Availability and quality of emergency obstetric and neonatal care services in Afghanistan

Kim, Young Mi; Zainullah, Partamin; Mungia, Jaime; Tappis, Hannah; Bartlett, Linda; Zaka, Nabila

doi:10.1016/j.ijgo.2011.10.017

Cited by 35 publications

(66 citation statements)

References 18 publications

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“…BPHS contracting is increasing in post-conflict settings, with some notable success in improving SRH access and outcomes [14, 48]. This study contributes perspectives on SRH service implementation through BPHS contracting across health-system components and levels in Afghanistan.…”

Section: Discussionmentioning

confidence: 98%

Perspectives on reproductive healthcare delivered through a basic package of health services in Afghanistan: a qualitative study

Howard

Woodward

Patel

et al. 2014

BMC Health Serv Res

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BackgroundContracting-out non-state providers to deliver a minimum package of essential health services is an increasingly common health service delivery mechanism in conflict-affected settings, where government capacity and resources are particularly constrained. Afghanistan, the longest-running example of Basic Package of Health Services (BPHS) contracting in a conflict-affected setting, enables study of how implementation of a national intervention influences access to prioritised health services. This study explores stakeholder perspectives of sexual and reproductive health (SRH) services delivered through the BPHS in Afghanistan, using Bamyan Province as a case study.MethodsTwenty-six in-depth interviews were conducted with health-system practitioners (e.g. policy/regulatory, middle management, frontline providers) and four focus groups with service-users. Inductive thematic coding used the WHO Health System Framework categories (i.e. service delivery, workforce, medicines, information, financing, stewardship), while allowing for emergent themes.ResultsImprovements were noted by respondents in all health-system components discussed, with significant improvements identified in service coverage and workforce, particularly improved gender balance, numbers, training, and standardisation. Despite improvements, remaining weaknesses included service access and usage - especially in remote areas, staff retention, workload, and community accountability.ConclusionsBy including perspectives on SRH service provision and BPHS contracting across health-system components and levels, this study contributes to broader debates on the effects of contracting on perceptions and experiences among practitioners and service-users in conflict-affected countries.

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Section: Discussionmentioning

confidence: 98%

Perspectives on reproductive healthcare delivered through a basic package of health services in Afghanistan: a qualitative study

Howard

Woodward

Patel

et al. 2014

BMC Health Serv Res

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“…The least common EmOC signal function varies from assisted vaginal delivery in Bangladesh 53 to administration of parenteral sedative in Pakistan. 54 However, only 68% of surveyed first-line referral facilities in Afghanistan could perform all basic EmOC signal functions, 55 whereas in India, 36% for private health facilities and 6% of government facilities were EmOC centers, 56 and 13% of public health facilities in Pakistan were basic EmOC facilities. 54 In the People's…”

Section: Discussionmentioning

confidence: 99%

Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh

Wichaidit

Alam

Halder

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Bangladesh's maternal mortality and neonatal mortality remain unacceptably high. We assessed the availability and quality of emergency obstetric care (EmOC) and emergency newborn care (EmNC) services at health facilities in Bangladesh. We randomly sampled 50 rural villages and 50 urban neighborhoods throughout Bangladesh and interviewed the director of eight and nine health facilities nearest to each sampled area. We categorized health facilities into different quality levels (high, moderate, low, and substandard) based on staffing, availability of a phone or ambulance, and signal functions (six categories for EmOC and four categories for EmNC). We interviewed the directors of 875 health facilities. Approximately 28% of health facilities did not have a skilled birth attendant on call 24 hours per day. The least commonly performed EmOC signal function was administration of anticonvulsants (67%). The quality of EmOC services was high in 33% and moderate in 52% of the health facilities. The least common EmNC signal function was kangaroo mother care (7%). The quality of EmNC was high in 2% and moderate in 33% of the health facilities. Approximately one-third of health facilities lack 24-hour availability of skilled birth attendants, increasing the risk of peripartum complications. Most health facilities offered moderate to high quality services for EmOC and low to substandard quality for EmNC.

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“…Evaluations of obstetric services and perinatal outcomes indicate numerous deficits in the quality of hospital care 24–26. Humiliating experiences endured by rural women in a provincial hospital appeared to discourage the uptake of services 27.…”

Section: Introductionmentioning

confidence: 99%

Understanding Afghan healthcare providers: a qualitative study of the culture of care in a Kabul maternity hospital

Arnold

Teijlingen

Ryan

et al. 2014

BJOG

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ObjectiveTo analyse the culture of a Kabul maternity hospital to understand the perspectives of healthcare providers on their roles, experiences, values and motivations and the impact of these determinants on the care of perinatal women and their babies.DesignQualitative ethnographic study.SettingA maternity hospital, Afghanistan.PopulationDoctors, midwives and care assistants.MethodsSix weeks of observation followed by 22 semi-structured interviews and four informal group discussions with staff, two focus group discussions with women and 41 background interviews with Afghan and non-Afghan medical and cultural experts.Main outcome measuresThe culture of care in an Afghan maternity hospital.ResultsA large workload, high proportion of complicated cases and poor staff organisation affected the quality of care. Cultural values, social and family pressures influenced the motivation and priorities of healthcare providers. Nepotism and cronyism created inequality in clinical training and support and undermined the authority of management to improve standards of care. Staff without powerful connections were vulnerable in a punitive inequitable environment—fearing humiliation, blame and the loss of employment.ConclusionsSuboptimal care put the lives of women and babies at risk and was, in part, the result of conflicting priorities. The underlying motivation of staff appeared to be the socio-economic survival of their own families. The hospital culture closely mirrored the culture and core values of Afghan society. In setting priorities for women's health post-2015 Millennium Development Goals, understanding the context-specific pressures on staff is key to more effective programme interventions and sustainability.

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Availability and quality of emergency obstetric and neonatal care services in Afghanistan

Cited by 35 publications

References 18 publications

Perspectives on reproductive healthcare delivered through a basic package of health services in Afghanistan: a qualitative study

Perspectives on reproductive healthcare delivered through a basic package of health services in Afghanistan: a qualitative study

Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh

Understanding Afghan healthcare providers: a qualitative study of the culture of care in a Kabul maternity hospital

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