Access to essential technologies for safe childbirth: a survey of health workers in Africa and Asia

Spector, J. Michael; Reisman, Jonathan; Lipsitz, Stuart R.; Desai, Priya; Gawande, Atul A.

doi:10.1186/1471-2393-13-43

Cited by 12 publications

(11 citation statements)

References 21 publications

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“…Structural and process components of quality of care help define the readiness of a facility to manage obstetric complications. Readiness to provide delivery and newborn care has been the focus of a limited set of studies [7, 8] and is also a measure of the obstacles to universal coverage and health system gaps [7, 9, 10].…”

Section: Introductionmentioning

confidence: 99%

Referral patterns through the lens of health facility readiness to manage obstetric complications: national facility-based results from Ghana

Bailey¹,

Awoonor-Williams

Lebrun

et al. 2019

Reprod Health

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Introduction Countries with high maternal and newborn mortality can benefit from national facility level data that describe intra-facility emergency referral patterns for major obstetric complications. This paper assesses the relationship between referral and facilities’ readiness to treat complications at each level of the health system in Ghana. We also investigate other facility characteristics associated with referral. Methods The National Emergency Obstetric and Newborn Care Assessment 2010 provided aggregated information from 977 health facilities. Readiness was defined in a 2-step process: availability of a health worker who could provide life-saving interventions and a minimum package of drugs, supplies, and equipment to perform the interventions. The second step mapped interventions to major obstetric complications. We used descriptive statistics and simple linear regression. Results Lower level facilities were likely to refer nearly all women with complications. District hospitals resolved almost two-thirds of all complicated cases, referring 9%. The most prevalent indications for referral were prolonged/obstructed labor and antepartum hemorrhage. Readiness to treat a complication was correlated with a reduction in referral for all complications except uterine rupture. Facility readiness was low: roughly 40% of hospitals and 10% of lower level facilities met the readiness threshold. Facilities referred fewer women when they had higher caseloads, more midwives, better infrastructure, and systems of communication and transport. Discussion Understanding how deliveries and obstetric complications are distributed across the health system helps policy makers contextualize decisions about the pathways to providing maternity services. Improving conditions for referral (by increasing access to communication and transport systems) and the management of obstetric complications (increasing readiness) will enhance quality of care and make referral more effective and efficient.

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Section: Introductionmentioning

confidence: 99%

Referral patterns through the lens of health facility readiness to manage obstetric complications: national facility-based results from Ghana

Bailey¹,

Awoonor-Williams

Lebrun

et al. 2019

Reprod Health

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“…Firstly, delays in receiving timely and appropriate care on reaching a health facility (Phase 3 delays) can be directly caused by having too few skilled staff available to carry out adequate care [ 18 ]. This intersects with resource and equipment shortages that delay onset of appropriate treatment and leave skilled staff unable to carry out their professional role or to operate to the required standard [ 19 ]. Staff shortages may also cause delays in initiating emergency interventions [ 11 ]; delays in authorising referral or referring upwards to busy senior staff; or lack of performance of the EmOC signal functions a [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Too few staff, too many patients: a qualitative study of the impact on obstetric care providers and on quality of care in Malawi

Bradley

Kamwendo

Chipeta

et al. 2015

BMC Pregnancy Childbirth

132

117

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BackgroundShortages of staff have a significant and negative impact on maternal outcomes in low-income countries, but the impact on obstetric care providers in these contexts is less well documented. Despite the government of Malawi’s efforts to increase the number of human resources for health, maternal mortality rates remain persistently high. Health workers’ perceptions of insufficient staff or time to carry out their work can predict key variables concerning motivation and attrition, while the resulting sub-standard care and poor attitudes towards women dissuade women from facility-based delivery. Understanding the situation from the health worker perspective can inform policy options that may contribute to a better working environment for staff and improved quality of care for Malawi’s women.MethodsA qualitative research design, using critical incident interviews, was used to generate a deep and textured understanding of participants’ experiences. Eligible participants had performed at least one of the emergency obstetric care signal functions a in the previous three months and had experienced a demotivating critical incident within the same timeframe. Data were analysed using NVivo software.ResultsEighty-four interviews were conducted. Concerns about staff shortages and workload were key factors for over 40% of staff who stated their intention to leave their current post and for nearly two-thirds of the remaining health workers who were interviewed. The main themes emerging were: too few staff, too many patients; lack of clinical officers/doctors; inadequate obstetric skills; undermining performance and professionalism; and physical and psychological consequences for staff. Underlying factors were inflexible scheduling and staff allocations that made it impossible to deliver quality care.ConclusionThis study revealed the difficult circumstances under which maternity staff are operating and the professional and emotional toll this exacts. Systems failures and inadequate human resource management are key contributors to the gaps in provision of obstetric care and need to be addressed. Thoughtful strategies that match supply to demand, coupled with targeted efforts to support health workers, are necessary to mitigate the effects of working in this context and to improve the quality of obstetric care for women in Malawi.

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“…WHO has provided evidence–based recommendations for the essential interventions and medicines needed to improve maternal health and prevent these maternal complications [ 9 – 12 ]. Even though the availability of essential medicines for maternal health is not well documented in many countries [ 13 ], recent data suggested that it is low in Africa and Asia [ 14 ].…”

mentioning

confidence: 99%

Barriers and facilitators to the quality use of essential medicines for maternal health in low–resource countries: An Ishikawa framework

Tran

Bero

2015

Journal of Global Health

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BackgroundAn estimated 800 women die every day due to complications related to pregnancy or childbirth. Complications such as postpartum haemorrhage (PPH) and pre–eclampsia and eclampsia can be prevented by the appropriate use of essential medicines. The objective of this study was to identify the common barriers and facilitators to the availability and use of oxytocin, ergometrine, and magnesium sulfate (MgSO4) – essential medicines indicated for the prevention and treatment of PPH and pre–eclampsia and eclampsia.MethodsWe analyzed seven UNFPA/WHO reports published in 2008–2010. These reports summarized country–wide rapid assessments of access to and use of essential medicines for maternal health in Mongolia, Nepal, Laos, the Democratic People’s Republic of Korea (DPRK), the Philippines, Vanuatu, and the Solomon Islands. We used a “fishbone” (Ishikawa) diagram as the analytic framework to identify facilitators and barriers at four health–system levels: government/regulatory, pharmaceutical supply, health facility, and health professional.ResultsCommon facilitators to the quality use of essential medicines for maternal health were observed at the government/regulatory and health professional level. A majority of countries had these medicines listed in their essential medicines lists. Awareness of the medicines was generally high among health professionals. Common barriers were identified at all health–system levels. First, standard treatment guidelines were not available, updated, or standardized. Second, there was an inadequate capacity to forecast and procure medicines. Third, a required MgSO4 antidote was often not available and the storage conditions for oxytocin were deficient.ConclusionsThe “fishbone” Ishikawa diagram is a useful tool for describing the findings of rapid assessments of quality use of essential medicines for maternal health across countries. The facilitators and barriers identified should guide the development of tailored intervention programs to improve and expand the use of these life–saving medicines.

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Access to essential technologies for safe childbirth: a survey of health workers in Africa and Asia

Cited by 12 publications

References 21 publications

Referral patterns through the lens of health facility readiness to manage obstetric complications: national facility-based results from Ghana

Referral patterns through the lens of health facility readiness to manage obstetric complications: national facility-based results from Ghana

Too few staff, too many patients: a qualitative study of the impact on obstetric care providers and on quality of care in Malawi

Barriers and facilitators to the quality use of essential medicines for maternal health in low–resource countries: An Ishikawa framework

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