Strengthening emergency obstetric care in Nepal: The Women's Right to Life and Health Project (WRLHP)

Rana, Tika; Chataut, B D; Shakya, Gautam Man; Nanda, Geeta; Pratt, Adrian; Sakai, Sachiko

doi:10.1016/j.ijgo.2007.05.017

Cited by 32 publications

(31 citation statements)

References 4 publications

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“…Youngleson et al [35] attribute much of their success to the ability of administration to implement changes in policies and resource allocation within a short time frame. The AMDD project in Nepal [59] noted that the national policy allowing delegation of key obstetric first aid procedures to nurses was essential to the program impact. Two other studies [34,63] emphasise the critical role that formal support from state and district health officers played in ensuring long term commitment and support for the quality improvement initiatives.…”

Section: Resultsmentioning

confidence: 99%

Do Strategies to Improve Quality of Maternal and Child Health Care in Lower and Middle Income Countries Lead to Improved Outcomes? A Review of the Evidence

2013

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ObjectivesEfforts to scale-up maternal and child health services in lower and middle income countries will fail if services delivered are not of good quality. Although there is evidence of strategies to increase the quality of health services, less is known about the way these strategies affect health system goals and outcomes. We conducted a systematic review of the literature to examine this relationship.MethodsWe undertook a search of MEDLINE, SCOPUS and CINAHL databases, limiting the results to studies including strategies specifically aimed at improving quality that also reported a measure of quality and at least one indicator related to health system outcomes. Variation in study methodologies prevented further quantitative analysis; instead we present a narrative review of the evidence.FindingsMethodologically, the quality of evidence was poor, and dominated by studies of individual facilities. Studies relied heavily on service utilisation as a measure of strategy success, which did not always correspond to improved quality. The majority of studies targeted the competency of staff and adequacy of facilities. No strategies addressed distribution systems, public-private partnership or equity. Key themes identified were the conflict between perceptions of patients and clinical measures of quality and the need for holistic approaches to health system interventions.ConclusionExisting evidence linking quality improvement strategies to improved MNCH outcomes is extremely limited. Future research would benefit from the inclusion of more appropriate indicators and additional focus on non-facility determinants of health service quality such as health policy, supply distribution, community acceptability and equity of care.

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Section: Resultsmentioning

confidence: 99%

Do Strategies to Improve Quality of Maternal and Child Health Care in Lower and Middle Income Countries Lead to Improved Outcomes? A Review of the Evidence

2013

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“…Others have found that increasing emergency obstetric services leads to increased institutional birth and that women consider service availability when deciding where to deliver [18–20]. Importantly, a recent quasi-experimental study comparing demand- and supply-side interventions demonstrated that when financial incentive programs were followed by increased access to BEmOC, communities saw the greatest gains in institutional birth, particularly for the most impoverished groups [21].…”

Section: Introductionmentioning

confidence: 99%

Impact of the roll out of comprehensive emergency obstetric care on institutional birth rate in rural Nepal

Maru

Bangura

Mehta

et al. 2017

BMC Pregnancy Childbirth

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BackgroundIncreasing institutional births rates and improving access to comprehensive emergency obstetric care are central strategies for reducing maternal and neonatal deaths globally. While some studies show women consider service availability when determining where to deliver, the dynamics of how and why institutional birth rates change as comprehensive emergency obstetric care availability increases are unclear.MethodsIn this pre-post intervention study, we surveyed two exhaustive samples of postpartum women before and after comprehensive emergency obstetric care implementation at a hospital in rural Nepal. We developed a logistic regression model of institutional birth factors through manual backward selection of all significant covariates within and across periods. Qualitatively, we analyzed birth stories through immersion crystallization.ResultsInstitutional birth rates increased after comprehensive emergency obstetric care implementation (from 30 to 77%, OR 7.7) at both hospital (OR 2.5) and low-level facilities (OR 4.6, p < 0.01 for all). The logistic regression indicated that comprehensive emergency obstetric care availability (OR 5.6), belief that the hospital is the safest birth location (OR 44.8), safety prioritization in decision-making (OR 7.7), and higher income (OR 1.1) predict institutional birth (p ≤ 0.01 for all). Qualitative analysis revealed comprehensive emergency obstetric care awareness, increased social expectation for institutional birth, and birth planning as important factors.ConclusionComprehensive emergency obstetric care expansion appears to have generated significant demand for institutional births through increased safety perceptions and birth planning. Increasing comprehensive emergency obstetric care availability increases birth safety, but it may also be a mechanism for increasing the institutional birth rate in areas of under-utilization.

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“…6 This highly complex, system-level issue must be addressed across the system rather than in isolation from it. [7][8][9][10][11][12] By coordinating actions across different parts of the health system, programmes to improve maternal and neonatal health can increase coverage and reduce barriers to the use of various services. Effective programmes assemble packages of appropriate reforms in each of the six main building blocks of the health system: 1,3 governance of the health sector (to provide sectoral policy and regulatory mechanisms, and partnerships with the private sector); infrastructure and technologies (to provide emergency referral centres linked to primary care providers); human resources (to scale up the availability of skilled attendance); financing (to reduce financial barriers for patients and incentivize providers), and services (to ensure quality and an appropriate configuration of maternal and neonatal health services across all levels of care, including family planning).…”

Section: Introductionmentioning

confidence: 99%

A systems approach to improving maternal health in the Philippines

Huntington

Banzon

Recidoro

2011

Bull. World Health Organ.

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Strengthening emergency obstetric care in Nepal: The Women's Right to Life and Health Project (WRLHP)

Cited by 32 publications

References 4 publications

Do Strategies to Improve Quality of Maternal and Child Health Care in Lower and Middle Income Countries Lead to Improved Outcomes? A Review of the Evidence

Do Strategies to Improve Quality of Maternal and Child Health Care in Lower and Middle Income Countries Lead to Improved Outcomes? A Review of the Evidence

Impact of the roll out of comprehensive emergency obstetric care on institutional birth rate in rural Nepal

A systems approach to improving maternal health in the Philippines

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