PMCID: PMC6433263 DOI: 10.1371/journal.pone.0214375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 03/12/2019] [Indexed: 12/04/2022] Open
Abstract
Background Maternity care services provide critical interventions aimed at improving maternal and newborn health. In this study, we examined determinants of antenatal care (ANC) content in Syria, together with changes over time. Methods We analysed two national surveys conducted by the Central Bureau of Statistics in Damascus (PAPFAM 2001 and MICS 2006). Findings of this initial analysis led to a qualitative study on adequacy of antenatal care content in two Syrian governorates, Aleppo and Latakia in 2010, which in turn informed further quantitative analysis. The perspectives and practices of doctors, women, midwives and health officials were explored using in-depth interviews. A framework approach was used to analyse the data. Results The quantitative analysis demonstrated that women’s education level, the type of health facility they attended and whether they had experienced health complications were important determinants of adequacy of ANC content received. The qualitative study revealed that additional factors related to supply side and demand side factors (e.g. organization of health services, doctors' selective prescription of ANC tests and women's selective uptake of those tests), influenced the quality of ANC and explained some regional differences between Aleppo and Latakia. Conclusions The percentage of women who received adequate ANC content was probably higher in Latakia than in Aleppo because women in Latakia were more educated, and because services were more available, accessible, and acceptable to them.
Collapse
Affiliation(s)
- Rima Mourtada
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Christian Bottomley
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Fiona Houben
- Faculty of Health and Wellbeing, Canterbury Christ Church University, Canterbury, Kent, United Kingdom
| | | | - Oona M. R. Campbell
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
12
|
Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, Adeyi O, Barker P, Daelmans B, Doubova SV, English M, García-Elorrio E, Guanais F, Gureje O, Hirschhorn LR, Jiang L, Kelley E, Lemango ET, Liljestrand J, Malata A, Marchant T, Matsoso MP, Meara JG, Mohanan M, Ndiaye Y, Norheim OF, Reddy KS, Rowe AK, Salomon JA, Thapa G, Twum-Danso NAY, Pate M. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health 2018; 6:e1196-e1252. [PMID: 30196093 PMCID: PMC7734391 DOI: 10.1016/s2214-109x(18)30386-3] [Citation(s) in RCA: 1479] [Impact Index Per Article: 246.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/16/2018] [Accepted: 08/10/2018] [Indexed: 12/19/2022]
Affiliation(s)
| | - Anna D Gage
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | - Keely Jordan
- New York University College of Global Public Health, New York, NY, USA
| | | | | | | | - Pierre Barker
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | | | | | - Mike English
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | | | | | - Oye Gureje
- WHO Collaborating Centre for Research and Training in Mental Health, Neuroscience, Drug and Alcohol Abuse, University of Ibadan, Ibadan, Nigeria
| | - Lisa R Hirschhorn
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lixin Jiang
- National Centre for Cardiovascular Disease, Beijing, China
| | | | | | | | - Address Malata
- Malawi University of Science and Technology, Limbe, Malawi
| | - Tanya Marchant
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - John G Meara
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Manoj Mohanan
- Duke University Sanford School of Public Policy, Durham, NC, USA
| | - Youssoupha Ndiaye
- Ministry of Health and Social Action of the Republic of Senegal, Dakar, Senegal
| | - Ole F Norheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Alexander K Rowe
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Gagan Thapa
- Legislature Parliament of Nepal, Kathmandu, Nepal
| | | | | |
Collapse
|
13
|
Benova L, Dennis ML, Lange IL, Campbell OMR, Waiswa P, Haemmerli M, Fernandez Y, Kerber K, Lawn JE, Santos AC, Matovu F, Macleod D, Goodman C, Penn-Kekana L, Ssengooba F, Lynch CA. Two decades of antenatal and delivery care in Uganda: a cross-sectional study using Demographic and Health Surveys. BMC Health Serv Res 2018; 18:758. [PMID: 30286749 PMCID: PMC6172797 DOI: 10.1186/s12913-018-3546-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 09/17/2018] [Indexed: 11/11/2022] Open
Abstract
Background Uganda halved its maternal mortality to 343/100,000 live births between 1990 and 2015, but did not meet the Millennium Development Goal 5. Skilled, timely and good quality antenatal (ANC) and delivery care can prevent the majority of maternal/newborn deaths and stillbirths. We examine coverage, equity, sector of provision and content of ANC and delivery care between 1991 and 2011. Methods We conducted a repeated cross-sectional study using four Uganda Demographic and Health Surveys (1995, 2000, 2006 and 2011).Using the most recent live birth and adjusting for survey sampling, we estimated percentage and absolute number of births with ANC (any and 4+ visits), facility delivery, caesarean sections and complete maternal care. We assessed socio-economic differentials in these indicators by wealth, education, urban/rural residence, and geographic zone on the 1995 and 2011 surveys. We estimated the proportions of ANC and delivery care provided by the public and private (for-profit and not-for-profit) sectors, and compared content of ANC and delivery care between sectors. Statistical significance of differences were evaluated using chi-square tests. Results Coverage with any ANC remained high over the study period (> 90% since 2001) but was of insufficient frequency; < 50% of women who received any ANC reported 4+ visits. Facility-based delivery care increased slowly, reaching 58% in 2011. While significant inequalities in coverage by wealth, education, residence and geographic zone remained, coverage improved for all indicators among the lowest socio-economic groups of women over time. The private sector market share declined over time to 14% of ANC and 25% of delivery care in 2011. Only 10% of women with 4+ ANC visits and 13% of women delivering in facilities received all measured care components. Conclusions The Ugandan health system had to cope with more than 30,000 additional births annually between 1991 and 2011. The majority of women in Uganda accessed ANC, but this contact did not result in care of sufficient frequency, content, and continuum of care (facility delivery). Providers in both sectors require quality improvements. Achieving universal health coverage and maternal/newborn SDGs in Uganda requires prioritising poor, less educated and rural women despite competing priorities for financial and human resources. Electronic supplementary material The online version of this article (10.1186/s12913-018-3546-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lenka Benova
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. .,Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.
| | - Mardieh L Dennis
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Isabelle L Lange
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Oona M R Campbell
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Peter Waiswa
- School of Public Health, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Manon Haemmerli
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Yolanda Fernandez
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Kate Kerber
- Saving Newborn Lives, Save the Children, 899 North Capitol Street, Suite 900, Washington, DC, 20002, USA.,Indigenous & Global Health Research Group, Department of Medicine, University of Alberta, University Terrace, 8303-112 Street, Edmonton, AB, T6G 2T4, Canada
| | - Joy E Lawn
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Andreia Costa Santos
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Fred Matovu
- School of Economics, Makerere University Kampala, Uganda and Policy Analysis & Development Research Institute (PADRI), Kampala, Uganda
| | - David Macleod
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Catherine Goodman
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Loveday Penn-Kekana
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Freddie Ssengooba
- School of Public Health, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Caroline A Lynch
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| |
Collapse
|
14
|
Arrieta A, Suárez G, Hakim G. Assessment of patient safety culture in private and public hospitals in Peru. Int J Qual Health Care 2018; 30:186-191. [PMID: 29228295 DOI: 10.1093/intqhc/mzx165] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 11/19/2017] [Indexed: 12/11/2022] Open
Abstract
Objective To assess the patient safety culture in Peruvian hospitals from the perspective of healthcare professionals, and to test for differences between the private and public healthcare sectors. Patient safety is defined as the avoidance and prevention of patient injuries or adverse events resulting from the processes of healthcare delivery. Design A non-random cross-sectional study conducted online. Setting An online survey was administered from July to August 2016, in Peru. This study reports results from Lima and Callao, which are the capital and the port region of Peru. Participants A total of 1679 healthcare professionals completed the survey. Participants were physicians, medical residents and nurses working in healthcare facilities from the private sector and public sector. Main outcomes Assessment of the degree of patient safety and 12 dimensions of patient safety culture in hospital units as perceived by healthcare professionals. Results Only 18% of healthcare professionals assess the degree of patient safety in their unit of work as excellent or very good. Significant differences are observed between the patient safety grades in the private sector (37%) compared to the public sub-sectors (13-15%). Moreover, in all patient safety culture dimensions, healthcare professionals from the private sector give more favorable responses for patient safety, than those from the public sub-systems. The most significant difference in support comes from patient safety administrators through communication and information about errors. Conclusions Overall, the degree of patient safety in Peru is low, with significant gaps that exist between the private and the public sectors.
Collapse
Affiliation(s)
- Alejandro Arrieta
- Department of Health Policy and Management, 11200 SW 8th St., Miami, FL 33199, USA
| | | | - Galed Hakim
- Baptist Health International, 1575 San Ignacio Av., Coral Gables, FL 33146, USA
| |
Collapse
|
15
|
Associations of acute conflict with equity in maternal healthcare: an uncontrolled before-and-after analysis of Egypt demographic and health survey data. Int J Equity Health 2018; 17:129. [PMID: 30157849 PMCID: PMC6114833 DOI: 10.1186/s12939-018-0845-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 08/15/2018] [Indexed: 11/13/2022] Open
Abstract
Background Equity of usage of maternal services during conflict is considered key to reducing maternal health risks globally. However, evidence showing how conflict affects maternal care use among different population groups is minimal. This study examined how the Egyptian acute conflict of 2011–2012 affected maternal care use among different socioeconomic, demographic, and geographic groups. Methods An ‘uncontrolled before-and-after’ study design was used to perform multi-level modelling regression analysis on 2014 Egypt Demographic and Health Survey data. The pre-conflict sample included 2569 births occurring from January 2009 to January 2011 and the peri-conflict sample included 4641 births from February 2011 to December 2012. Results Interaction analysis indicated that the effect of conflict on some aspects of maternal care differed by mother’s age, residential status, employment, education level and household wealth. In the stratum-specific analysis, increased odds of skilled delivery during conflict was relatively greater among women who were rural (odds ratio [OR] 1.02; 95%CI 1.02–1.03), educated to primary level (OR 1.04; 95%CI 1.01–1.07), employed (OR 1.04; 95%CI 1.01–1.07), less poor (OR 1.03; 95%CI 1.02–1.05) or middle-income (OR 1.02; 95%CI 1.01–1.04), than pre-conflict. Similarly, increased odds of physician-assisted delivery during conflict was relatively greater for women who were rural (OR 1.03; 95%CI 1.02–1.04), educated to primary level (OR 1.05; 95% CI 1.01–1.10), employed (OR 1.07; 95%CI 1.02–1.11), or from less poor/middle-income (OR 1.03; 95%CI 1.01–1.05 each), and richest quintiles (OR 1.02; 95%CI 1.00–1.03). Decreased odds of postnatal care during conflict was relatively greater among women aged 25–29 (OR 0.92; 95%CI 0.88–0.96) compared to older women. Conclusions The association between acute conflict and maternal services usage indicated some vertical equity, as equity patterns during conflict differed from recent trends in Egypt. The association between conflict and maternal care usage among potentially marginalised groups was minimal and not notably inequitable. Specific strategies should be included in maternal health policies to mitigate the unpredictable effect of conflict on maternal care equity. Further research is needed to determine how conflict affects out-of-pocket expenditures and quality-of-care among different socioeconomic groups.
Collapse
|
16
|
Benova L, Tunçalp Ö, Moran AC, Campbell OMR. Not just a number: examining coverage and content of antenatal care in low-income and middle-income countries. BMJ Glob Health 2018; 3:e000779. [PMID: 29662698 PMCID: PMC5898334 DOI: 10.1136/bmjgh-2018-000779] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/19/2018] [Accepted: 03/20/2018] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Antenatal care (ANC) provides a critical opportunity for women and babies to benefit from good-quality maternal care. Using 10 countries as an illustrative analysis, we described ANC coverage (number of visits and timing of first visit) and operationalised indicators for content of care as available in population surveys, and examined how these two approaches are related. METHODS We used the most recent Demographic and Health Survey to analyse ANC related to women's most recent live birth up to 3 years preceding the survey. Content of care was assessed using six components routinely measured across all countries, and a further one to eight additional country-specific components. We estimated the percentage of women in need of ANC, and using ANC, who received each component, the six routine components and all components. RESULTS In all 10 countries, the majority of women in need of ANC reported 1+ ANC visits and over two-fifths reported 4+ visits. Receipt of the six routine components varied widely; blood pressure measurement was the most commonly reported component, and urine test and information on complications the least. Among the subset of women starting ANC in the first trimester and receiving 4+ visits, the percentage receiving all six routinely measured ANC components was low, ranging from 10% (Jordan) to around 50% in Nigeria, Nepal, Colombia and Haiti. CONCLUSION Our findings suggest that even among women with patterns of care that complied with global recommendations, the content of care was poor. Efficient and effective action to improve care quality relies on development of suitable content of care indicators.
Collapse
Affiliation(s)
- Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Özge Tunçalp
- Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Allisyn C Moran
- Department of Maternal, Newborn, Child and Adolescent Health, WHO, Geneva, Switzerland
| | - Oona Maeve Renee Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
17
|
Hangoma P, Robberstad B, Aakvik A. Does Free Public Health Care Increase Utilization and Reduce Spending? Heterogeneity and Long Term Effects. WORLD DEVELOPMENT 2018; 101:334-350. [PMID: 29422705 PMCID: PMC5798631 DOI: 10.1016/j.worlddev.2017.05.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Zambia removed user fees in publicly supported-government and faith based- health facilities in 54 out of 72 districts in 2006. This was extended to rural areas of previously unaffected districts in 2007. The natural experiment provided by the step-wise implementation of the removal policy and five waves of nationally representative household survey data enables us to study the impact of the removal policy on utilization and household health expenditure. We find that the policy increased overall use of health services in the short term and the effects were sustained in the long term. The increases were higher for individuals whose household heads were unemployed or had no or less education. The policy also led to a small shift in care seeking from private to publicly supported facilities, an effect driven primarily by individuals whose household heads were either formally employed or engaged in farming. The likelihood of incurring any spending reduced, although this weakened slightly in the long term. At the same time, there was an upward pressure on conditional health expenditure, i.e., expenditure was higher after removal of fees for those who incurred any spending. Hence, total (unconditional) household health expenditure was not significantly affected.
Collapse
Affiliation(s)
- Peter Hangoma
- Health Economics and Econometrics Unit (HEEU), School of Public Health, University of Zambia
- Center for International Health, University of Bergen
| | | | | |
Collapse
|
18
|
Do M, Wang W, Hembling J, Ametepi P. Quality of antenatal care and client satisfaction in Kenya and Namibia. Int J Qual Health Care 2017; 29:183-193. [PMID: 28453821 DOI: 10.1093/intqhc/mzx001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 01/10/2017] [Indexed: 11/12/2022] Open
Abstract
Objective Despite much progress in maternal health service coverage, the quality of care has not seen parallel improvement. This study assessed the quality of antenatal care (ANC), an entry point to the health system for many women. Design The study used data from recent Service Provision Assessment (SPA) surveys of nationally representative health facilities in Kenya and Namibia. Setting Kenya and Namibia represent the situation in much of sub-Saharan Africa, where ANC is relatively common but maternal mortality remains high. Participants The SPA comprised an inventory of health facilities that provided ANC, interviews with ANC providers and clients, and observations of service delivery. Interventions Not applicable. Main Outcome Measures Quality was measured in terms of structure and process of service provision, and client satisfaction as the outcome of service provision. Results Wide variations in structural and process attributes of quality of care existed in both Kenya and Namibia; however, better structural quality did not translate to better service delivery process or greater client satisfaction. Long waiting time was a common problem and was generally more serious in hospitals and health centers than in clinics and smaller facilities; it was consistently associated with lower client satisfaction. The study also indicates that the provider's technical preparedness may not be sufficient to provide good-quality services and to ensure client satisfaction. Conclusions Findings highlight important program implications, including improving ANC services and promoting their use at health clinics and lower-level facilities, and ensuring that available supplies and equipment are used for service provision.
Collapse
Affiliation(s)
- Mai Do
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112, USA
| | - Wenjuan Wang
- ICF, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA
| | - John Hembling
- Catholic Relief Services, 228 W. Lexington St., Baltimore, MD 21201, USA
| | | |
Collapse
|
19
|
Owolabi OO, Wong KLM, Dennis ML, Radovich E, Cavallaro FL, Lynch CA, Fatusi A, Sombie I, Benova L. Comparing the use and content of antenatal care in adolescent and older first-time mothers in 13 countries of west Africa: a cross-sectional analysis of Demographic and Health Surveys. THE LANCET CHILD & ADOLESCENT HEALTH 2017; 1:203-212. [PMID: 30169169 DOI: 10.1016/s2352-4642(17)30025-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 06/20/2017] [Accepted: 06/21/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND West Africa has the highest proportion of married adolescents, and the highest adolescent childbirth rate and maternal death rate in sub-Saharan Africa. However, few studies have focused on the type and quality of health care accessed by pregnant young women in countries in this subregion. METHODS We obtained data from Demographic and Health Surveys done between 2010 and 2014, to compare the use, timing, source, and components of antenatal care between adolescent and older first-time mothers in 13 west African countries. The sample included primiparous women who were aged 15-49 years with a livebirth in the 5-year survey recall period, and women were assigned to one of three groups on the basis of age at the time of childbirth: adolescent (10-19 years), young adults (20-24 years), or adults (25 years or older). We calculated the percentage of women who: attended at least one antenatal care visit, completed at least one visit during the first trimester of pregnancy, attended four or more appointments in antenatal care, and received four components of antenatal care (blood pressure measurement, urine tests, blood tests, and information on complications), as well as the sector where the women received care. We primarily report the comparison between adolescents and young adults. FINDINGS In 2016, we acquired data from the Demographic Health Surveys from 13 west African countries between 2010 and 2014 on primiparous women. The study sample was 19 211 women, of whom 10 025 (52%) were adolescents, 6099 (32%) were young adults, and 3087 (16%) were adults. Overall, 17 386 (91%) of 19 211 first-time mothers made use of antenatal care facilities on at least one occasion. 3597 (41%) of 8741 adolescents compared with 8202 (47%) of all 17 386 women began the use of antenatal care during the first trimester. Across west Africa, 5430 (62%) of 8741 adolescents had four or more antenatal care visits compared with 4067 (71%) of 5717 young adults and 2358 (81%) of 2928 adults. Of those who had four or more visits to antenatal care, 2779 (51%) of 5430 adolescents received all the antenatal care components examined compared with 2488 (61%) of 4067 young adults and 1600 (68%) of 2358 adults. Although most women received antenatal care in the public sector, in nine of the 13 countries, the proportion of women that used the private sector was higher in older mothers. INTERPRETATION Although a large percentage of west African adolescents use some antenatal care for their first birth, they seek care later, make fewer visits during pregnancy, and receive fewer components of care than older first-time mothers. Governments must ensure the pregnancy care accessed by adolescent mothers is of high quality and tailored to meet their needs. FUNDING MSD for Mothers.
Collapse
Affiliation(s)
- Onikepe O Owolabi
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; Guttmacher Institute, New York, NY, USA.
| | - Kerry L M Wong
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Mardieh L Dennis
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Emma Radovich
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Francesca L Cavallaro
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Caroline A Lynch
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Adesegun Fatusi
- Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile Ife, Nigeria
| | - Issiaka Sombie
- West African Health Organization, Bobo-Dioulasso, Burkina Faso
| | - Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
20
|
Kim C, Saeed KMA, Salehi AS, Zeng W. An equity analysis of utilization of health services in Afghanistan using a national household survey. BMC Public Health 2016; 16:1226. [PMID: 27919238 PMCID: PMC5139141 DOI: 10.1186/s12889-016-3894-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 11/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Afghanistan has made great strides in the coverage of health services across the country but coverage of key indicators remains low nationally and whether the poorest households are accessing these services is not well understood. METHODS We analyzed the Afghanistan Mortality Survey 2010 on utilization of inpatient and outpatient care, institutional delivery and antenatal care by wealth quintiles. Concentration indexes (CIs) were generated to measure the inequality of using the four services. Additional analyses were conducted to examine factors that explain the health inequalities (e.g. age, gender, education and residence). RESULTS Among households reporting utilization of health services, public health facilities were used more often for inpatient care, while they were used less for outpatient care. Overall, the utilization of inpatient and outpatient care, and antenatal care was equally distributed among income groups, with CIs of 0.04, 0.03 and 0.08, respectively. However, the poor used more public facilities while the wealthy used more private facilities. There was a substantial inequality in the use of institutional delivery services, with a CI of 0.31. Poorer women had a lower rate of institutional deliveries overall, in both public and private facilities, compared to the wealthy. Location was an important factor in explaining the inequality in the use of health services. CONCLUSIONS The large gap between the rich and poor in access to and utilization of key maternal services, such as institutional delivery, may be a central factor to the high rates of maternal mortality and morbidity and impedes efforts to make progress toward universal health coverage. While poorer households use public health services more often, the use of public facilities for outpatient visits remains half that of private facilities. Pro-poor targeting as well as a better understanding of the private sector's role in increasing equitable coverage of maternal health services is needed. Equity-oriented approaches in health should be prioritized to promote more inclusive health system reforms.
Collapse
Affiliation(s)
- Christine Kim
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | | | | | - Wu Zeng
- Schneider Institutes for Health Policy, Heller School, Brandeis University, MS 035, Waltham, MA 02454 USA
| |
Collapse
|
21
|
Grépin KA. Private Sector An Important But Not Dominant Provider Of Key Health Services In Low- And Middle-Income Countries. Health Aff (Millwood) 2016; 35:1214-21. [DOI: 10.1377/hlthaff.2015.0862] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Karen A. Grépin
- Karen A. Grépin ( ) is an associate professor in the Department of Health Sciences, Wilfred Laurier University, in Waterloo, Ontario
| |
Collapse
|
22
|
Saad–Haddad G, DeJong J, Terreri N, Restrepo–Méndez MC, Perin J, Vaz L, Newby H, Amouzou A, Barros AJD, Bryce J. Patterns and determinants of antenatal care utilization: analysis of national survey data in seven countdown countries. J Glob Health 2016; 6:010404. [PMID: 27231540 PMCID: PMC4871063 DOI: 10.7189/jogh.06.010404] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Antenatal care (ANC) is critical for improving maternal and newborn health. WHO recommends that pregnant women complete at least four ANC visits. Countdown and other global monitoring efforts track the proportions of women who receive one or more visits by a skilled provider (ANC1+) and four or more visits by any provider (ANC4+). This study investigates patterns of drop-off in use between ANC1+ and ANC4+, and explores inequalities in women's use of ANC services. It also identifies determinants of utilization and describes countries' ANC-related policies, and programs. METHODS We performed secondary analyses using Demographic Health Survey (DHS) data from seven Countdown countries: Bangladesh, Cambodia, Cameroon, Nepal, Peru, Senegal and Uganda. The descriptive analysis illustrates country variations in the frequency of visits by provider type, content, and by household wealth, women's education and type of residence. We conducted a multivariable analysis using a conceptual framework to identify determinants of ANC utilization. We collected contextual information from countries through a standard questionnaire completed by country-based informants. RESULTS Each country had a unique pattern of ANC utilization in terms of coverage, inequality and the extent to which predictors affected the frequency of visits. Nevertheless, common patterns arise. Women having four or more visits usually saw a skilled provider at least once, and received more evidence-based content interventions than women reporting fewer than four visits. A considerable proportion of women reporting four or more visits did not report receiving the essential interventions. Large disparities exist in ANC use by household wealth, women's education and residence area; and are wider for a larger number of visits. The multivariable analyses of two models in each country showed that determinants had different effects on the dependent variable in each model. Overall, strong predictors of ANC initiation and having a higher frequency (4+) of visits were woman's education and household wealth. Gestational age at first visit, birth rank and preceding birth interval were generally negatively associated with initiating visits and with having four or more visits. Information on country policies and programs were somewhat informative in understanding the utilization patterns across the countries, although timing of adoption and actual implementation make direct linkages impossible to verify. CONCLUSION Secondary analyses provided a more detailed picture of ANC utilization patterns in the seven countries. While coverage levels differ by country and sub-groups, all countries can benefit from specific in-country assessments to properly identify the underserved women and the reasons behind low coverage and missed interventions. Overall, emphasis needs to be put on assessing the quality of care offered and identifying women's perception to the care as well as the barriers hindering utilization. Country policies and programs need to be reviewed, evaluated and/or implemented properly to ensure that women receive the recommended number of ANC visits with appropriate content, especially, poor and less educated women residing in rural areas.
Collapse
Affiliation(s)
- Ghada Saad–Haddad
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Jocelyn DeJong
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | | | | | - Jamie Perin
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lara Vaz
- Save the Children, Washington D.C., USA
| | - Holly Newby
- Division of Data, Research and Policy, United Nations Children’s Fund, New York City, NY, USA
| | - Agbessi Amouzou
- Division of Data, Research and Policy, United Nations Children’s Fund, New York City, NY, USA
| | | | - Jennifer Bryce
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
23
|
Campbell OMR, Benova L, MacLeod D, Baggaley RF, Rodrigues LC, Hanson K, Powell‐Jackson T, Penn‐Kekana L, Polonsky R, Footman K, Vahanian A, Pereira SK, Santos AC, Filippi VGA, Lynch CA, Goodman C. Family planning, antenatal and delivery care: cross‐sectional survey evidence on levels of coverage and inequalities by public and private sector in 57 low‐ and middle‐income countries. Trop Med Int Health 2016; 21:486-503. [DOI: 10.1111/tmi.12681] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Oona M. R. Campbell
- Faculty of Epidemiology and Population Health London School of Hygiene and Tropical Medicine London UK
| | - Lenka Benova
- Faculty of Epidemiology and Population Health London School of Hygiene and Tropical Medicine London UK
| | - David MacLeod
- Faculty of Epidemiology and Population Health London School of Hygiene and Tropical Medicine London UK
| | - Rebecca F. Baggaley
- Faculty of Epidemiology and Population Health London School of Hygiene and Tropical Medicine London UK
| | - Laura C. Rodrigues
- Faculty of Epidemiology and Population Health London School of Hygiene and Tropical Medicine London UK
| | - Kara Hanson
- Faculty of Public Health and Policy London School of Hygiene and Tropical Medicine London UK
| | - Timothy Powell‐Jackson
- Faculty of Public Health and Policy London School of Hygiene and Tropical Medicine London UK
| | - Loveday Penn‐Kekana
- Faculty of Epidemiology and Population Health London School of Hygiene and Tropical Medicine London UK
| | - Reen Polonsky
- Faculty of Epidemiology and Population Health London School of Hygiene and Tropical Medicine London UK
| | - Katharine Footman
- Faculty of Epidemiology and Population Health London School of Hygiene and Tropical Medicine London UK
| | - Alice Vahanian
- Faculty of Epidemiology and Population Health London School of Hygiene and Tropical Medicine London UK
| | - Shreya K. Pereira
- Faculty of Public Health and Policy London School of Hygiene and Tropical Medicine London UK
| | - Andreia Costa Santos
- Faculty of Public Health and Policy London School of Hygiene and Tropical Medicine London UK
| | - Veronique G. A. Filippi
- Faculty of Epidemiology and Population Health London School of Hygiene and Tropical Medicine London UK
| | - Caroline A. Lynch
- Faculty of Epidemiology and Population Health London School of Hygiene and Tropical Medicine London UK
| | - Catherine Goodman
- Faculty of Public Health and Policy London School of Hygiene and Tropical Medicine London UK
| |
Collapse
|
24
|
Benova L, Macleod D, Footman K, Cavallaro F, Lynch CA, Campbell OMR. Role of the private sector in childbirth care: cross-sectional survey evidence from 57 low- and middle-income countries using Demographic and Health Surveys. Trop Med Int Health 2015; 20:1657-73. [PMID: 26412496 DOI: 10.1111/tmi.12598] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Maternal mortality rates have decreased globally but remain off track for Millennium Development Goals. Good-quality delivery care is one recognised strategy to address this gap. This study examines the role of the private (non-public) sector in providing delivery care and compares the equity and quality of the sectors. METHODS The most recent Demographic and Health Survey (2000-2013) for 57 countries was used to analyse delivery care for most recent birth among >330 000 women. Wealth quintiles were used for equity analysis; skilled birth attendant (SBA) and Caesarean section rates served as proxies for quality of care in cross-sectoral comparisons. RESULTS The proportion of women who used appropriate delivery care (non-facility with a SBA or facility-based births) varied across regions (49-84%), but wealth-related inequalities were seen in both sectors in all regions. One-fifth of all deliveries occurred in the private sector. Overall, 36% of deliveries with appropriate care occurred in the private sector, ranging from 9% to 46% across regions. The presence of a SBA was comparable between sectors (≥93%) in all regions. In every region, Caesarean section rate was higher in the private compared to public sector. The private sector provided between 13% (Latin America) and 66% (Asia) of Caesarean section deliveries. CONCLUSION This study is the most comprehensive assessment to date of coverage, equity and quality indicators of delivery care by sector. The private sector provided a substantial proportion of delivery care in low- and middle-income countries. Further research is necessary to better understand this heterogeneous group of providers and their potential to equitably increase the coverage of good-quality intrapartum care.
Collapse
Affiliation(s)
- Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - David Macleod
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Katharine Footman
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Francesca Cavallaro
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Caroline A Lynch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
25
|
Campbell OMR, Benova L, Macleod D, Goodman C, Footman K, Pereira AL, Lynch CA. Who, What, Where: an analysis of private sector family planning provision in 57 low- and middle-income countries. Trop Med Int Health 2015; 20:1639-56. [PMID: 26412363 DOI: 10.1111/tmi.12597] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Family planning service delivery has been neglected; rigorous analyses of the patterns of contraceptive provision are needed to inform strategies to address this neglect. METHODS We used 57 nationally representative Demographic and Health Surveys in low- and middle-income countries (2000-2013) in four geographic regions to estimate need for contraceptive services, and examined the sector of provision, by women's socio-economic position. We also assessed method mix and whether women were informed of side effects. RESULTS Modern contraceptive use among women in need was lowest in sub-Saharan Africa (39%), with other regions ranging from 64% to 72%. The private sector share of the family planning market was 37-39% of users across the regions and 37% overall (median across countries: 41%). Private sector users accessed medical providers (range across regions: 30-60%, overall mean: 54% and median across countries 23%), specialised drug sellers (range across regions: 31-52%, overall mean: 36% and median across countries: 43%) and retailers (range across regions: 3-14%, overall mean: 6% and median across countries: 6%). Private retailers played a more important role in sub-Saharan Africa (14%) than in other regions (3-5%). NGOs and FBOs served a small percentage. Privileged women (richest wealth quintile, urban residents or secondary-/tertiary-level education) used private sector services more than the less privileged. Contraceptive method types with higher requirements (medical skills) for provision were less likely to be acquired from the private sector, while short-acting methods/injectables were more likely. The percentages of women informed of side effects varied by method and provider subtype, but within subtypes were higher among public than private medical providers for four of five methods assessed. CONCLUSION Given the importance of private sector providers, we need to understand why women choose their services, what quality services the private sector provides, and how it can be improved. However, when prioritising one of the two sectors (public vs. private), it is critical to consider the potential impact on contraceptive prevalence and equity of met need.
Collapse
Affiliation(s)
- Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - David Macleod
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Catherine Goodman
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Katharine Footman
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Caroline A Lynch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
26
|
Footman K, Benova L, Goodman C, Macleod D, Lynch CA, Penn-Kekana L, Campbell OMR. Using multi-country household surveys to understand who provides reproductive and maternal health services in low- and middle-income countries: a critical appraisal of the Demographic and Health Surveys. Trop Med Int Health 2015; 20:589-606. [PMID: 25641212 PMCID: PMC4409817 DOI: 10.1111/tmi.12471] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The Demographic and Health Surveys (DHS) are a vital data resource for cross-country comparative analyses. This study is part of a set of analyses assessing the types of providers being used for reproductive and maternal health care across 57 countries. Here, we examine some of the challenges encountered using DHS data for this purpose, present the provider classification we used, and provide recommendations to enable more detailed and accurate cross-country comparisons of healthcare provision. METHODS We used the most recent DHS surveys between 2000 and 2012; 57 countries had data on family planning and delivery care providers and 47 countries had data on antenatal care. Every possible response option across the 57 countries was listed and categorised. We then developed a classification to group provider response options according to two key dimensions: clinical nature and profit motive. RESULTS We classified the different types of maternal and reproductive healthcare providers, and the individuals providing care. Documented challenges encountered during this process were limitations inherent in household survey data based on respondents' self-report; conflation of response options in the questionnaire or at the data processing stage; category errors of the place vs. professional for delivery; inability to determine whether care received at home is from the public or private sector; a large number of negligible response options; inconsistencies in coding and analysis of data sets; and the use of inconsistent headings. CONCLUSIONS To improve clarity, we recommend addressing issues such as conflation of response options, data on public vs. private provider, inconsistent coding and obtaining metadata. More systematic and standardised collection of data would aid international comparisons of progress towards improved financial protection, and allow us to better characterise the incentives and commercial nature of different providers.
Collapse
Affiliation(s)
- K Footman
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - L Benova
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - C Goodman
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - D Macleod
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - C A Lynch
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - L Penn-Kekana
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - O M R Campbell
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|