BMC Pregnancy and Childbirth | |
Quality care during labour and birth: a multi-country analysis of health system bottlenecks and potential solutions | |
Research | |
Matthews Mathai1  Sue Fawcus2  Jiji Elizabeth Mathews3  G Justus Hofmeyr4  Aline Simen-Kapeu5  Kim E Dickson5  Louise Tina Day6  Gaurav Sharma7  Andrew Weeks8  Luc de Bernis9  Tina Lavender1,10  | |
[1] Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland;Department of Obstetrics & Gynaecology, University of Cape Town, Observatory, 7925, Cape Town, South Africa;Department of Obstetrics and Gynaecology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India;Department of Obstetrics and Gynaecology, East London Hospital Complex, University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, East London, South Africa;Health Section, Programme Division, UNICEF Headquarters, 3 United Nations Plaza, 10017, New York, USA;LAMB, Integrated Rural Health & Development, 5250, Dinajpur, Bangladesh;Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, United Kingdom;Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK;Sanyu Research Unit, University of Liverpool, c/o Liverpool Women's Hospital, Crown Street, L8 7SS, Liverpool, UK;UN Population Fund, Geneva, Switzerland;University of Manchester School of Nursing, Midwifery & Social Work, Jean McFarlane Building University Place, Oxford Road, M13 9PL, Manchester, UK; | |
关键词: Health Workforce; Major Bottleneck; Significant Bottleneck; Important Solution; Assisted Vaginal Delivery; | |
DOI : 10.1186/1471-2393-15-S2-S2 | |
来源: Springer | |
【 摘 要 】
BackgroundGood outcomes during pregnancy and childbirth are related to availability, utilisation and effective implementation of essential interventions for labour and childbirth. The majority of the estimated 289,000 maternal deaths, 2.8 million neonatal deaths and 2.6 million stillbirths every year could be prevented by improving access to and scaling up quality care during labour and birth.MethodsThe bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops engaged technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks", factors that hinder the scale up, of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for skilled birth attendance and basic and comprehensive emergency obstetric care.ResultsAcross 12 countries the most critical bottlenecks identified by workshop participants for skilled birth attendance were health financing (10 out of 12 countries) and health workforce (9 out of 12 countries). Health service delivery bottlenecks were found to be the most critical for both basic and comprehensive emergency obstetric care (9 out of 12 countries); health financing was identified as having critical bottlenecks for comprehensive emergency obstetric care (9 out of 12 countries). Solutions to address health financing bottlenecks included strengthening national financing mechanisms and removing financial barriers to care seeking. For addressing health workforce bottlenecks, improved human resource planning is needed, including task shifting and improving training quality. For health service delivery, proposed solutions included improving quality of care and establishing public private partnerships.ConclusionsProgress towards the 2030 targets for ending preventable maternal and newborn deaths is dependent on improving quality of care during birth and the immediate postnatal period. Strengthening national health systems to improve maternal and newborn health, as a cornerstone of universal health coverage, will only be possible by addressing specific health system bottlenecks during labour and birth, including those within health workforce, health financing and health service delivery.
【 授权许可】
CC BY
© Sharma et al. 2015
【 预 览 】
Files | Size | Format | View |
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RO202311094573553ZK.pdf | 4671KB | download |
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