Exploratory study on development challenges of maternal and child healthcare institutions in China: a qualitative study combining interviews and focus groups

A comparative evaluation of child health care in China using multicriteria decision analysis methods

Child health is an important public health issue in China and the Chinese government always attached great importance to child health care. With the implementation of a series of medical and health reforms in China in recent decades, the status of child health improved year by year. Objectives This study aims to comprehensively evaluate if the measures implemented in the medical and health reforms effectively promoted the development of Chinese child health care in recent years and provide theoretical support for future decision-making on the policies of child health care in China. Methods A total of six indicators were selected from the China Health Statistics Yearbook. Based on the multi-criteria decision analysis (MCDA) algorithm, three different evaluation methods were applied in the study, which are the weighted technique for order preference by similarity to an ideal solution (TOPSIS) method, the weighted rank-sum ratio (RSR) method, and the fuzzy comprehensive evaluation (FCE). Each indicator's weight was calculated by the entropy weight methods objectively. The sensitivity analysis was conducted to validate the stability and accuracy of the rank results. Results The results indicated that the rank values of each year's child health care calculated by the different evaluation methods were not exactly the same, but the overall trend is consistent which is that child health care in China improved year by year from 2000 to 2020. The top 5 were ranked from 2016-2020 and the bottom 5 were ranked from 2000-2004. Conclusions The results indicated that the policies and measures implemented in the medical and health reforms, as well as improved sanitation conditions, availability of healthy food and water, etc., have jointly promoted the development of child health care in China in the past 20 years, providing a scientific theoretical basis for future policy-making to promote child health care.

Unpacking the challenges of fragmentation in community-based maternal newborn and child health and health system in rural Ethiopia: A qualitative study

INTRODUCTION

In Ethiopia, country-wide community-based primary health programs have been in effect for about two decades. Despite the program's significant contribution to advancing Maternal Newborn and Child Health (MNCH), Ethiopia's maternal and child mortality is still one of the highest in the world. The aim of this manuscript is to critically examine the multifaceted fragmentation challenges of Ethiopia's Community Health Workers (CHWs) program to deliver optimum MNCH and build a resilient community health system.

METHODS

We conducted a qualitative case study in West Shewa Zone, rural Ethiopia. A purposive sampling technique was used to recruit participants. Data sources were two focus group discussions with sixteen CHWs, twelve key informant interviews with multilevel public health policy actors, and a policy document review related to the CHW program to triangulate the findings. Thematic analysis of the qualitative data was conducted. The World Health Organization's health systems framework and socio-ecological model guided the data collection, analysis, and interpretation.

RESULTS

The CHWs program has been an extended arm of Ethiopia's primary health system and has contributed to improved health outcomes. However, the program has been facing unique systemic challenges that stem from the fragmentation of health finance; medical and equipment supply; working and living infrastructures; CHWs empowerment and motivation, monitoring, supervision, and information; coordination and governance; and community and stakeholder engagement. The ongoing COVID-19 and volatile political and security issues are exacerbating these fragmentation challenges.

CONCLUSION

This study emphasized the gap between the macro (national) level policy and the challenge during implementation at the micro (district)level. Fragmentation is a blind spot for the community-based health system in rural Ethiopia. We argue that the fragmentation challenges of the community health program are exacerbating the fragility of the health system and fragmentation of MNCH health outcomes. This is a threat to sustain the MNCH outcome gains, the realization of national health goals, and the resilience of the primary health system in rural Ethiopia. We recommend that beyond the current business-as-usual approach, it is important to emphasize an evidence-based and systemic fragmentation monitoring and responsive approach and to better understand the complexity of the community-based health system fragmentation challenges to sustain and achieve better health outcomes. The challenges can be addressed through the adoption of transformative and innovative approaches including capitalizing on multi-stakeholder engagement and health in all policies in the framework of co-production.

Application of Smart Mobile Medical Services in Maternal Health Care Management

In order to standardize the health management of pregnant women, improve the health level of pregnant women, and improve the outcome of pregnancy with the help of the smartphone mobile terminal app, the 100 pregnant women who gave birth in the hospital and participated in the management of the health assistant app were selected as the observation group, and the 100 hospitalized pregnant women who did not participate in the management of the app were selected as the control group. The two groups of pregnant women were compared in their knowledge of health care, compliance of prenatal examination, delivery mode, and follow-up rate. The results showed that the observation group was significantly higher than the control group in the knowledge of health care during pregnancy and perinatal period, the rate of natural childbirth, the compliance rate of prenatal examination, and the follow-up rate. After the system was launched, the number of registered pregnant women reached more than 60% of the total number of pregnant women in the hospital, the number of clicks reached more than 2 million times, the number of clinic settlement accounted for more than 30%, and the interpretation rate of fetal heart rate in outpatient and remote clinics reached more than 20%. The diagnosis and treatment process has been significantly improved, and the implementation effect has reached the expectation. O2O maternal and child service mode has been realized through mobile internet technology. It has been proved that the use of smart mobile terminals in the out-of-hospital health care management of pregnant women not only facilitates medical staff to provide timely personalized medical services for pregnant women but also is convenient for pregnant women to obtain health care knowledge through multiple channels, improve the quality of home health management for pregnant women, and effectively improve the pregnancy outcome.

An integrated model for evaluation of maternal health care in China

In recent years, in the context of China’s continuous medical and health reforms, the health status of Chinese women and children has been significantly improved through the continuous efforts of staff at all levels of maternal and child health care institutions. Many indicators in maternal health care have improved significantly, but the speed and magnitude of changes have varied. The purpose of this study is to evaluate the dynamic changes in China’s maternal health status from 2004 to 2018, in order to determine whether China’s medical and health reform measures in recent years have improved maternal health. A total of 6 evaluation indicators from the data of China Health Statistics Yearbook 2019 were selected. Then, based on the multi-criteria decision-making (MCDA) methodology, the entropy weighted technique for order preference by similarity to an ideal solution (TOPSIS), entropy weighted rank-sum ratio (RSR) method and the fuzzy comprehensive evaluation were employed in this study. In addition, sensitivity analysis was engaged to validate the stability and accuracy of the achieved results. The study results shows the ranking values of various methods were not exactly the same, but the overall trend was consistent. Overall, the maternal health care in China improved from 2004 to 2018 year by year, of which the top four were ranked from 2015 to 2018, and relatively poor from 2004 to 2006. This means that the policies and measures implemented in China’s medical and health reform in the past few decades have effectively promoted China’s maternal health care, and this will also provide a theoretical basis for future decisions to promote maternal health care.