Limited Service Availability, Readiness, and Use of Facility-Based Delivery Care in Haiti: A Study Linking Health Facility Data and Population Data

Winner, Michelle; Burgert, Clara R.

doi:10.9745/ghsp-d-16-00311

Cited by 45 publications

(69 citation statements)

References 29 publications

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“…Information from Malaria Indicator Surveys and of the Health Management Information System can be included as additional components of this index to look into other aspects of case management, such as delays of seeking care, the severity of cases consulting or the quality of care provided. Our results corroborate with previous investigations done in Ghana, Mozambique, Tanzania, Nigeria, Bangladesh and Haiti that also used SARA or similar survey data and revealed a positive effect of readiness on health outcome[15][16][17][18]24,25].The lack of a statistically important association between facility readiness and malaria mortality in medical centres might be explained by the severity of malaria cases seeking treatment in medical centres. Indeed, peripheral health centres refer complicated cases to medical centres.…”

supporting

confidence: 91%

“…The index was utilized to assess the association between facility readiness with child survival, low birth weight, maternal and neonatal death in Ghana [15]. PCA has been applied to relate general service readiness and health financing factors in 10 countries in Africa and Asia [16], health facility readiness to pregnancy delivery services and service utilization in Haiti [17] or to assess facility readiness to maternal health services over time in Nigeria [18]. Of note, Ssempiira et al (2019) criticized the use of PCA on binary items and derived a readiness index based on multiple correspondence analysis (MCA) [19].…”

Section: Introductionmentioning

confidence: 99%

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Constructing a malaria-related health service readiness index and assessing its association with malaria mortality in under 5-year-old children in Burkina Faso

Millogo¹,

Doamba²,

Sié³

et al. 2020

Preprint

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Background: The Service Availability and Readiness Assessment (SARA) surveys generate data on the readiness of health facility services. We constructed a readiness index related to malaria services and determined the association between health facility malaria readiness and malaria mortality in children under the age of 5 years in Burkina Faso.Methods: Data on inpatients visits and malaria-related deaths in under 5-year-old children were extracted from the national Health Management Information System (HMIS) in Burkina Faso. Bayesian geostatistical models with variable selection were fitted to malaria mortality data. The most important facility readiness indicators related to general and malaria-specific services were determined. Multiple correspondence analysis (MCA) was used to construct a composite facility readiness score based on multiple factorial axes. The analysis was carried out separately for 112 medical centres and 546 peripheral health centres.Results: Malaria mortality rate in medical centres was 4.8 times higher than that of peripheral health centres (3.46% vs. 0.72%, p<0.0001). Essential medicines was the domain with the lowest readiness (only 0.1% of medical centres and 0% of peripheral health centres had the whole set of tracer items of essential medicines). Basic equipment readiness was the highest. The composite readiness score explained 30% and 53% of the original set of items for medical centres and peripheral health centres, respectively. Mortality rate ratio (MRR) was by 59% (MRR = 0.41, 95% Bayesian credible interval (BCI): 0.19-0.91) lower in the high readiness group of peripheral health centres, compared to the low readiness group. Medical centres readiness was not related to malaria mortality. The geographical distribution of malaria mortality rate indicate that regions with health facilities with high readiness show lower mortality rates.Conclusion: Performant health services in Burkina Faso are associated with lower malaria mortality rates. Health system readiness should be strengthened in the regions of Sahel, Sud-Ouest and Boucle du Mouhoun. Emphasis should be given to improving the management of essential medicines and to reducing delays of emergency transportation between the different levels of the health system.

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supporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Constructing a malaria-related health service readiness index and assessing its association with malaria mortality in under 5-year-old children in Burkina Faso

Millogo¹,

Doamba²,

Sié³

et al. 2020

Preprint

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“…Previous studies have used a more nuanced service quality score based on a variety of measures of facility, provider, and service availability 7,8,38 but relied on measurement at a single point in time. Exploring methods to combine the richness of facility survey data with the timeliness of supply logistics data may eliminate the tradeoff between breadth and depth, providing a fruitful avenue for further study.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Access to Contraceptive Services on Injectable Use and Demand for Family Planning in Malawi

Skiles¹,

Cunningham²,

Inglis³

et al. 2015

International Perspectives on Sexual and Reproductive Health

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Context Previous studies have identified positive relationships between geographic proximity to family planning services and contraceptive use but have not accounted for the effect of contraceptive supply reliability or the diminishing influence of facility access as distance increases. Methods We used kernel density estimation to geographically link a woman’s use of injectable contraceptives and demand for birth spacing/limiting in Malawi with routine contraceptive logistics data from family planning service delivery points. Using linear probability models, we estimated the associations between access to services, measured by distance alone and distance adjusted by supply reliability, and injectable use and demand for birth spacing or limiting in rural and urban environments. Results Access to services is an important predictor of injectable use. Women in rural communities with the most access by both measures were over 7 percentage points more likely to report injectable use than women with the least access. In urban environments, women with more reliable contraceptive supplies reported up to 18.3 percentage points higher demand for birth spacing or limiting than women with the least distance-and-supply access. Conclusions Our findings highlight the importance of product availability in the local service environment, and its relationship with demand for and use of family planning. Constructing facility service environments using kernel density estimation provides a refined means of linking women with services that takes into account distance decay and supply reliability. Distinct urban and rural results highlight the importance of considering both urban and rural service environments when working to improve modern contraceptive use.

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“…Lower level facilities in Haiti have been found to be poorly equipped to provide obstetric care even if they do provide labor and delivery services. [25] We also found that the risk of dying was highest among babies admitted at birth fromindicating that the sickest babies were also those who were transferred right at birth from HIC as opposed to babies born elsewhere who likely died before being brought in, contributing to potential selection bias in our sample. We did not record length of stay in hours and it is possible that babies admitted from HIC were merely alive for a few hours before succumbing to their illnesses.…”

Section: Discussionmentioning

confidence: 71%

Care for Neonates in Haiti’s Health System – Outcomes and Lessons

Dev

Casseus

Baptiste

et al. 2020

Preprint

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BackgroundThe rate of facility births in Haiti has doubled in the past two decades but this has not resulted in comparable reductions in maternal or neonatal mortality. To care for newborns requiring hospitalization in Haiti, we worked with the public health leadership in the Haitian department of the South (Sud) to establish a ward for compromised neonates in a large public hospital with over 3000 annual deliveries but no neonatal care capacity. MethodsSignificant investments were made in establishing basic neonatal services, train nurses, install and manage a supply chain, and strengthen infrastructure. We present outcomes for 1399 neonates admitted to the ward during the first two years of operation. ResultsTwo-thirds of admissions were made from the hospital’s maternity ward at birth while the remaining babies were born at home or referring facilities. Inborn neonates had better rates of hospital survival than those born elsewhere. They were also more likely to be born via cesarean section and to be admitted right at birth. Babies born elsewhere were more likely to die during their hospital stay. There were no differences between the proportion of premature or low Conclusionsbirth weight babies born at the hospital or elsewhere. Nursing care proved to be a critical part of the care delivery system. We conclude that integrated, high frequency nursing training is necessary for both maternity and neonatal nurses to support maternal and newborn care. Resources are needed to address prematurity as an important outcome, especially as it is indicative of poor prenatal care, regardless of place of birth.

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Limited Service Availability, Readiness, and Use of Facility-Based Delivery Care in Haiti: A Study Linking Health Facility Data and Population Data

Cited by 45 publications

References 29 publications

Constructing a malaria-related health service readiness index and assessing its association with malaria mortality in under 5-year-old children in Burkina Faso

Constructing a malaria-related health service readiness index and assessing its association with malaria mortality in under 5-year-old children in Burkina Faso

The Effect of Access to Contraceptive Services on Injectable Use and Demand for Family Planning in Malawi

Care for Neonates in Haiti’s Health System – Outcomes and Lessons

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