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The association between voucher scheme and maternal healthcare services among the rural women in Bangladesh: A cross sectional study.
Bangladesh Journal of Medical Science. 2018; 17(4):545-555.Background: Maternal health voucher scheme, providing financial support to poor women, is popularly known as subsidies in maternity care services including antenatal, delivery and postnatal care and also economic barriers while seeking treatment from qualified service providers. The aim of this study is to evaluate the association of voucher scheme on receiving maternal healthcare services among the rural women in Bangladesh. Methods: This is a cross sectional study where total sample size was (n=500) rural women who were selected by using convenience sampling method. Among them, 250 women were voucher scheme receivers and other 250 women were non-voucher scheme receivers. A structured questionnaire was adopted for data collection between November and December 2015. In the final analysis, cross tabular analysis and logistic regression model were used, and adjusted odds ratios (ORs) were reported. Results: The study found a strong relation between voucher scheme and maternal healthcare services among the rural women in Bangladesh where majority (88.4%) voucher scheme receivers received information or treatment of Reproductive Tract Infections (RTIs) and Sexually Transmitted Infections (STIs) while non-voucher scheme receivers received only 10%. Most of the respondents (93%) voucher scheme receivers received at least 3 times of antenatal care visit; but only 28% received non-voucher scheme receivers at least 3 times of antenatal care visit. Voucher scheme receivers received 17.127 times more likelihood to receive skilled birth attendance and 25.344 times more likelihood to receive institutional delivery services and positively significant (5 percent) compared to those who did not receive maternal heath voucher scheme. Moreover, 92.4% voucher receivers received transport cost and 73.2%, received safe home delivery services while 22.8% non-voucher scheme receivers received transport cost and only 20.4% received safe home delivery services. Majority (94%) voucher scheme receivers received long time birth control services while only 19.2% non-voucher scheme receivers received long time birth control services. Conclusion: Women who did not receive maternal health voucher scheme found the status of lower antenatal, delivery and postnatal care services receiving trends compared to the women who received the maternal health voucher scheme. It is recommended an effective monitoring system and necessary interventions getting overall developed health status in Bangladesh. © 2018, Ibn Sina Trust. All Rights Reserved.
Medicaid Family Planning Expansions: The Effect of State Plan Amendments on Postpartum Contraceptive Use.
Journal of Women's Health. 2018 Nov 28;OBJECTIVE: To determine the effect of state Medicaid family planning (FP) programs transitioning from a Section 1115 waiver to a State Plan Amendment (SPA) on reproductive health outcomes. MATERIALS AND METHODS: Data were from the Pregnancy Risk Assessment Monitoring System on 75,082 women who had a live birth between 2007 and 2013 and were living in one of nine states. We performed a difference-in-differences analysis to quantify the effect of the transition on postpartum contraceptive (PPC) use and unintended births (UBs). RESULTS: Over 80% of the sample reported using PPC; half reported an UB. The odds of PPC use among women who were living in a study state and gave birth after the transition were 1.14 times that of women who were living in a comparison state and/or gave birth before the transition (95% confidence interval: 1.04-1.24). CONCLUSIONS: Findings suggest that women living in states that transitioned from a waiver to SPA experienced an increased likelihood of PPC compared with those living in comparison states.
When things fall apart: local responses to the reintroduction of user-fees for maternal health services in rural Malawi.
Reproductive Health Matters. 2018 Nov 2; 1-11.Despite the strong global focus on improving maternal health during past decades, there is still a long way to go to ensure equitable access to services and quality of care for women and girls around the world. To understand widely acknowledged inequities and policy-to-practice gaps in maternal health, we must critically analyse the workings of power in policy and health systems. This paper analyses power dynamics at play in the implementation of maternal health policies in rural Malawi, a country with one of the world's highest burdens of maternal mortality. Specifically, we analyse Malawi's recent experience with the temporary reintroduction of user-fees for maternity services as a response to the suspension of donor funding, a shift in political leadership and priorities, and unstable service contracts between the government and its implementing partner, the Christian Health Association of Malawi. Based on ethnographic research conducted in 2015/16, the article describes the perceptions and experiences of policy implementation among various local actors (health workers, village heads and women). The way in which maternity services "fall apart" and are "fixed" is the result of dynamic interactions between policy and webs of accountability. Policies meet with a cascade of dynamic responses, which ultimately result in the exclusion of the most vulnerable rural women from maternity care services, against the aims of global and national safe motherhood policies.
Washington, D.C., Population Council, The Evidence Project, 2018 Mar. 8 p. (Case Study)Women of reproductive age in Cambodia, and many other developing countries, comprise a large part of factories’ workforce. Integrating family planning and reproductive health information and services into factories can improve workers’ health and help countries achieve FP2020 commitments. This case study looks at the process of how the Cambodian Ministry of Labor and Vocational Training launched, as formal policy, a set of workplace health infirmary guidelines for enterprises. What made this policy process unique for Cambodia – and what can be replicated by health advocates elsewhere – is that a group of organizations typically focused on public health policy successfully engaged on labor policy with a labor ministry. This case study describes the policy process, which was underpinned by the strategic use of evidence in decision-making and has been hailed by government, donors, civil society and industry as a success. The learnings presented in this case study should be useful to health advocates, labor advocates, and program designers.
Bulletin of the World Health Organization. 2018 Dec; 96(12):798-799.Add to my documents.
Mapping evidence on decision-making on contraceptive use among adolescents: a scoping review protocol.
Systematic Reviews. 2018 Nov 20; 7(1):201.BACKGROUND: Contraceptive use among adolescents remains consistently low globally. Numerous studies have been done investigating factors that contribute to low contraceptive prevalence rates in this special population. It is particularly vital to understand decision-making processes that adolescents undergo when deciding whether or not to use contraceptives. Therefore, this scoping review seeks to map available evidence on decision-making processes in contraceptive use among adolescents. METHODS: We will conduct a scoping review to explore, describe and map literature on the adolescent decision-making regarding contraceptive use. The primary search will include peer-reviewed and review articles. Databases, including PubMed, MEDLINE with Full Text via EBSCOhost, PsychINFO via EBSCOhost, CINAHL with Full Text via EBSCOhost, Google Scholar, Science Direct and Scopus, will be searched for articles that meet the eligibility criteria. Keyword searches will be used, and for articles included after title screening, abstract and full articles will be screened by two independent reviewers with a third as a decider on any disputes. Content analysis will be used to present the narrative account of the reviews. DISCUSSION: Understanding how adolescents make decisions about whether or not to use contraception is essential for improving contraceptive prevalence rates in this special population. It is envisioned that the results from this review will highlight key evidence on how adolescent make decisions regarding contraceptive use as well as gaps and opportunities for future research. It will also be important in enhancing and re-focusing adolescent sexual and reproductive health policies and programmes.
Mapping the extent to which performance-based financing (PBF) programs reflect quality, informed choice and voluntarism and implications for family planning services A review of indicators.
Washington, D.C., Population Council, The Evidence Project, 2018 Sep. 23 p. (Research Report)Results-based financing (RBF) initiatives, which operate within the much larger financial and programming contexts of health systems, aim to expand coverage, improve quality and reduce consumer financial obligations at the country level in line with a nation’s decision to progress toward universal health coverage. RBF programs have the potential to ensure that clients’ needs for quality services are met through use of strategic incentives in health care provision and promoting more client-centered healthcare systems. Performance-based financing (PBF) programs are considered a specific subset of RBF initiatives and are distinguished by a focus on monetary incentives to healthcare providers for achieving agreed performance measure under certain conditions. While both PBF, which uses financial disbursements to incentivize health service delivery and quality, and rights-based programming have informed at different times efforts to strengthen and scale FP services, there is has been little done to understand the linkages between PBF and a rights-based approach (RBA) to FP services. To address this gap, a review of PBF operations manuals was undertaken together with an analysis of PBF indicators relevant to FP services. This paper presents the results of the analysis of PBF indicators from country-sourced operational documents to determine the extent to which FP indicators are sensitive to the principles associated with an RBA. The review catalogued FP indicators used in PBF programs and assessed their sensitivity to the rights principles. The relevant indicators were sources through 23 operational documents and 18 quality checks. We found 452 FP-related indicators, 57 were for quantity-based performance indicators and 395 questions were used to assess the quality of FP services. The majority of quantity-based performance indicators related to contraceptive service utilization. Fewer quantity-based indicators linked performance incentives to FP counselling, antenatal care, provision or referral by community health workers and one related to demand side incentive for FP counseling. The rights principles most often addressed are availability, quality, including privacy and confidentiality, and informed choice and acceptability and accountability were addressed to a lesser extent. There was no implicit link to the rights principles of accessibility, non-discrimination, and agency. The review shows that existing PBF indicators capture some key elements of an RBA. For instance, aspects of quality and availability are extensively measured. Adapting existing measures could help to ensure existing indicators better align with an RBA. For example, informed choice is tracked in several PBF programs now but with further adoption and adaptation of the method information index and related counseling quality indicators, it is reasonable to expect a greater alignment of PBF with rights principles. Despite the opportunity for greater integration, there are challenges inherent in measuring some dimensions of an RBA, particularly related to client-provider interactions, service users’ experience and engagement. For instance, agency and accessibility require information from the consumer perspective that is not easily observed by third parties.
Mapping the extent to which performance-based financing (PBF) programs reflect quality, informed choice, and voluntarism and implications for family planning services A review of PBF operational manuals.
Washington, D.C., Population Council, The Evidence Project, 2018 Sep. 38 p. (Research Report)Expanding access to and use of voluntary family planning (FP) services is a well-established global health goal– it is a specific target under the Sustainable Development Goal (SDG) of good health and well-being, an integral component of Every Woman Every Child (EWEC), and the overall objective of the Family Planning 2020 (FP2020) partnership, among other initiatives. One promising approach for achieving global voluntary FP goals is performance-based financing (PBF), which deploys financial incentives to the health system to improve service availability, utilization, and quality as well as addressing some public financial management bottlenecks by directly targeting resources to facilities based on performance. Setting global voluntary FP goals implies following a rights-based approach to family planning, which uses a set of standards and principles to guide program assessment, planning, implementation, monitoring, and evaluation that enables individuals and couples to decide freely and responsibly the number and spacing of their children, to have the information and services to do so, and to be treated equitably and free of discrimination. While both PBF, which uses financial disbursements to incentivize health service delivery and quality, and rights-based programming have informed efforts to strengthen and scale FP services, there are gaps in understanding the linkages between PBF and a rights-based approach (RBA) to FP services. To address this gap, a review of performance-based financing (PBF) operations manuals was undertaken together with an analysis of PBF indicators relevant to FP services. This report assesses whether existing FP indicators are sensitive to the principles associated with an RBA.
Can community health workers manage uncomplicated severe acute malnutrition? A review of operational experiences in delivering severe acute malnutrition treatment through community health platforms?
Maternal and Child Nutrition. 2018 Oct 13; 13 p.Community health workers (CHWs) play an important role in the detection and referral of children with severe acute malnutrition (SAM) in many countries. However, distance to health facilities remains a significant obstacle for caregivers to attend treatment services, resulting in SAM treatment coverage rates below 40% in most areas of intervention. The inclusion of SAM treatment into the current curative tasks of CHWs has been proposed as an approach to increase coverage. A literature review of operational experiences was conducted to identify opportunities and challenges associated with this model. A total of 18 studies providing evidence on coverage, clinical outcomes, quality of care, and/or cost-effectiveness were identified. The studies demonstrate that CHWs can identify and treat uncomplicated cases of SAM, achieving cure rates above the minimum standards and reducing default rates to less than 8%. Although the evidence is limited, these findings suggest that early detection and treatment in the community can increase coverage of SAM in a cost-effective manner. Adequate training and close supervision were found to be essential to ensure high-quality performance of CHWs. Motivation through financial compensation and other incentives, which improve their social recognition, was also found to be an important factor contributing to high-quality performance. Another common challenge affecting performance is insufficient stock of key commodities (i.e., ready-to-use therapeutic food). The review of the evidence ultimately demonstrates that the successful delivery of SAM treatment via CHWs will require adaptations in nutrition and health policy and practice.
Implementation of Fee-Free Maternal Health-Care Policy in Ghana: Perspectives of Users of Antenatal and Delivery Care Services From Public Health-Care Facilities in Accra.
International Quarterly of Community Health Education. 2018 Jul; 38(4):259-267.In 2008, the government of Ghana implemented a national user fee maternal care exemption policy through the National Health Insurance Scheme to improve financial access to maternal health services and reduce maternal as well as perinatal deaths. Although evidence shows that there has been some success with this initiative, there are still issues relating to cost of care to beneficiaries of the initiative. A qualitative study, comprising 12 focus group discussions and 6 interviews, was conducted with 90 women in six selected urban neighborhoods in Accra, Ghana, to examine users' perspectives regarding the implementation of this policy initiative. Findings showed that direct cost of delivery care services was entirely free, but costs related to antenatal care services and indirect costs related to delivery care still limit the use of hospital-based midwifery and obstetric care. There was also misunderstanding about the initiative due to misinformation created by the government through the media.We recommend that issues related to both direct and indirect costs of antenatal and delivery care provided in public health-care facilities must be addressed to eliminate some of the lingering barriers relating to cost hindering the smooth operation and sustainability of the maternal care fee exemption policy.
Impact of conditional cash transfer scheme (MAMATA) on the prevalent MCH care practices in rural areas of Ganjam district, Orissa: a descriptive study.
International Journal of Community Medicine and Public Health. 2018 Aug; 5(8):3537-3543.Background: RMNCH services are provided in an integrated manner to it’s beneficiaries under the premise of Primary Health Care. The utilization rates for such services have remained abysmally low and stagnated over the years. The problem lies in failure to generate a demand for such services among it’s beneficiaries. MAMATA a conditional cash transfer scheme implemented in Odisha, aims to bring around radical changes by addressing the issue of demand generation. The objectives of the study were to assess the implementation of MAMATA scheme services in the study area and to assess the impact made by the scheme in their life. Methods: The study was conducted on 200 women, who were randomly selected from the 903 pregnant women registered under Mamata Scheme from a randomly selected block of Odisha. They were then followed up for a period of 15 months. Results: Implementation of the scheme in the district was smooth, the instalments were paid regularly in most of the cases without any delay. Impact of the scheme- 98% got adequate rest during pregnancy, because of the scheme. 95% utilized the money for purchasing nutritious food and procuring medicines. The scheme has also helped develop a health seeking attitude in most of the beneficiaries (85%). 97% felt a sense of empowerment and independence compared to the past. Conclusions: The benefits of MAMATA scheme percolated beyond the boundaries of demand generation. It also brought about a sense of empowerment and independence among it’s beneficiaries.
Baltimore, Maryland, Advance Family Planning, Bill & Melinda Gates Institute for Population and Reproductive Health, 2018 Jan. 4 p.This case study explores that, despite Lagos State’s investment in family planning, hidden, out-of-pocket costs prevented achieving the goal. Moreover, the advocates’ attainment of a policy directive to address this lacked additional funding to carry it out. The study highlights the importance of advocates’ follow-through--and how the SMART approach enabled them to carry a commitment toward implementation.
Durham, North Carolina, FHI 360, 2018 Apr. 6 p.Since the London Summit on Family Planning (FP) in 2012, more than 40 countries have committed to making high-quality, voluntary FP services, information, and supplies more available, acceptable, and affordable for an additional 120 million women and girls in the world’s 69 poorest countries by 2020. Meeting the commitments of this initiative, known as FP2020, will ensure that every woman and every girl has the right, and the means, to shape her own life-to grow, to thrive, and to plan the family she wants. Costed implementation plans (CIPs) are multi-year action plans that contain detailed resource projections for achieving the goals of a FP program, thus enabling countries to operationalize and monitor progress toward their FP2020 commitments. Thus far, close to 30 countries in Africa and Asia have developed CIPs at either a national or subnational level, with new CIPs being developed on an ongoing basis. Translating CIPs into action, and ultimately into results, requires a sustained deliberate approach to the execution process throughout the plan. This notion may sound simple and straightforward, but it can be complex. Strategic planners agree that planning seldom fails; it is the execution that fails. Extensive literature describes the factors that can stall a plan, including lack of buy-in and ownership, unclear lines of responsibility and accountability, lack of dedicated efforts to mobilize resources, inability to recognize and facilitate change processes, poor communication and coordination among stakeholders, and inadequate leadership and management skills to effect execution. This case study describes the process of translating the plan into sustained action and measurable results-execution, challenges, and lessons learned. It is based on consultations with stakeholders, conducted in August 2016 to understand the execution process, and is enriched by reports from performance-monitoring efforts and follow-up with in-country stakeholders. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], 2018. 116 p.The guideline uses state-of-the-art evidence to identify effective policy options to strengthen community health worker (CHW) programme performance through their proper integration in health systems and communities. The development of this guideline followed the standardized WHO approach. This entailed a critical analysis of the available evidence, including 16 systematic reviews of the evidence, a stakeholder perception survey to assess feasibility and acceptability of the policy options under consideration, and the deliberations of a Guideline Development Group which comprised representation from policy makers and planners from Member States, experts, labour unions, professional associations and CHWs. Critical to the success of these efforts will be ensuring appropriate labour conditions and opportunities for professional development, as well as creating a health ecosystem in which workers at different levels collaborate to meet health needs. Adapted to context, the guideline is a tool that supports optimizing health policies and systems to achieve significant gains to meet the ambition of universal access to primary health care services.
International Journal of Community Medicine and Public Health. 2018 Sep; 5(9):3860-3864.Background: The field of medicine has changed over the years owing to the constant scientific advances and research. From a time when spontaneous vaginal delivery used to be the norm, to now, where the rates of Caesarean deliveries seemed to be increasing, obstetric care has evolved considerable. Several healthcare initiatives and schemes have been framed for the betterment of the female reproductive health in recent times. It is important to understand both medical as well socio-cultural factors that have caused this increase in the caesarean births. This study was conducted keeping in mind this trend and to find out the level of awareness regarding patterns of deliveries that factors into this trend. Methods: Cross – sectional study was done in women residing in an urban slum of Ahmedabad in February 2014. 68 consenting female were randomly selected for the study from the slum of „Madi no Kuvo . Results: Majority of females (69%) were from age group 20-30 years. With a total number of 123 deliveries counted within the 68 female interviewed 67% were normal vaginal deliveries. 63% of surveyed women had deliveries at government hospital as civil hospital is nearby localities surveyed and cost incurrence was there in about half of deliveries while 27 % deliveries occurred at private hospitals. Conclusions: Majority of women would prefer to have normal delivery whenever it is possible. Majority of people were unaware about different government schemes to help females during pregnancy.
Supporting community mobilizers to provide quality sexual and reproductive health care in urban Tanzania.
Watertown, Massachusetts, Pathfinder International, 2018 Oct. 12 p.Gaps in human resources for health are among the most influential factors underlying poor health systems performance. Community health workers have positively impacted health outcomes by providing health services and linking the community to the health system. While there is evidence to support capacity development and successful deployment of community health workers, evidence of effective quality assurance mechanisms is lacking. Chaguo la Maisha--a three-year, anonymously-funded project implemented by Pathfinder International in Dar es Salaam, Tanzania--aimed to create an enabling environment for women to choose whether and when to bear children. Community health workers are integral to achieving this goal. This technical brief explores the project components designed to support quality in community health worker services and to support community health workers to build service-seeking behaviors as well as mutual accountability and shared responsibility for health between the community and the facility.
Barriers to utilization of long acting reversible and permanent contraceptive methods in Ethiopia: Systematic review.
Ethiopian Journal of Reproductive Health. 2018 Jul; 10(3):1-24.BACKGROUND: Globally the use of Long-Acting Reversible and Permanent Methods (LARPMs) has been recommended as the first-line, highly effective options for pregnancy prevention. They have greater efficacy than short acting contraceptive methods and are associated with lower rates of unwanted pregnancy. Ethiopia has made significant progress in family planning (FP); however, one fourth of married women still have unmet need for FP and nearly three-fourth of family planning users depend on short acting injectable contraceptives. The aim of this study was to review existing researches to identify barriers to long acting reversible and permanent contraceptive use in emerging regions of Ethiopia. METHOD: Published and unpublished literatures were searched using major search engines and different search terms related to the topic. Literature search was carried out from March to May 2016. Six selection criteria were prepared to summarize the findings using PRISMA protocol. A checklist of eight-item quality assessment criteria was used to rate the quality of studies independently by two investigators, and the third investigator cross checked and decided on agreements. The studies were critically appraised, and thematic analysis was used to synthesize the data. RESULTS: Using the screening criteria, 69 eligible full-text articles and reports were reviewed; of which 34 articles and 8 policy/strategy documents were considered for data synthesis. The review has included policy related, individual, socio-cultural and health facility related barriers/factors affecting LARPMs use in emerging regions. Lack of strategies to reach the mobile population of emerging regions, facility readiness to provide LARPMs and quality of care were major policy and health care factors contributing for the low utilization of LARPMs. Low knowledge of LARPMs, health concerns, fear of side effects, and lower education were among individual level barriers identified through the review. Moreover, the review showed that men’s (partner’s) objection, desire for more children (especially by the male partner), absence of male involvement, lack of women’s decision-making power and lack of discussion with partners were gender related barriers. CONCLUSION: The regional disparity in LARPM use, particularly in emerging regions, requires targeted policy and strategic direction to address the prevailing inequality in family planning use and method mix. To improve the utilization of LARPMs, efforts should be made to address the key demand and supply side barriers. More context specific research evidences should be generated to understand barriers that are specific to these regions.
Assessment of maternal and child health (MCH) practices with a focus on Janani Suraksh Yojana (JSY).
Global Journal of Medicine and Public Health. 2012; 1(6):9 p.Background: Janani Suraksha Yojana (JSY) is a safe motherhood intervention encompassing conditional cash transfer scheme initiated under National Rural Health Mission (NRHM). Objective A rapid appraisal was conducted to assess selected maternal and child health (MCH) practices among rural mothers in a block of Haryana with a focus on JSY. Methodology: Using stratified random sampling, 6 health subcentre area in a rural block of Haryana were selected and all available JSY (n=72) mothers with their child in age-group of 6-11 months were covered. Similar numbers of non-JSY (n=76) mother were also contacted by the investigators using pre-designed, pre-tested semi-structure interview schedule. Results: Out of 148 mothers, majority (77.02%) were in the age-group of 20-24 years; overall 52.02% [45.83% (JSY) vs. 57.89% (non-JSY)] had completed atleast 9 years of schooling; all (100%) JSY beneficiaries belonged to affirmative group (OBC/SC) but only 38.89% of them possessed BPL-card; a total of 68 (45.94%), 62 (41.89%) and 18 (12.16%) mothers had one, two & three living children respectively and 93% women were home-maker. Higher proportion of non-JSY (72.36%) viz. JSY (54.16%) mothers had institutional delivery (p<0.05). Pre-lacteal feed was administered to 60% of newborn while 95% received colostrum; however only 32.43% were initiated on breast-milk within first hour of birth inspite of all being normal vaginal deliveries. Nearly 91.66% of JSY and 22.36% of non-JSY mothers were aware of the financial scheme (p<0.05); only 20.83% JSY mothers received money within one-month of delivery; 47.22% of mothers spent money either on themselves or child care while amongst rest it got utilized within general family pool.
The implementation of the free maternal health policy in rural Northern Ghana: synthesised results and lessons learnt.
BMC Research Notes. 2018 May 29; 11(1):341.OBJECTIVE: A free maternal health policy was implemented under Ghana's National Health Insurance Scheme to promote the use of maternal health services. Under the policy, women are entitled to free services throughout pregnancy and at childbirth. A mixed methods study involving women, providers and insurance managers was carried out in the Kassena-Nankana municipality of Ghana. It explored the affordability, availability, acceptability and quality of services. In this manuscript, we present synthesised results categorised as facilitators and barriers to access as well as lessons learnt (implications). RESULTS: Reasonable waiting times, cleanliness of facilities as well as good interpersonal relationships with providers were the facilitators to access. Barriers included out of pocket payments, lack of, or inadequate supply of drugs and commodities, equipment, water, electricity and emergency transport. Four lessons (implications) were identified. Firstly, out of pocket payments persisted. Secondly, the health system was not strengthened before implementing the free maternal health policy. Thirdly, lower level facilities were poorly resourced. Finally, the lack of essential inputs and infrastructure affected quality of care and therefore, access to care. It is suggested that the Government of Ghana, the Health Insurance Scheme and other stakeholders improve the provision of resources to facilities.
Expanding adolescent access to hormonal contraception: an update on over-the-counter, pharmacist prescribing, and web-based telehealth approaches.
Current Opinion In Obstetrics and Gynecology. 2018 Dec; 30(6):458-464.PURPOSE OF REVIEW: Hormonal contraceptives are largely responsible for recent declines in unintended adolescent pregnancies, with oral contraceptives being the most commonly used. Young people face multiple barriers to accessing effective contraception in clinical settings. This article reviews innovations in contraceptive access. RECENT FINDINGS: The three biggest innovations are over-the-counter oral contraceptives (OTC-OCs), pharmacist-prescribing, and web-based telehealth platforms. In many countries, oral contraceptives are available OTC, and FDA trials for OTC-OCs are underway in the United States. Many states have passed legislation allowing pharmacists to prescribe contraceptives after a brief health screening. Web-based telehealth platforms also provide prescription contraceptive access. There is a small but growing body of literature that demonstrates young people's interest in, and capacity to consent to, hormonal contraceptives in nontraditional settings. State-to-state variability in minor consent, pharmacist prescribing, and telehealth laws act as barriers to young people's access to these newer options. SUMMARY: Access to hormonal contraception is expanding outside of clinical settings, reducing barriers. Adolescents' unique needs should be considered in the design, implementation, and evaluation of these new approaches. More data is needed to ensure that adolescents are not excluded from expanded contraceptive access options, as they are disproportionately affected by unintended pregnancy.
How much do conditional cash transfers increase the utilization of maternal and child health care services? New evidence from Janani Suraksha Yojana in India.
Economics and Human Biology. 2018; 31:164-183.Janani Suraksha Yojana (safe motherhood scheme, or JSY) provides cash incentives to marginal pregnant women in India conditional on having mainly institutional delivery. Using the fourth round of district level household survey (DLHS-4), we have estimated its effects on both intended and unintended outcomes. Our estimates of average treatment effect on the treated (ATT) from propensity score matching are remarkably higher than those found in previous prominent studies using the second and third rounds of the survey (DLHS-2 and DLHS-3). When we apply fuzzy regression discontinuity design exploiting the second birth order, our estimates of local average treatment effect (LATE) are much higher than that of ATT. For example, due to JSY, institutional delivery increases by around 16 percentage points according to ATT estimate but about 23 percentage points according to LATE estimate. © 2018
International Journal of Health Governance. 2018; 23(3):226-232.Purpose: The purpose of this paper is to describe the challenges faced by health professionals in meeting Millennium Goal 5 and reducing maternal mortality in Uganda. Design/methodology/approach: Uganda is a low income land locked country with some major challenges around maternal health. There are many comprehensive and visionary plans produced by the Ugandan Government, however, there is a disconnect between policy and practice and there are many barriers to be addressed in order to reduce maternal mortality in Uganda. Findings: Despite making considerable progress in reducing maternal mortality, Millenium Development Goal (MDG) 5 was not achieved and every day 300 children and 20 mothers die in Uganda. Major barriers include lack of resources, both human and equipment, disparities in access to care, lack of clinical skills and knowledge and financial constraints. The Millennium goals are now behind us and focus has shifted to the sustainable development goals (SDGs). The Ugandan Government must focus on using these goals as part of developing the maternal and child health strategy by prioritising the human resource and health financial issues and continuing to work towards reducing maternal and perinatal mortality. Originality/value: This paper gives a succinct review of the progress of Uganda towards meeting the Millennium Goal 5 and makes key recommendations for addressing SDG 3. © 2018, Emerald Publishing Limited.
Strengthening maternal and child health in China: Lessons from transforming policy proposals into action.
Bioscience Trends. 2018 May 13; 12(2):211-214.China has made impressive achievements in improving maternal and child health (MCH) over the past few decades. This paper uses a policy lens to examine reasons for these achievements as well as barriers to further success. We found that strong governmental commitment and leadership, effective coordination, proactive participation of different stakeholders, and the provision of adequate resources were associated with China's success in improving MCH outcomes. Other low- and middle-income countries can learn valuable lessons from China's experience. These lessons include i) prioritizing MCH on the national development agenda, ii) keeping national ownership over health development cooperation, and iii) establishing effective monitoring, evaluation and accountability mechanisms for MCH programs.
Health and sustainable development; strengthening peri-operative care in low income countries to improve maternal and neonatal outcomes.
Reproductive Health. 2018 Oct 5; 15(1):168.BACKGROUND: Uganda is far from meeting the sustainable development goals on maternal and neonatal mortality with a maternal mortality ratio of 383/100,000 live births, and 33% of the women gave birth by 18 years. The neonatal mortality ratio was 29/1000 live births and 96 stillbirths occur every day due to placental abruption, and/or eclampsia - preeclampsia and other unkown causes. These deaths could be reduced with access to timely safe surgery and safe anaesthesia if the Comprehensive Emergency Obstetric and Newborn Care services (CEmONC), and appropriate intensive care post operatively were implemented. A 2013 multi-national survey by Epiu et al. showed that, the Safe Surgical Checklist was not available for use at main referral hospitals in East Africa. We, therefore, set out to further assess 64 government and private hospitals in Uganda for the availability and usage of the WHO Checklists, and investigate the post-operative care of paturients; to advocate for CEmONC implementation in similarly burdened low income countries. METHODS: The cross-sectional survey was conducted at 64 government and private hospitals in Uganda using preset questionnaires. RESULTS: We surveyed 41% of all hospitals in Uganda: 100% of the government regional referral hospitals, 16% of government district hospitals and 33% of all private hospitals. Only 22/64 (34.38%: 95% CI = 23.56-47.09) used the WHO Safe Surgical Checklist. Additionally, only 6% of the government hospitals and 14% not-for profit hospitals had access to Intensive Care Unit (ICU) services for postoperative care compared to 57% of the private hospitals. CONCLUSIONS: There is urgent need to make WHO checklists available and operationalized. Strengthening peri-operative care in obstetrics would decrease maternal and neonatal morbidity and move closer to the goal of safe motherhood working towards Universal Health Care.
The community is just a small circle: citizen participation in the free maternal and child healthcare programme of Enugu State, Nigeria.
Global Health Action. 2018; 11(1):1421002.BACKGROUND: There is a gap in knowledge about how citizen participation impacts governance of free healthcare policies for universal health coverage in low- and middle-income countries. OBJECTIVE: This study provides evidence about how social accountability initiatives influenced revenue generation, pooling and fund management, purchasing and capacity of health facilities implementing the free maternal and child healthcare programme (FMCHP) in Enugu State, Nigeria. METHODS: The study adopted a descriptive, qualitative case-study design to explore how social accountability influenced implementation of the FMCHP at the state level and in two health districts (Isi-Uzo and Enugu Metropolis) in Enugu State. Data were collected from policymakers (n = 16), providers (n = 16) and health facility committee leaders (n = 12) through in-depth interviews. We also conducted focus-group discussions (n = 4) with 42 service users and document review. Data were analysed using thematic analysis. RESULTS: It was found that health facility committees (HFCs) have not been involved in the generation of funds, fund management and tracking of spending in FMCHP. The HFCs did not also seem to have increased transparency of benefits and payment of providers. The HFCs emerged as the dominant social accountability initiative in FMCHP but lacked power in the governance of free health services. The HFCs were constrained by weak legal framework, ineffectual FMCHP committees at the state and district levels, restricted financial information disclosure, distrustful relationships with policymakers and providers, weak patient complaint system and low use of service charter. CONCLUSION: The HFCs have not played a significant role in health financing and service provision in FMCHP. The gaps in HFCs' participation in health financing functions and service delivery need to be considered in the design and implementation of free maternal and child healthcare policies that aim to achieve universal health coverage.