Evidence from district level inputs to improve quality of care for maternal and newborn health: interventions and findings

Abstract

District level healthcare serves as a nexus between community and district level facilities. Inputs at the district level can be broadly divided into governance and accountability mechanisms; leadership and supervision; financial platforms; and information systems. This paper aims to evaluate the effectivness of district level inputs for imporving maternal and newborn health. We considered all available systematic reviews published before May 2013 on the pre-defined district level interventions and included 47 systematic reviews.Evidence suggests that supervision positively influenced provider’s practice, knowledge and client/provider satisfaction. Involving local opinion leaders to promote evidence-based practice improved compliance to the desired practice. Audit and feedback mechanisms and tele-medicine were found to be associated with improved immunization rates and mammogram uptake. User-directed financial schemes including maternal vouchers, user fee exemption and community based health insurance showed significant impact on maternal health service utilization with voucher schemes showing the most significant positive impact across all range of outcomes including antenatal care, skilled birth attendant, institutional delivery, complicated delivery and postnatal care. We found insufficient evidence to support or refute the use of electronic health record systems and telemedicine technology to improve maternal and newborn health specific outcomes.There is dearth of evidence on the effectiveness of district level inputs to improve maternal newborn health outcomes. Future studies should evaluate the impact of supervision and monitoring; electronic health record and tele-communication interventions in low-middle-income countries.

Effect of a participatory multisectoral maternal and newborn intervention on maternal health service utilization and newborn care practices: a quasi-experimental study in three rural Ugandan districts

“…The second delay has been mitigated by two main strategies, which aim to bring the services closer to those in need by providing home-based care, such as the use of CHWs and community midwives [14,20,21], and to improve access to transportation to allow the pregnant women to reach facilities more quickly. The latter includes strategies that provide easier access to cash, through the use of vouchers and conditional cash transfers, and community-based initiatives that improve the transportation itself [22–25]. Quality improvement initiatives such as maternal and newborn audits, monitoring labour, referral protocols and transport, are some of the strategies that have been used to reduce inter-institutional delays in providing care [6,16,22,26].…”

“…The latter includes strategies that provide easier access to cash, through the use of vouchers and conditional cash transfers, and community-based initiatives that improve the transportation itself [22–25]. Quality improvement initiatives such as maternal and newborn audits, monitoring labour, referral protocols and transport, are some of the strategies that have been used to reduce inter-institutional delays in providing care [6,16,22,26]. …”

ACC/AHA Special Report: Clinical Practice Guideline Implementation Strategies: A Summary of Systematic Reviews by the NHLBI Implementation Science Work Group

“…Provide patient pamphlets 47 Easy to understand and use 48 Minimal resources needed to implement 48 Involving end-users in guidelines development, implementation, and testing 15,48,50,52 Use of computerized guidelines in practice settings 15,16 Involving Stakeholders Involvement in planning, developing, or leading interventions designed to influence practice patterns and clinical outcomes 19,30,34,40,56 Leadership Leader's social influence is recognized 30 Formal leadership 40 Local management support and enthusiasm 24,51 Adequate time to promote new practice 24 …”

“…Skepticism-concern about evidence base of guidelines, lack of universal acceptance of recommendations, implied rationing of services, fear of litigation 24,47,[49][50][51] Lack of knowledge of guidelines 24,32,49,50 Age-older or more experienced clinicians less inclined to use 48 …”

Quality of hospital services in 5S-KAIZEN-TQM implemented secondary level hospital: a cross-sectional study

“…More than three-fourth (76.0%) of the respondents replied that they were satisfied on receiving the nursing services and rest of them (24.0%) were not satisfied. Asian countries like Bangladesh often fight with inadequate human resource, shortage of supplies along with the inadequate access to necessary medicines and technologies which resulted a compromise with the quality of care (Salam et al, 2014;Islam et al, 2015;Chowdhury et al, 2009). However, many of the Asian countries addressed the quality issues by adopting the 5S-KAIZEN-TQM approaches successfully (Islam et al, 2015;Bhuiyan and Baghel, 2005).…”