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Title: The quality of family planning services and client satisfaction in the public and private sectors in Kenya.
Author: Agha S; Do M
Source: International Journal For Quality In Health Care. 2009 Apr;21(2):87-96.
Abstract: OBJECTIVE: To compare the quality of family planning services delivered at public and private facilities in Kenya. METHODS: Data from the 2004 Kenya Service Provision Assessment were analysed. The Kenya Service Provision Assessment is a representative sample of health facilities in the public and private sectors, and comprises data obtained from a facility inventory, service provider interviews, observations of client-provider interactions and exit interviews. Quality-of-care indicators are compared between the public and private sectors along three dimensions: structure, process and outcome. RESULTS: Private facilities were superior to public sector facilities in terms of physical infrastructure and the availability of services. Public sector facilities were more likely to have management systems in place. There was no difference between public and private providers in the technical quality of care provided. Private providers were better at managing interpersonal aspects of care. The higher level of client satisfaction at private facilities could not be explained by differences between public and private facilities in structural and process aspects of care. CONCLUSIONS: Formal private sector facilities providing family planning services exhibit greater readiness to provide services and greater attention to client needs than public sector facilities in Kenya. Consistent with this, client satisfaction is much higher at private facilities. Technical quality of care provided is similar in public and private facilities.
Language: English
Keywords:
KENYA | RESEARCH REPORT | DATA ANALYSIS | CLIENTS | FAMILY PLANNING | SATISFACTION | PUBLIC SECTOR | PRIVATE SECTOR | QUALITY OF HEALTH CARE | HEALTH SERVICES | REPRODUCTIVE HEALTH | PROGRAM EVALUATION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Program Activities | Programs | Organization and Administration | Psychological Factors | Behavior | Macroeconomic Factors | Economic Factors | Health Services Evaluation | Delivery of Health Care | Health
Document Number: 342098

4.
Peer Reviewed

Title: Quality of obstetric care in public-sector facilities and constraints to implementing emergency obstetric care services: evidence from high- and low-performing districts of Bangladesh.
Author: Anwar I; Kalim N; Koblinsky M
Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):139-55.
Abstract: This study explored the quality of obstetric care in public-sector facilities and the constraints to programming comprehensive essential obstetric care (EOC) services in rural areas of Khulna and Sylhet divisions, relatively high- and low-performing areas of Bangladesh respectively. Quality was explored by physically inspecting all public-sector EOC facilities and the constraints through in-depth interviews with public-sector programme managers and service providers. Distribution of the functional EOC facilities satisfied the United Nation's minimum criteria of at least one comprehensive EOC and four basic EOC facilities for every 500,000 people in Khulna but not in Sylhet region. Human-resource constraints were the major barrier for maternal health. Sanctioned posts for nurses were inadequate in rural areas of both the divisions; however, deployment and retention of trained human resources were more problematic in rural areas of Sylhet. Other problems also plagued care, including unavailability of blood in rural settings and lack of use of evidence-based techniques. The overall quality of care was better in the EOC facilities of Khulna division than in Sylhet. 'Context' of care was also different in these two areas: the population in Sylhet is less literate, more conservative, and faces more geographical and sociocultural barriers in accessing services. As a consequence of both care delivered and the context, more normal vaginal and caesarian-section deliveries were carried out in the public-sector EOC facilities in the Khulna region, with the exception of the medical college hospitals. To improve maternal healthcare, there is a need for a human-resource plan that increases the number of posts in rural areas and ensures availability. All categories of maternal healthcare providers also need training on evidence-based techniques. While the centralized push system of management has its strengths, special strategies for improving the response in the low-performing areas is urgently warranted.
Language: English
Keywords:
BANGLADESH | RURAL AREAS | RESEARCH REPORT | OBSTETRICS | EMERGENCY SERVICES | IMPLEMENTATION | MATERNAL HEALTH SERVICES | QUALITY OF HEALTH CARE | OBSTACLES | HEALTH FACILITIES | PUBLIC SECTOR | HUMAN RESOURCES | BLOOD SUPPLY | SAFE MOTHERHOOD | Developing Countries | Asia, Southern | Asia | Geographic Factors | Population | Medicine | Health Services | Delivery of Health Care | Health | Programs | Organization and Administration | Maternal-Child Health Services | Primary Health Care | Health Services Evaluation | Program Evaluation | Macroeconomic Factors | Economic Factors | Equipment and Supplies | Medical Procedures | Maternal Health
Document Number: 341937

Peer Reviewed

Title: Neonatal near miss: a measure of the quality of obstetric care.
Author: Avenant T
Source: Best Practice and Research. Clinical Obstetrics and Gynaecology. 2009 Jun;23(3):369-374.
Abstract: Thirty-seven percent of under-five deaths occur in the neonatal period. Identifying and correcting factors that contribute to neonatal and maternal care are of the utmost importance. Evaluation of severe acute maternal morbidity, also known as �near miss�, is used to improve obstetric practice. Neonatal near miss in conjunction with neonatal mortality can be used in a similar fashion to identify deficiencies in care. No accepted definition of neonatal near miss currently exists. None of the neonatal morbidity scoring systems is applicable or appropriate for this purpose. Organ system based criteria are objective and allow for identifying severe morbidities and identifying primary causes. This system can be of use in a variety of settings to identify health system problems and to institute remedial action where necessary.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | PREGNANCY | MATERNAL MORTALITY | PERINATAL MORTALITY | MORBIDITY | QUALITY OF HEALTH CARE | MATERNAL-CHILD HEALTH SERVICES | MEASUREMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Reproduction | Mortality | Population Dynamics | Demographic Factors | Population | Diseases | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Primary Health Care | Health Services | Delivery of Health Care | Health | Research Methodology
Document Number: 341303

Peer Reviewed

Title: Maternal mortality in Syria: causes, contributing factors and preventability.
Author: Bashour H; Abdulsalam A; Jabr A; Cheikha S; Tabbaa M; Lahham M; Dihman R; Khadra M; Campbell OM
Source: Tropical Medicine and International Health. 2009 Sep;14(9):1122-7.
Abstract: OBJECTIVES: To describe the biomedical and other causes of maternal death in Syria and to assess their preventability. METHODS: A reproductive age mortality study (RAMOS) design was used to identify pregnancy related deaths. All deaths among women aged 15-49 reported to the national civil register for 2003 were investigated through home interviews. Verbal autopsies were used to ascertain the cause of death among pregnancy related maternal deaths, and causes and preventability of deaths were assessed by a panel of doctors. RESULTS: A total of 129 maternal deaths were identified and reviewed. Direct medical causes accounted for 88%, and haemorrhage was the main cause of death (65%). Sixty nine deaths (54%) occurred during labour or delivery. Poor clinical skills and lack of clinical competency were behind 54% of maternal deaths. Ninety one percent of maternal deaths were preventable. CONCLUSIONS: The causes of maternal death in Syria and their contributing factors reflect serious defects in the quality of maternal care that need to be urgently rectified.
Language: English
Keywords:
SYRIA | RESEARCH REPORT | RECORDS | MATERNAL MORTALITY | CAUSES OF DEATH | PREGNANCY OUTCOMES | MATERNAL HEALTH SERVICES | QUALITY OF HEALTH CARE | Developing Countries | Middle East | Information Processing | Information | Mortality | Population Dynamics | Demographic Factors | Population | Pregnancy | Reproduction | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration
Document Number: 342964

Title: [Newborn babies' health in Rwanda: evolution of factors associated with neonatal mortality trends] La sante des nouveau-nes au Rwanda. Evolution des facteurs associes aux tendances
Author: Beck L
Source: Sante Publique. 2009 Mar-Apr;21(2):159-72.
Abstract: In spite of increasing attention for maternal and child health, neonatal mortality (before the age of one month) represents a significant part of infant mortality in sub-Saharan Africa. Several demographic and health surveys show the lack of any major improvement since the 1980s in Rwanda, and despite some indication of minor improvement, any real progress has been countered by periods of aggravation of the situation. However, a noticeable decrease in neonatal mortality seems to have begun since the year 2000. This study describes the evolution of the determinants of neonatal mortality between 1980 and 2000 and the obstacles that hinder its sustainable decline. Regressive logistical analyses conducted with data on several different generations of newborns showed the persistence of some unfavourable factors and conditions, such as the short period of time between births of babies carried to term and premature births. Nevertheless, although the conditions for pregnancy and delivery are still insufficient, the quality of pre-natal and newborn care seems to be improving.
Language: French
Keywords:
RWANDA | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | NEONATAL MORTALITY | DEATH RATE | MORTALITY DETERMINANTS | MATERNAL-CHILD HEALTH SERVICES | NEEDS | QUALITY OF HEALTH CARE | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Infant Mortality | Mortality | Primary Health Care | Health Services | Delivery of Health Care | Health | Economic Factors | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration
Document Number: 342436

Peer Reviewed

Title: Women's perspectives on family planning service quality: an exploration of differences by race, ethnicity and language.
Author: Becker D; Klassen AC; Koenig MA; LaVeist TA; Sonenstein FL; Tsui AO
Source: Perspectives On Sexual and Reproductive Health. 2009 Sep;41(3):158-65.
Abstract: CONTEXT: Despite calls to make family planning services more responsive to the values, needs and preferences of clients, few studies have asked clients about their experiences or values, and most have used surveys framed by researchers', rather than clients', perspectives. METHODS: Forty in-depth interviews exploring lifetime experiences with and values regarding services were conducted with 18-36-year-old women who visited family planning clinics in the San Francisco Bay Area in 2007. Women were categorized as black, white, English- or Spanish-speaking Latina, or of mixed ethnicity to allow examination of differences by racial, ethnic and language group. Interviews were audiotaped, transcribed and coded thematically; matrices were then used to compare the themes that emerged across the subgroups. RESULTS: Eight themes emerged as important to women's views of services: service accessibility, information provision, attention to client comfort, providers' personalization of care, service organization, providers' empathy, technical quality of care and providers' respect for women's autonomy. Women reported that it was important to feel comfortable during visits, to feel that their decision-making autonomy was respected, to have providers show empathy and be nonjudgmental, and to see the same provider across visits. The only notable difference among racial, ethnic and language groups was that Spanish-speaking Latinas wanted to receive language-appropriate care and contraceptive information. CONCLUSIONS: Future surveys of family planning service quality should include measures of the factors that women value in such care, and efforts to improve providers' communication and counseling skills should emphasize the personalization of services and respect for clients' autonomy.
Language: English
Keywords:
UNITED STATES OF AMERICA | CALIFORNIA | RESEARCH REPORT | INTERVIEWS | FAMILY PLANNING SURVEYS | WOMEN | CLIENTS | ETHNIC GROUPS | FAMILY PLANNING | LANGUAGE | HEALTH SERVICES | QUALITY OF HEALTH CARE | COMMUNICATION | COUNSELING | Developed Countries | North America | Americas | Data Collection | Research Methodology | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | Cultural Background | Population Characteristics | Delivery of Health Care | Health | Health Services Evaluation | Program Evaluation | Clinic Activities
Document Number: 342713

10.

11.
Peer Reviewed

Title: Maternal healthcare financing: Gujarat's Chiranjeevi Scheme and its beneficiaries.
Author: Bhat R; Mavalankar DV; Singh PV; Singh N
Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):249-58.
Abstract: Maternal mortality is an important public-health issue in India, specifically in Gujarat. Contributing factors are the Government's inability to operationalize the First Referral Units and to provide an adequate level of skilled birth attendants, especially to the poor. In response, the Gujarat state has developed a unique public-private partnership called the Chiranjeevi Scheme. This scheme focuses on institutional delivery, specifically emergency obstetric care for the poor. The objective of the study was to explore the targeting of the scheme, its coverage, and socioeconomic profile of the beneficiaries and to assess financial protection offered by the scheme, if any, in Dahod, one of the initial pilot districts of Gujarat. A household-level survey of beneficiaries (n=262) and non-users (n=394) indicated that the scheme is well-targeted to the poor but many poor people do not use the services. The beneficiaries saved more than Rs 3000 (US$ 75) in delivery-related expenses and were generally satisfied with the scheme. The study provided insights on how to improve the scheme further. Such a financing scheme could be replicated in other states and countries to address the cost barrier, especially in areas where high numbers of private specialists are available.
Language: English
Keywords:
INDIA | RESEARCH REPORT | PILOT PROJECTS | LOW INCOME POPULATION | MATERNAL HEALTH SERVICES | FINANCIAL ACTIVITIES | OBSTETRICS | EMERGENCY SERVICES | PROGRAM EVALUATION | MATERNAL MORTALITY | QUALITY OF HEALTH CARE | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Medicine | Programs | Organization and Administration | Mortality | Population Dynamics | Demographic Factors | Population | Health Services Evaluation
Document Number: 341931

12.

Title: The impact of race and ethnicity on receipt of family planning services in the United States.
Author: Borrero S; Schwarz EB; Creinin M; Ibrahim S
Source: Journal of Women's Health. 2009 Jan-Feb;18(1):91-6.
Abstract: OBJECTIVE: This study sought to examine the independent effect of patient race or ethnicity on the use of family planning services and on the likelihood of receiving counseling for sterilization and other birth control methods. METHODS: This study used national, cross-sectional data collected by the 2002 National Survey of Family Growth (NSFG). Our analysis included women aged 18-44 years who had heterosexual intercourse within the past 12 months, who were not actively seeking to get pregnant, and who had not undergone surgical sterilization. The primary outcome was receipt of family planning services within the past 12 months. Specific services we examined were (1) provision of or prescription for a method of birth control, (2) checkup related to using birth control, (3) counseling about sterilization, and (4) counseling about birth control. RESULTS: Although we found no racial/ethnic differences in the overall use of family planning services, there were racial/ethnic differences in the specific type of service received. Hispanic and black women were more likely than white women to receive counseling for birth control (adjusted OR 1.5, 95% confidence interval [CI] 1.2, 1.8, and adjusted OR 1.3, 95% CI 1.1, 1.7, respectively). Hispanic women were more likely than white women to report having been counseled about sterilization (adjusted OR 1.5, 95% CI 1.0, 2.3). CONCLUSIONS: Minority women were more likely to receive counseling about sterilization and other birth control methods. However, there were no differences in access to family planning services by race or ethnicity. Future studies are needed to examine the quality and content of contraceptive counseling received by minority compared with nonminority women.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | ETHNIC GROUPS | HISPANICS | BLACKS | SOCIOCULTURAL FACTORS | FAMILY PLANNING PROGRAMS | IMPACT | COUNSELING | QUALITY OF HEALTH CARE | Developed Countries | North America | Americas | Research Methodology | Cultural Background | Population Characteristics | Demographic Factors | Population | Family Planning | Communication | Clinic Activities | Program Activities | Programs | Organization and Administration | Health Services Evaluation | Program Evaluation
Document Number: 331216

13.

Peer Reviewed

Title: Dried blood spots are a useful tool for quality assurance of rapid HIV testing in Kigali, Rwanda.
Author: Chaillet P; Zachariah R; Harries K; Rusanganwa E; Harries AD
Source: Transactions of the Royal Society of Tropical Medicine and Hygiene. 2009 Jun;103(6):634-7.
Abstract: A study was conducted in two primary health facilities in Kigali, Rwanda, to determine whether dried blood spots (DBS) used for quality control of HIV testing would give comparable results with serum after being stored for a period of 14 days and 30 days at ambient temperature. DBS and serum specimens were collected from patients undergoing HIV testing. ELISA performed on serum at baseline (gold standard) was compared with DBS results. The study included a total of 491 patients, comprising 92 (19%) males and 399 (81%) females with a median age of 27 years. A total of 148 individuals (30%) were HIV-positive. The average ambient temperature under which DBS specimens were stored at the health facilities was 23 degrees C (range 18-25 degrees C). The kappa statistic at 14 days and 30 days was 0.99 (99.4% agreement) and 0.98 (99.2% agreement), respectively, signifying almost 'perfect agreement (P<0.001)' with the gold standard. In a resource-limited sub-Saharan African country embarking on scaling-up of HIV testing, DBS stored at ambient conditions for up to 1 month were found to be a useful and robust tool to perform quality control of rapid HIV testing at the health centre level.
Language: English
Keywords:
RWANDA | RESEARCH REPORT | LABORATORY PROCEDURES | CLIENTS | HIV TESTING | HIV INFECTIONS | AIDS | QUALITY OF HEALTH CARE | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Program Activities | Programs | Organization and Administration | Viral Diseases | Diseases | Health Services Evaluation | Program Evaluation
Document Number: 342745

14.

Title: Making payment for performance work.
Author: Eichler R; Levine R
Source: In: Performance incentives for global health: potential and pitfalls [by] Rena Eichler, Ruth Levine and the Performance-Based Incentives Working Group. Washington, D.C., Center for Global Development, 2009. :51-78.
Abstract: Here we discuss key issues to consider when designing and the steps to implementing a performance incentives program. Among our examples are those that went wrong as well as those that went right, because valuable lessons can be learned from each. While some of the issues may seem complicated, it is not necessary to get all the details right at the outset: refinements can and should be introduced along the way. Fundamentally different from many traditional approaches to improving the delivery of health services, performance incentives are about establishing what the results should be and then letting the key actors -- the patients, the providers -- figure out how to achieve them. Along the way, learning and fine-tuning are part and parcel of the process. (Excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | LITERATURE REVIEW | PERFORMANCE IMPROVEMENT | INCENTIVES | HEALTH SERVICES | QUALITY OF HEALTH CARE | WAGES | DELIVERY OF HEALTH CARE | MONITORING | EVALUATION | HEALTH SERVICES ADMINISTRATION | Management | Organization and Administration | Policy | Political Factors | Sociocultural Factors | Health | Health Services Evaluation | Program Evaluation | Programs | Macroeconomic Factors | Economic Factors
Document Number: 331463

15.

Title: Money into health.
Author: Eichler R; Levine R
Source: In: Performance incentives for global health: potential and pitfalls, [by] Rena Eichler, Ruth Levine and the Performance-Based Incentives Working Group. Washington, D.C., Center for Global Development, 2009. :3-9.
Abstract: This book addresses one set of approaches to using money and other material goods to affect the actions of those who are delivering and receiving health services. More specifically, it is about how to use particular types of incentives -- those that reward or penalize specific types of results -- to motivate health-related behaviors. Performance incentives are defined as the transfer of money or material goods conditional on taking a measurable action or achieving a predetermined performance target. In the conceptualization we use, performance incentives include those that operate at the level of the health facilities (or networks of facilities), the individual provider, the household decisionmakers, and the patients. In other words, we look at incentives on both the demand and the supply sides, at both individual and collective levels. In our framework, we do not include the conditional payments that donor agencies offer to national governments, such as additional grant monies if and when particularpolicy decisions are made. We look solely at the interface between provider and patient. (Excerpt)
Language: English
Keywords:
UNITED STATES OF AMERICA | DEVELOPING COUNTRIES | LITERATURE REVIEW | MALARIA PREVENTION | AIDS PREVENTION | HIV PREVENTION | FINANCIAL ACTIVITIES | FUNDS | HEALTH SERVICES | DELIVERY OF HEALTH CARE | QUALITY OF HEALTH CARE | PROGRAM ACTIVITIES | Developed Countries | North America | Americas | Malaria | Parasitic Diseases | Diseases | AIDS | HIV Infections | Viral Diseases | Economic Factors | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration
Document Number: 331460

16.

Title: Problems to solve.
Author: Eichler R; Levine R
Source: In: Performance incentives for global health: potential and pitfalls [by] Rena Eichler, Ruth Levine and the Performance-Based Incentives Working Group. Washington, D.C., Center for Global Development, 2009. :11-21.
Abstract: In the vast majority of low-income countries, health system performance is way off the mark. Many of the individuals who could benefit most from preventive and therapeutic health services do not receive them, and when they do, the quality of the services is low. The most obvious reason for the deficiencies is limited resources. On average, low-income countries -- those with a gross national income of less than $1,095 in 2009 dollars -- spend about 4.1 percent of gross domestic product from both public and private sources. At current levels of spending, even adjusting for differences in the cost of labor and other inputs across countries, it is impossible for basic services of acceptable quality to reach the majority of the population. Beyond this, a range of systemic shortcomings is evident: quality control and supervision are absent, supply chains are broken, the transfer and use of information are weak, managerial skills are in short supply in both public and private sectors, and the absolute number of health workers at virtually all levels is lower than optimal by technical standards. To solve a problem, one must identify it and understand its underlying causes. Here we highlight both a set of important problems and the reasons to believe -- at least on conceptual grounds -- that introducing financial and other material incentives can improve health sector performance. (Excerpts)
Language: English
Keywords:
DEVELOPING COUNTRIES | LITERATURE REVIEW | LOW INCOME POPULATION | HEALTH SERVICES | PERFORMANCE IMPROVEMENT | INCENTIVES | PREVENTIVE HEALTH CARE | QUALITY OF HEALTH CARE | CHILD HEALTH | MANAGEMENT | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Delivery of Health Care | Health | Organization and Administration | Policy | Political Factors | Sociocultural Factors | Health Services Evaluation | Program Evaluation | Programs
Document Number: 331461

17.
Peer Reviewed

Title: Family planning provider referral, facilitation behavior, and patient follow-up for abnormal Pap smears.
Author: Felix HC; Bronstein J; Bursac Z; Stewart MK; Foushee HR; Klapow J
Source: Public Health Reports. 2009 Sep-Oct;124(5):733-44.
Abstract: OBJECTIVES: Family planning (FP) clinics are important access points for cervical cancer screening and referrals for follow-up care for abnormal Papanicolaou (Pap) smears for a substantial number of U.S. women. Because little is known about referral and facilitation practices in these clinics or client action based on referrals, we sought to determine FP provider referral and facilitation practices when seeing FP clients with abnormal Pap smear results, and FP client follow-up for abnormal Pap smears due to FP provider referrals. METHODS: We conducted a mail survey of Medicaid-enrolled FP providers in Arkansas and Alabama, and conducted a telephone survey with a sample of FP clients of those providers responding to the provider survey. RESULTS: Major provider factors associated with referral included rural location, health department and clinic institutional setting, large Title X practice/clinic size, and high FP clinic focus. Major factors associated with facilitation included rural location, non-physician specialty, health department and clinic institutional setting, and small Title X clinic size. Of women reporting abnormal results, 62.4% reported follow-up care. Of those who received follow-up care, 40.0% received some care and a referral from their FP provider. A major factor associated with clients seeking follow-up care was being told by their FP provider where to go for follow-up care. Age was a major factor associated with clients actually obtaining follow-up care. CONCLUSIONS: Where follow-up care is not available at the FP site, referrals are critical and are a major factor associated with whether women seek care for the condition. Interventions to increase follow-up rates should focus on provider and system features, rather than clients.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | REFERRAL AND CONSULTATION | FAMILY PLANNING | CERVICAL CANCER | SCREENING | PAP SMEAR | HEALTH SERVICES | QUALITY OF HEALTH CARE | Developed Countries | North America | Americas | Program Activities | Programs | Organization and Administration | Cancer | Neoplasms | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Delivery of Health Care | Health | Laboratory Examinations and Diagnoses | Health Services Evaluation | Program Evaluation
Document Number: 342766

18.

Peer Reviewed

Title: Identifying barriers from home to the appropriate hospital through near-miss audits in developing countries.
Author: Filippi V
Source: Best Practice and Research. Clinical Obstetrics and Gynaecology. 2009 Jun;23(3):389-400.
Abstract: Near-miss cases often arrive in critical condition in referral hospitals in developing countries. Understanding the reasons why women arrive at these hospitals in a moribund state is crucial to the reduction of the incidence and case fatality of severe obstetric complications. This paper discusses how near-miss audits can empower the hospital teams to document and help reduce barriers to obstetric care in the most useful way and makes practical suggestions on interviews, analytical framework, ethical issues and staff motivation. Review of the evidence shows that case reviews and confidential enquiries appear particularly suitable to the understanding of delays. Criterion-based audits can also achieve this by establishing criteria for referral. However, hospital staff have limited intervention tools at their disposal to address barriers to emergency care at the community level. It is therefore important to involve the district management team and representatives of the community in auditing the health care seeking and treatment of women with near-miss complications.
Language: English
Keywords:
DEVELOPING COUNTRIES | RESEARCH REPORT | INCIDENCE | PREGNANT WOMEN | PREGNANCY COMPLICATIONS | EMERGENCY SERVICES | QUALITY OF HEALTH CARE | Measurement | Research Methodology | Population Characteristics | Demographic Factors | Population | Diseases | Health Services | Delivery of Health Care | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration
Document Number: 341304

19.

Peer Reviewed

Title: What does access to maternal care mean among the urban poor? Factors associated with use of appropriate maternal health services in the slum settlements of Nairobi, Kenya.
Author: Fotso J; Ezeh A; Madise N; Ziraba A; Ogollah R
Source: Maternal and Child Health Journal. 2009 Jan;13(1):130-7.
Abstract: Objectives: The study seeks to improve understanding of maternity health seeking behaviors in resource-deprived urban settings. The objective of this paper is to identify the factors which influence the choice of place of delivery among the urban poor, with a distinction between sub-standard and "appropriate" health facilities. Methods: The data are from a maternal health project carried out in two slums of Nairobi, Kenya. A total of 1,927 women were interviewed, and 25 health facilities where they delivered, were assessed. Facilities were classified as either "inappropriate" or "appropriate". Place of delivery is the dependent variable. Ordered logit models were used to quantify the effects of covariates on the choice of place of delivery, defined as a three-category ordinal variable. Results: Although 70% of women reported that they delivered in a health facility, only 48% delivered in a facility with skilled attendant. Besides education and wealth, the main predictors of place of delivery included being advised during antenatal care to deliver at a health facility, pregnancy "wantedness", and parity. The influence of health promotion (i.e., being advised during antenatal care visits) was significantly higher among the poorest women. Conclusion: Interventions to improve the health of urban poor women should include improvements in the provision of, and access to, quality obstetric health services. Women should be encouraged to attend antenatal care where they can be given advice on delivery care and other pregnancy-related issues. Target groups should include poorest, less educated and higher parity women.
Language: English
Keywords:
KENYA | RESEARCH REPORT | KAP SURVEYS | SLUMS | URBAN POPULATION | WOMEN IN DEVELOPMENT | MATERNAL HEALTH SERVICES | UTILIZATION OF HEALTH CARE | PROGRAM ACCESSIBILITY | QUALITY OF HEALTH CARE | CHILDBIRTH | EDUCATIONAL STATUS | PROMOTION | ANTENATAL CARE | MULTIPARITY | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Population | Population Characteristics | Demographic Factors | Economic Development | Economic Factors | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration | Health Services Evaluation | Pregnancy Outcomes | Pregnancy | Reproduction | Socioeconomic Status | Socioeconomic Factors | Marketing | Parity | Fertility Measurements | Fertility | Population Dynamics
Document Number: 308031

20.

21.

Peer Reviewed

Title: Evaluation of cluster-randomized trials on maternal and child health research in developing countries.
Author: Handlos LN; Chakraborty H; Sen PK
Source: Tropical Medicine and International Health. 2009 Aug;14(8):947-56.
Abstract: OBJECTIVE: To summarize and evaluate all publications including cluster-randomized trials used for maternal and child health research in developing countries during the last 10 years. METHODS: All cluster-randomized trials published between 1998 and 2008 were reviewed, and those that met our criteria for inclusion were evaluated further. The criteria for inclusion were that the trial should have been conducted in maternal and child health care in a developing country and that the conclusions should have been made on an individual level. Methods of accounting for clustering in design and analysis were evaluated in the eligible trials. RESULTS: Thirty-five eligible trials were identified. The majority of them were conducted in Asia, used community as randomization unit, and had less than 10,000 participants. To minimize confounding, 23 of the 35 trials had stratified, blocked, or paired the clusters before they were randomized, while 17 had adjusted for confounding in the analysis. Ten of the 35 trials did not account for clustering in sample size calculations, and seven did not account for the cluster-randomized design in the analysis. The number of cluster-randomized trials increased over time, and the trials generally improved in quality. CONCLUSIONS: Shortcomings exist in the sample-size calculations and in the analysis of cluster-randomized trials conducted during maternal and child health research in developing countries. Even though there has been improvement over time, further progress in the way that researchers utilize and analyse cluster-randomized trials in this field is needed.
Language: English
Keywords:
DEVELOPING COUNTRIES | RESEARCH REPORT | EVALUATION | DATA ANALYSIS | MATERNAL HEALTH | CHILD HEALTH | MATERNAL-CHILD HEALTH SERVICES | QUALITY OF HEALTH CARE | Research Methodology | Health | Primary Health Care | Health Services | Delivery of Health Care | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration
Document Number: 342974

22.

Title: Maternal mortality due to cardiac disease in Sri Lanka.
Author: Haththotuwa HR; Attygalle D; Jayatilleka AC; Karunaratna V; Thorne SA
Source: International Journal of Gynaecology and Obstetrics. 2009 Mar;104(3):194-8.
Abstract: OBJECTIVE: To investigate Sri Lankan maternal deaths due to heart disease and to consider low-cost interventions to reduce these deaths. METHODS: A qualitative study based on retrospective audit of all maternal deaths and late maternal deaths in Sri Lanka caused by cardiac disease in 2004. RESULTS: A total of 145 maternal deaths were recorded in 2004, for a maternal mortality rate of 38 per 100,000. There were 42 indirect deaths, 25 of which were due to cardiac disease; 23 deaths had a specific cardiac cause listed. Standard care was identified in prepregnancy counseling, contraception, and prenatal community and specialist care. CONCLUSION: Cardiac disease is a major cause of maternal mortality in Sri Lanka, second only to postpartum hemorrhage. Rheumatic mitral valve disease is responsible for more than a third of maternal deaths from cardiac disease. Substandard care was identified in all cases; strategies to improve care could allow a reduction in maternal cardiac deaths.
Language: English
Keywords:
SRI LANKA | RESEARCH REPORT | RETROSPECTIVE STUDIES | PREGNANT WOMEN | MATERNAL MORTALITY | HEART DISEASES | QUALITY OF HEALTH CARE | EXAMINATIONS AND DIAGNOSES | CAUSES OF DEATH | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Mortality | Population Dynamics | Diseases | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 341384

23.
Peer Reviewed

Title: Maternal health: a case study of Rajasthan.
Author: Iyengar SD; Iyengar K; Gupta V
Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):271-92.
Abstract: This case study has used the results of a review of literature to understand the persistence of poor maternal health in Rajasthan, a large state of north India, and to make some conclusions on reasons for the same. The rate of reduction in Rajasthan's maternal mortality ratio (MMR) has been slow, and it has remained at 445 per 1000 livebirths in 2003. The government system provides the bulk of maternal health services. Although the service infrastructure has improved in stages, the availability of maternal health services in rural areas remains poor because of low availability of human resources, especially midwives and clinical specialists, and their non-residence in rural areas. Various national programmes, such as the Family Planning, Child Survival and Safe Motherhood and Reproductive and Child Health (phase 1 and 2), have attempted to improve maternal health; however, they have not made the desired impact either because of an earlier emphasis on ineffective strategies, slow implementation as reflected in the poor use of available resources, or lack of effective ground-level governance, as exemplified by the widespread practice of informally charging users for free services. Thirty-two percent of women delivered in institutions in 2005-2006. A 2006 government scheme to give financial incentives for delivering in government institutions has led to substantial increase in the proportion of institutional deliveries. The availability of safe abortion services is limited, resulting in a large number of informal abortion service providers and unsafe abortions, especially in rural areas. The recent scheme of Janani Suraksha Yojana provides an opportunity to improve maternal and neonatal health, provided the quality issues can be adequately addressed.
Language: English
Keywords:
INDIA | LITERATURE REVIEW | MATERNAL HEALTH | REPRODUCTIVE HEALTH | WOMEN'S STATUS | MATERNAL MORTALITY | MATERNAL HEALTH SERVICES | UTILIZATION OF HEALTH CARE | QUALITY OF HEALTH CARE | SAFE MOTHERHOOD | PERFORMANCE IMPROVEMENT | HUMAN RESOURCES | CONTRACEPTION | ABORTION | Asia, Southern | Asia | Developing Countries | Health | Socioeconomic Factors | Economic Factors | Mortality | Population Dynamics | Demographic Factors | Population | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Management | Family Planning | Fertility Control, Postconception
Document Number: 341929 Notification

24.

Peer Reviewed

Title: The persistence and challenges of homebirths: perspectives of traditional birth attendants in urban Kenya.
Author: Izugbara C; Ezeh A; Fotso JC
Source: Health Policy and Planning. 2009 Jan;24(1):36-45.
Abstract: Through an analysis of focus group discussion data, we examine Kenyan traditional birth attendants' (TBAs) accounts of the persistence of homebirths and the key challenges they present. TBAs associated the continued demand for homebirths with the wide-ranging character and quality of their services. They did not consider their lack of formal training on matters of pregnancy and birthing to be a particular challenge to their work. Rather, they identified the non-cooperative and disrespectful attitudes of their counterparts in hospital settings as the most important issue. Further efforts are needed to make TBAs realize how much better their services could become if they adopted more modern ways of assisting in deliveries, unlearnt their belief in the superiority of their particular type of practice, and understood how their lack of formal training is a key issue.
Language: English
Keywords:
KENYA | RESEARCH REPORT | FOCUS GROUPS | TRADITIONAL BIRTH ATTENDANTS | CHILDBIRTH | OBSTACLES | QUALITY OF HEALTH CARE | MATERNAL HEALTH | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Data Collection | Research Methodology | Health Personnel | Delivery of Health Care | Health | Pregnancy Outcomes | Pregnancy | Reproduction | Organization and Administration | Health Services Evaluation | Program Evaluation | Programs
Document Number: 330475

25.

Title: Task sharing in family planning.
Author: Janowitz B; Stanback J
Source: [Unpublished] 2009. [4] p.
Abstract: Many developing countries face strains in meeting the demands for provision of health services because of limited medical personnel. This situation has been exacerbated by the continued "brain drain" of highly trained medical professionals, and, more recently, by the increased demand for HIV services, especially in countries with a generalized epidemic. This has led to renewed interest in task sharing, also known as task shifting. A key feature of task sharing is that those with less medical or paramedical training can provide some of the same services with the same quality as those with more training. While the term �task sharing� is new, the concept has been applied for many years in family planning programs as various tasks became shared between doctors and nurses or between nurses and community health workers. The consensus reported in a recent WHO document, �Task Shifting to Tackle Health Worker Shortages�, was that task sharing �will positively affect health outcome. In family planning, perhaps the most important reason for task shifting is to bring services to women with poor access. Since it is not always cost effective to build clinics in sparsely populated rural areas, women will either be forced to travel long distances for services or non-clinic-based services must be provided in local communities. (Excerpts)
Language: English
Keywords:
GLOBAL | CRITIQUE | HEALTH PERSONNEL | FAMILY PLANNING PROGRAMS | PROGRAM ACCESSIBILITY | NEEDS | QUALITY OF HEALTH CARE | COMMUNITY-BASED DISTRIBUTION | TRAINING ACTIVITIES | SUPERVISION | CONTRACEPTIVE USAGE | Delivery of Health Care | Health | Family Planning | Program Evaluation | Programs | Organization and Administration | Economic Factors | Health Services Evaluation | Nonclinical Distribution | Distributional Activities | Program Activities | Training Programs | Education | Management | Contraception
Document Number: 331837

26.

Peer Reviewed

Title: Cesarean delivery surveillance system at a maternity hospital in Kabul, Afghanistan.
Author: Kandasamy T; Merialdi M; Guidotti RJ; Betran AP; Harris-Requejo J
Source: International Journal of Gynecology and Obstetrics. 2009;104:14-17.
Abstract: Objective: To use an active facility-based maternal and newborn surveillance system to describe cesarean delivery practices and outcomes in a resource-poor setting. Methods: Using data from operating room logbooks, 392 cesarean deliveries were evaluated between April 1 and June 30 2006 at a large public maternity hospital in Kabul, Afghanistan. Results: The perinatal mortality rate was 89 per 1000 births: 57% antepartum and 37% intrapartum stillbirths. Fetuses with normal birth weight comprised 85% of intrapartum stillbirths. Obstructed labor, uterine rupture, and malpresentation accounted for more than 50% of perinatal deaths. The cesarean delivery rate was 10.2% and there were 2 maternal deaths. Conclusion: The high percentage of intrapartum stillbirths among normal birth weight fetuses suggests a need for improved labor monitoring and surgical obstetric practices. The use of a facility-based perinatal surveillance system is critical in guiding such quality assurance initiatives.
Language: English
Keywords:
AFGHANISTAN | RESEARCH REPORT | DATA COLLECTION | CESAREAN SECTION | HOSPITALS | MONITORING | OBSTETRICS | ANESTHESIA | QUALITY OF HEALTH CARE | PERINATAL MORTALITY | MATERNAL MORTALITY | FETAL DEATH | BIRTH WEIGHT | Asia, Southern | Asia | Developing Countries | Research Methodology | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Health Facilities | Evaluation | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Mortality | Population Dynamics | Demographic Factors | Population | Body Weight | Physiology | Biology
Document Number: 340226

27.
Title: Challenges impacting on the quality of care to persons living with HIV/AIDS and other terminal illnesses with reference to Kanye community home-based care programme.
Author: Kang'ethe SM
Source: SAHARA J. 2009 Mar;6(1):24-32.
Abstract: HIV/AIDS has been found to be a challenging disease to humanity, its challenge spin-offs falling especially on to the caregivers of those infected and affected by the virus. This paper aims to discuss the challenges influencing the state of caregiving in the Kanye community home-based care (CHBC) programme in Botswana. The study was qualitative in design and explorative in nature, involving 82 primary caregivers in focus group discussions, and 5 CHBC nurses in individual interviews. Caregivers were found challenged by lack of community networks support, inadequate sanitary and care packages, poor shelter compromising privacy, inadequate income and food for their clients, inadequate care motivation as their volunteerism does not attract any payment, inadequate health personnel to offer psychosocial support like counselling, and an unconducive caring environment generally. Putting in place policies to redress caregivers' poverty, helping caregivers start income-generating projects, increasing community assistance and caregiving facilities are recommended as factors to address caregiver challenges.
Language: English
Keywords:
BOTSWANA | RESEARCH REPORT | QUALITATIVE RESEARCH | COMMUNITY WORKERS | HOME CARE | QUALITY OF HEALTH CARE | AIDS | HIV INFECTIONS | POVERTY | INCOME GENERATION PROGRAMS | INCENTIVES | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Health Personnel | Delivery of Health Care | Health | Care and Support | Health Services | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Viral Diseases | Diseases | Socioeconomic Factors | Economic Factors | Economic Development | Policy | Political Factors | Sociocultural Factors
Document Number: 341415

28.

Title: Comprehensive care and HIV prophylaxis after sexual assault in rural South Africa: the Refentse intervention study.
Author: Kim JC; Askew I; Muvhango L; Dwane N; Abramsky T; Jan S; Ntlemo E; Chege J; Watts C
Source: BMJ. 2009;338:b515.
Abstract: PROBLEM: Although international guidelines specify the central role of the health sector in providing comprehensive care, including HIV post-exposure prophylaxis (PEP), after sexual assault, in both industrialised and developing countries there are many challenges to providing timely and comprehensive services. DESIGN: A nurse driven model of post-rape care was integrated into existing hospital services; the before and after study design evaluated impacts on quality of care, reviewing 334 hospital charts and conducting interviews with 16 service providers and 109 patients. SETTING: 450 bed district hospital in rural South Africa. KEY MEASURES FOR IMPROVEMENT: Quality of care after rape (forensic history and examination, provision of emergency contraception, prophylaxis for sexually transmitted infections, referrals); provision of HIV counselling and testing and provision and completion of full 28 day course of PEP; and service utilisation (number of service providers seen on first visit and number of rape cases presenting to hospital per month). STRATEGIES FOR CHANGE: After completing baseline research, we introduced a five part intervention model, consisting of a sexual violence advisory committee, hospital rape management policy, training workshop for service providers, designated examining room, and community awareness campaigns. Effect of change Existing services were fragmented and of poor quality. After the intervention, there were considerable improvements in clinical history and examination, pregnancy testing, emergency contraception, prophylaxis for sexually transmitted infections; HIV counselling and testing, PEP, trauma counselling, and referrals. Completion of the 28 day course of PEP drugs increased from 20% to 58%. LESSONS LEARNT: It is possible to improve the quality of care after sexual assault, including HIV prophylaxis, within a rural South African hospital at modest cost, using existing staff. With additional training, nurses can become the primary providers of this care.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | EVALUATION | INTERVIEWS | RURAL AREAS | CLIENTS | HEALTH FACILITIES | HEALTH SERVICES | HIV TESTING | COUNSELING | RAPE | EMERGENCY CONTRACEPTION | QUALITY OF HEALTH CARE | PSYCHOLOGICAL FACTORS | PROGRAM DESIGN | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Data Collection | Research Methodology | Geographic Factors | Population | Program Activities | Programs | Organization and Administration | Delivery of Health Care | Health | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Clinic Activities | Crime | Social Problems | Sociocultural Factors | Contraception | Family Planning | Health Services Evaluation | Program Evaluation | Behavior
Document Number: 330914

29.

Title: Audit for maternal and newborn health services in resource-poor countries.
Author: Kongnyuy EJ; van den Broek N
Source: BJOG. 2009 Jan;116(1):7-10.
Abstract: Each year more than 536 000 women worldwide die from complications of pregnancy and childbirth. Many more survive but will suffer ill health and disability as a result of these complications. In addition, an estimated 4 million neonatal deaths occur each year, accounting for almost 40% of all deaths in children younger than 5 years. The key strategies that have been identified to reduce this global burden are the presence of skilled birth attendants, the availability of essential (or emergency) obstetric care4 and newborn care. To have major effects on maternal outcomes, it is crucial that these elements are not just available but also of high quality. And assessment of quality requires effective clinical audit. However, anyone who has undertaken a clinical audit will realise that the practice is not as simple as the theory, and 'closing the loop' (to achieve the desired endpoint of improvements in clinical care) is often difficult. So the process of clinical audit itself must be critically evaluated. (excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | SUMMARY REPORT | INFANT | INFANT HEALTH | QUALITY OF HEALTH CARE | MATERNAL-CHILD HEALTH SERVICES | NEEDS ASSESSMENT | PERFORMANCE IMPROVEMENT | COST EFFECTIVENESS | MEASUREMENT | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Child Health | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Primary Health Care | Health Services | Delivery of Health Care | Evaluation | Management | Evaluation Indexes | Quantitative Evaluation | Research Methodology
Document Number: 330471

30.

Peer Reviewed

Title: Bypassing primary care facilities for childbirth: a population-based study in rural Tanzania.
Author: Kruk ME; Mbaruku G; McCord CW; Moran M; Rockers PC; Galea S
Source: Health Policy and Planning. 2009 Jul;24(4):279-88.
Abstract: In an effort to reduce maternal mortality, developing countries have been investing in village-level primary care facilities to bring skilled delivery services closer to women. We explored the extent to which women in rural western Tanzania bypass their nearest primary care facilities to deliver at more distant health facilities, using a population-representative survey of households (N = 1204). Using a standardized instrument, we asked women who had a delivery within 5 years about the place of their most recent delivery. Information on all functioning health facilities in the area were obtained from the district health office. Women who delivered in a health facility that was not the nearest available facility were considered bypassers. Forty-four per cent (186/423) of women who delivered in a health facility bypassed their nearest facility. In adjusted analysis, women who bypassed were more likely than women who did not bypass to be 35 or older (OR 2.5, P Language: English
Keywords:
TANZANIA | RESEARCH REPORT | PRIMARY HEALTH CARE | HEALTH FACILITIES | MATERNAL HEALTH SERVICES | QUALITY OF HEALTH CARE | OBSTETRICS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Health Services | Delivery of Health Care | Health | Maternal-Child Health Services | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Medicine
Document Number: 342992


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