Background: Postpartum contraceptives use offers a distinctive opportunity to maintain appropriate birth spacing for health benefits to both mother and child. However, the concept of postpartum family planning (PPFP) is poorly understood and contraceptives use during the postpartum period remains low in Nepal. Therefore, this study aimed to assess the factors affecting the utilization of family planning (FP) methods among postpartum mothers in the Kailali district, Nepal. Methods: A community-based cross-sectional study was conducted between September and October 2013 among postpartum mothers in Kailali district. Simple random sampling was applied to select a total of 427 study participants. A pre-tested standard semi-structured questionnaire was used for gathering data. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 20.0. Results: Overall, 32.8% of the postpartum women used different types of contraceptives. Condoms (37.1%) followed by Depo-Provera 29.3% were the most used postpartum contraceptives. Half (50%) of the postpartum women had an unmet need for family planning. Multiple logistic regression model revealed that the occupation of husband [AOR=3.2 (95% CI: 2.0-6.00], past use of family planning methods [AOR=4.0 (95% CI:2.4-6.5)] and resumption of menstruation [AOR=2.5 (95% CI:1.6-4.1)] were significantly associated with the use of modern contraceptives during the first year of the postpartum period. Conclusion: Contraceptive uptake within the first year of postpartum was found to be low among women in the Kailali district, Nepal. Previous experience with the use of family planning methods, occupation of the husbands, and resumption of menstruation are important factors in the PPFP decisions of women in this population. Therefore, the family planning program should work on improving couples' knowledge of the risk of pregnancy, fertility returning time and modern contraceptives use during the postpartum period targeting women whose husbands are in migrant occupations, who are not menstruating and who have not used FP before.
Background: Development assistance for health (DAH) is an important mechanism for funding and technical support to low-income countries. Despite increased DAH spending, intractable health challenges remain. Recent decades have seen numerous efforts to reform DAH models, yet pernicious challenges persist amidst structural complexities and a growing number of actors. Systems-based approaches are promising for understanding these types of complex adaptive systems. This paper presents a systems-based understanding of DAH, including barriers to achieving sustainable and effective country-driven models for technical assistance and capacity strengthening to achieve better outcomes Methods: We applied an innovative systems-based approach to explore and map how donor structures, processes, and norms pose challenges to improving development assistance models. The system mapping was carried out through an iterative co-creation process including a series of discussions and workshops with diverse stakeholders across 13 countries. Results: Nine systemic challenges emerged: 1) reliance on external implementing partners undermines national capacity; 2) prioritizing global initiatives undercuts local programming; 3) inadequate contextualization hampers program sustainability; 4) decision-maker blind spots inhibit capacity to address inequities; 5) power asymmetries undermine local decision making; 6) donor funding structures pose limitations downstream; 7) program fragmentation impedes long-term country planning; 8) reliance on incomplete data perpetuates inequities; and 9) overemphasis on donor-prioritized data perpetuates fragmentation. Conclusions: These interconnected challenges illustrate interdependencies and feedback loops manifesting throughout the system. A particular driving force across these system barriers is the influence of power asymmetries between actors. The articulation of these challenges can help stakeholders overcome biases about the efficacy of the system and their role in perpetuating the issues. These findings indicate that change is needed not only in how we design and implement global health programs, but in how system actors interact. This requires co-creating solutions that shift the structures, norms, and mindsets governing DAH models.
Background: Development assistance for health (DAH) is an important mechanism for funding and technical support to low-income countries. Despite increased DAH spending, intractable health challenges remain. Recent decades have seen numerous efforts to reform DAH models, yet pernicious challenges persist amidst structural complexities and a growing number of actors. Systems-based approaches are promising for understanding these types of complex adaptive systems. This paper presents a systems-based understanding of DAH, including barriers to achieving sustainable and effective country-driven models for technical assistance and capacity strengthening to achieve better outcomes Methods: We applied an innovative systems-based approach to explore and map how donor structures, processes, and norms pose challenges to improving development assistance models. The system mapping was carried out through an iterative co-creation process including a series of discussions and workshops with diverse stakeholders across 13 countries. Results: Nine systemic challenges emerged: 1) reliance on external implementing partners undermines national capacity; 2) prioritizing global initiatives undercuts local programming; 3) inadequate contextualization hampers program sustainability; 4) decision-maker blind spots inhibit capacity to address inequities; 5) power asymmetries undermine local decision making; 6) donor funding structures pose limitations downstream; 7) program fragmentation impedes long-term country planning; 8) reliance on incomplete data perpetuates inequities; and 9) overemphasis on donor-prioritized data perpetuates fragmentation. Conclusions: These interconnected challenges illustrate interdependencies and feedback loops manifesting throughout the system. A particular driving force across these system barriers is the influence of power asymmetries between actors. The articulation of these challenges can help stakeholders overcome biases about the efficacy of the system and their role in perpetuating the issues. These findings indicate that change is needed not only in how we design and implement global health programs, but in how system actors interact. This requires co-creating solutions that shift the structures, norms, and mindsets governing DAH models.
Back Background ground Despite there being many state and non-governmental organisation (NGO) health programs, Nepal still has a high maternal mortality ratio of 258. Previous research has indicated that social accountability mechanisms can improve maternal health. However, the functioning of these mechanisms has not yet been explored in Nepal. Social accountability mechanisms can be identified and analysed through the information, dialogue & negotiation model. Objec Objectiv tive e To identify the role of social accountability mechanisms in maternal health and the challenges regarding these mechanisms in Baglung district, Nepal. Methods Methods Ten semi-structured interviews were held with healthcare officials, healthcare providers, NGO staff and mothers at the community level, and four focus group discussions were held with pregnant women and recent mothers, healthcare providers and Health Facility Operation and Management Committee (HFOMC) members. Data was coded and analysed with ATLAS.ti using the information, dialogue & negotiation model. R Results esults Mothers' Groups, Female Community Health Volunteers (FCHVs) and the HFOMC function as a two-step social accountability mechanism. The FCHVs act as a bridge between Mothers' Groups at the community level and the HFOMC. The HFOMC holds dialogues and negotiations with the district and central government. There seem to be two main obstructions in the information flow from the central or district levels to the community. They are located between the central government level and/or district level and the HFOMC, and between the HFOMC and the FCHV and Mothers' Groups. The information from the community to higher levels seems to have an obstruction in the voicing of service-related needs/complaints in the Mothers' Groups and another obstruction of HFOMCs rarely interacting with health sector actors other than the local health facility. C Conclusions onclusions The information, dialogue & negotiation model is a sensitive analytical model to understand the functioning and challenges of social accountability in the maternal health care system of Nepal. The community-based accountability chain of HFOMC, FCHVs and Mothers' Groups presents a structure that facilitates the optimisation of maternal health services. Recommendations are given to improve gaps in this accountability chain. Maternal health is of great importance in all societies. It is defined by the WHO as "the health of women during pregnancy, childbirth and the postpartum period (42 days post-delivery)". 1 This study examines the situation in Nepal, a small country in the Himalayas with a population of around 27 million, where maternal mortality was shown to be still
Back Background ground Despite there being many state and non-governmental organisation (NGO) health programs, Nepal still has a high maternal mortality ratio of 258. Previous research has indicated that social accountability mechanisms can improve maternal health. However, the functioning of these mechanisms has not yet been explored in Nepal. Social accountability mechanisms can be identified and analysed through the information, dialogue & negotiation model. Objec Objectiv tive e To identify the role of social accountability mechanisms in maternal health and the challenges regarding these mechanisms in Baglung district, Nepal. Methods Methods Ten semi-structured interviews were held with healthcare officials, healthcare providers, NGO staff and mothers at the community level, and four focus group discussions were held with pregnant women and recent mothers, healthcare providers and Health Facility Operation and Management Committee (HFOMC) members. Data was coded and analysed with ATLAS.ti using the information, dialogue & negotiation model. R Results esults Mothers' Groups, Female Community Health Volunteers (FCHVs) and the HFOMC function as a two-step social accountability mechanism. The FCHVs act as a bridge between Mothers' Groups at the community level and the HFOMC. The HFOMC holds dialogues and negotiations with the district and central government. There seem to be two main obstructions in the information flow from the central or district levels to the community. They are located between the central government level and/or district level and the HFOMC, and between the HFOMC and the FCHV and Mothers' Groups. The information from the community to higher levels seems to have an obstruction in the voicing of service-related needs/complaints in the Mothers' Groups and another obstruction of HFOMCs rarely interacting with health sector actors other than the local health facility. C Conclusions onclusions The information, dialogue & negotiation model is a sensitive analytical model to understand the functioning and challenges of social accountability in the maternal health care system of Nepal. The community-based accountability chain of HFOMC, FCHVs and Mothers' Groups presents a structure that facilitates the optimisation of maternal health services. Recommendations are given to improve gaps in this accountability chain. Maternal health is of great importance in all societies. It is defined by the WHO as "the health of women during pregnancy, childbirth and the postpartum period (42 days post-delivery)". 1 This study examines the situation in Nepal, a small country in the Himalayas with a population of around 27 million, where maternal mortality was shown to be still
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