Effectiveness of participatory community solutions strategy on improving household and provider health care behaviors and practices: A mixed-method evaluation

Tiruneh, Gizachew; Zemichael, Nebreed Fesseha; Betemariam, Wuleta; Karim, Ali Mehryar

doi:10.1371/journal.pone.0228137

Cited by 7 publications

(14 citation statements)

References 57 publications

(73 reference statements)

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“…The survey employed a two-stage stratified cluster sampling method. The details of the design are described somewhere else [ 23 ].…”

Section: Methodsmentioning

confidence: 99%

“…Verbal consents from respondents were sought and documented by interviewers before interviewing. Voluntary participation was ensured during interviews [ 23 ]. For this study, we obtained permission to use the data from the JSI, and ethics approval was obtained from the Research and Ethics Committee of the Department of Health Studies of the University of Gondar (reference number V/P/RCS/05/2505/2019; dated on 25 August 2019).…”

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confidence: 99%

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Determinants of postnatal care utilization in Ethiopia: a multilevel analysis

Tiruneh¹,

Worku

Berhane

et al. 2020

BMC Pregnancy Childbirth

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Background The expansion of primary health care services in Ethiopia made basic health services available and accessible. The Last Ten Kilometers (L10K) project has strengthened the primary health care system through implementing innovative strategies to engage local communities to improve maternal and newborn health care behavior and practices in Amhara, Oromia, Southern Nations, Nationalities and Peoples [SNNP], and Tigray regions over a decade. Despite the efforts of the government and its partners to improve the use of maternal health services, the coverage of postnatal care is persistently low in the country. This study examined the individual and community level determinants for the persistently low uptake of postnatal care in the project areas. Methods The study used a cross-sectional population-based survey that measured maternal and newborn health care practices among women who had live births in the last 12 months preceding the survey in Amhara, Oromia, SNNP, and Tigray regions. Multilevel random effects binary logistic regression analysis was used to assess the independent effects of community-and individual-level factors and moderating effects on the uptake of postnatal care. Results This study identified region of residence, obstetric factors, and health service-related factors to be significant determinants for use of postnatal care. Obstetric factors include knowledge of obstetric danger signs (AOR: 1.30; 95% CI: 1.05–1.60), cesarean section mode of delivery (AOR: 1.96; 95% CI: 1.28–3.00), and institutional delivery (AOR: 10.29; 95% CI: 7.57–13.98). While the health service-related factors include attended family conversation during pregnancy (AOR: 1.48; 95% CI: 1.04–2.12), birth notification (AOR: 2.66; 95% CI: 2.15–3.29), home visits by community health workers (AOR: 1.98; 95% CI: 1.58–2.50), and being recognized as a model family (AOR: 1.27; 95% CI: 1.03–1.57). Conclusion This study demonstrated that community-level interactions and promotive health services including antepartum home visits by community health workers, family conversation, birth notification, and model family, are important determinants to seek postnatal care. The findings also highlight the need for expansion of health facilities or design appropriate strategies to reach the disadvantaged communities. Program managers are recommended to strengthen community-based interventions to improve postnatal care utilization.

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“…The survey employed a two-stage stratified cluster sampling method. The details of the design are described somewhere else [ 23 ].…”

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Determinants of postnatal care utilization in Ethiopia: a multilevel analysis

Tiruneh¹,

Worku

Berhane

et al. 2020

BMC Pregnancy Childbirth

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“…This was undertaken to enumerate a representative sample of 2,724 women aged 15 to 49 years who had a live birth in the 12 months preceding the survey. The details of the design are described elsewhere [25].…”

Section: Data Sourcementioning

confidence: 99%

“…Verbal consent from respondents was sought and documented by interviewers before interviewing. Voluntary participation was ensured during interviews [25].…”

Section: Ethics Approval and Consent To Participatementioning

confidence: 99%

Predictors of maternal and newborn health service utilization across the continuum of care in Ethiopia: A multilevel analysis

Tiruneh¹,

Demissie

Worku

et al. 2022

PLoS ONE

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Background The continuum of care for maternal and newborn health is a systematic approach for delivery of an integrated effective package of life-saving interventions throughout pregnancy, childbirth, and postpartum as well as across levels of service delivery to women and newborns. Nonetheless, in low-income countries, coverage of these interventions across the life cycle continuum is low. This study examined the predictors of utilization of maternal and newborn health care services along the continuum of care in Ethiopia. Methods This was a cross-sectional population-based study. We measured maternal and newborn health care utilization practices among women who had live births in the last 12 months preceding the survey in Amhara, Oromia, SNNP, and Tigray regions of Ethiopia. We fitted multilevel random-effects logistic regression models to examine the predictors of the continuum of care accounting for the survey design, and individual, and contextual characteristics of the respondents. Results Our analysis revealed that only one-fifth of women utilized maternal and newborn health services across the antepartum, intrapartum, and postpartum continuum; most women discontinued at the postpartum stage. Continued use of services varied significantly across wealth, model family, prenatal stay at maternity waiting homes, antenatal care in the first trimester, complete antenatal care service, and the administrative region at all antepartum, intrapartum, and postpartum stages. Moreover, family conversation during pregnancy [AOR: 2.12; 95% CI: 1.56–2.88], delivery by cesarean [AOR: 2.70; 95% CI: 1.82–4.02] and birth notified to health extension workers [AOR: 1.95; 95% CI: 1.56–2.43] were found to be predictors of the continuum of care at the postpartum stage. Conclusion In Ethiopia, despite good access to antepartum care, compliance with continuity of care across the pathway decreased with significant inequitable distributions, the poorest segment of the population being at most disadvantage. The main modifiable program factors connected to the continued uptake of maternal health services include family conversation, pregnant women conference, complete antenatal care, antenatal care in the first trimester, and birth notification.

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“…Facility health staff and Community representatives played a vital role in the management and execution of DHFF activities, including planning, budgeting, and review of the overall facility performance. 63 These facilitated interactions between services providers and clients, and provided the primary health facility with opportunities to strengthen community engagement. 44 , 64 This approach raised working morale and a sense of ownership among health facility staff, community health governing committee members, and service beneficiaries.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Direct Health Facility Financing Program in Improving Maternal Health Services in Pangani District, Tanzania

Tukay¹,

Pasape²,

Tani³

et al. 2021

IJWH

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Background: Maternal morbidity and mortality remain significant public health concerns globally, with Tanzania reporting 398 deaths per 100,000 live births annually. While national level data provide some insights into the issue, a focus on sub-national levels is required because of differences in contexts such as rural-urban disparities in maternal mortality. This study examined Direct Health Facility Financing (DHFF) and its effects on the quality of maternal health services in Pangani, a rural district in Tanzania. Methods: This study was conducted in Pangani district of Tanga region in Tanzania. The study used both qualitative and quantitative methods, including 16 in-depth interviews with the council health management teams, facility in charges, maternity nurse in charge, and 5 focus group discussions with community health governing committee members. The number of deliveries that occurred in health facilities, as well as medical supplies, equipment, and reagents purchased by the facilities, were compared using descriptive statistics before and after the DHFF implementation. Results: Direct disbursement of funds from the central government through the Ministry of Finance and Planning to the primary health facilities reduced delays in procurement, improved community outreach services, and improved community leaders' engagements. Deliveries occurring at health facilities increased by 33.6% (p < 0.001) one year after the HDFF implementation. Various medicines, delivery kits, and some reagents increased significantly (p < 0.05). However, the lack of computers and poor internet connectivity, an insufficient supply of medical equipment and unstable stock of the Medical Stores Department increased the difficulty of obtaining the missed items from the selected prime vendor. Conclusion:Overall, this study shows a positive impact of the DHFF on maternal health service delivery in Pangani district. Specifically, an increase in the number of medical supplies, equipment, and reagents necessary to provide maternal health services contributed to the observed increase in facility deliveries by 33.6%. Moreover, the system minimizes unnecessary delays in the procurement processes of required drugs, supplies, and other facility reagents. To maximize the impact of the HDFF system, lack of computers, unstable internet, limited knowledge of the staff about the system, and inadequate health workforce should be addressed. Therefore, strengthening the DHFF system and staff training in-service and on the job is essential for smooth implementation.

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Effectiveness of participatory community solutions strategy on improving household and provider health care behaviors and practices: A mixed-method evaluation

Cited by 7 publications

References 57 publications

Determinants of postnatal care utilization in Ethiopia: a multilevel analysis

Determinants of postnatal care utilization in Ethiopia: a multilevel analysis

Predictors of maternal and newborn health service utilization across the continuum of care in Ethiopia: A multilevel analysis

Evaluation of the Direct Health Facility Financing Program in Improving Maternal Health Services in Pangani District, Tanzania

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