Can positive inquiry strengthen obstetric referral systems in Cambodia?

Abstract

SummaryMaternal death remains high in low resource settings. Current literature on obstetric referral that sets out to tackle maternal death tends to focus on problematization. We took an alternative approach and rather asked what works in contemporary obstetric referral in a low income setting to find out if positive inquiry could generate original insights on referral that could be transformative. We documented and analysed instances of successful referral in a rural province of Cambodia that took place within the last year. Thirty women, their families, healthcare staff and community volunteers were purposively sampled for in‐depth interviews, conducted using an appreciative inquiry lens. We found that referral at its best is an active partnership between families, community and clinicians that co‐constructs care for labouring women during referral and delivery. Given the short time frame of the project we cannot conclude if this new understanding was transformative. However, we can show that acknowledging positive resources within contemporary referral systems enables health system stakeholders to widen their understanding of the kinds of resources that are available to them to direct and implement constructive change for maternal health. Copyright © 2016 John Wiley & Sons, Ltd.

Challenges and opportunities in addressing social determinants of child health in Cambodia: perspectives and experience of frontline providers in two health districts

“…Coordination of service providers and referral system is established to facilitate identification of needs and access to different services, such as psychosocial and mental health support, economic needs, shelter, legal support, and/or health services to treat injuries. Cambodia has established several referral systems in the health sector which are working (Bell et al 2015 ; Le et al 2018 ; Nakahara et al 2010 ). The experience can inform referral pathways/mechanisms for specific social problems which are agreed on and endorsed by relevant subnational authorities and social service providers.…”

“…The training has to be appropriate to capacity, the health system context and culture. Community workers, volunteers and local authorities are also among the first contact people in the community and can serve to facilitate access to and referral for services, and including them as important stakeholders in SDH intervention is necessary (Le et al 2018 ). Despite the fact that population health is so intertwined with socio-economic, political and cultural conditions, studies on SDH in low- and middle-income countries have been limited and often neglected.…”

Does appreciative inquiry decrease false positive diagnosis during leprosy case detection campaigns in Bihar, India? An operational research study

“…It is a process which shifts the focus of programme or organization from problem identification, defensiveness and denial of facts towards discovery of programme strengths and building on what works well in the given setting and context [9]. This approach has been found effective in improving obstetric referral system in Cambodia [10], improvement of community-based mental health services [11], improvement in nursing care in hospital setting in the United Kingdom [12], and development of better health care work environment in NHS [13]. AI offers a framework which positively influences organizational growth by generating common goals and actions to be achieved by the programme staff [11].…”