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

Abstract

Most of the maternal and newborn deaths occur at birth or within 24 hours of birth. Therefore, essential lifesaving interventions need to be delivered at basic or comprehensive emergency obstetric care facilities. Facilities provide complex interventions including advice on referrals, post discharge care, long-term management of chronic conditions along with staff training, managerial and administrative support to other facilities. This paper reviews the effectiveness of facility level inputs for improving maternal and newborn health outcomes. We considered all available systematic reviews published before May 2013 on the pre-defined facility level interventions and included 32 systematic reviews.Findings suggest that additional social support during pregnancy and labour significantly decreased the risk of antenatal hospital admission, intrapartum analgesia, dissatisfaction, labour duration, cesarean delivery and instrumental vaginal birth. However, it did not have any impact on pregnancy outcomes. Continued midwifery care from early pregnancy to postpartum period was associated with reduced medical procedures during labour and shorter length of stay. Facility based stress training and management interventions to maintain well performing and motivated workforce, significantly reduced job stress and improved job satisfaction while the interventions tailored to address identified barriers to change improved the desired practice. We found limited and inconclusive evidence for the impacts of physical environment, exit interviews and organizational culture modifications.At the facility level, specialized midwifery teams and social support during pregnancy and labour have demonstrated conclusive benefits in improving maternal newborn health outcomes. However, the generalizability of these findings is limited to high income countries. Future programs in resource limited settings should utilize these findings to implement relevant interventions tailored to their needs.

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

“…Consequently, we decided to implement a package of intervention elements based on existing evidence of their effectiveness [16,17,19,20,27], feasibility of implementation and acceptability by the local stakeholders. Although evidence around the effectiveness of community-based savings groups and locally organized transport systems is more limited than evidence about strategies such as the use of CHWs, the literature shows that such arrangements have been included in intervention packages that have contributed to improved access to maternal healthcare services [6,45,46].…”

“…Strategies such as home visits by community health workers (CHWs), to increase awareness about the importance of maternal and newborn danger signs and the importance of seeking care at health facilities [16,19–21], have been used to address the first delay. 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.…”

“…Community-based strategies that involve the training of CHWs and traditional birth attendants have resulted in increased awareness of maternal and newborn health and newborn danger signs, increased utilization of antenatal care (ANC) and facility delivery [1,17,20,27,28], and increased newborn care practices such as clean cord care, immediate breastfeeding, thermal care and delayed bathing [19,21]. Community mobilization and the use of community support groups have also resulted in increased awareness and knowledge about maternal and newborn health and increased facility deliveries [6].…”

Measuring the impact of a quality improvement collaboration to decrease maternal mortality in a Ghanaian regional hospital

“…The worsening staffing ratios for many provider groups in this report are concerning. An increasing workload can be detrimental to morale, workplace health, attentiveness, and outcome [18]. One model described that a midwife could conduct an average of 175 births per year and that six midwives would be required for approximately 1000 births [19].…”

Moving beyond silos: How do we provide distributed personalized medicine to pregnant women everywhere at scale? Insights from PRE‐EMPT

“…As with communities, so must those who wish to innovate across the maternal − fetal − newborn continuum engage with, and take into account, existing health system strategies and interventions [42–45]. In our view, to be attractive to those who fund health delivery, whether governments, multilaterals, nongovernmental organizations, or the private sector, strategies for mHealth‐supported individualized care must be integrated into existing and evolving health systems, and be comprehensive enough to be attractive to implementers.…”