Objectives. To A functioning referral system is critical to the maternal health program, especially in the management of obstetric emergencies. This study explored supply-side barriers affecting the effective implementation of the said service delivery network (SDN) in Legazpi, Albay in the Bicol Region of the Philippines. Methods. Face-to-face in-depth interviews using semi-structured questionnaires were performed with health care providers involved in the SDN in Albay. Extensive note taking was done by the primary investigator while participants were observed during performance of duties from June - November 2018. Interviews were audio-recorded, transcribed, translated into English, and analyzed thematically along with the observation notes using NVivo. A deductive-dominant approach was utilized for the data content analysis. Results. Referral system barriers identified were cross-cutting across the different components of the health system such as governance, human health resource, service delivery and information systems. The barriers were further classified into individual, organizational and external-related factors in relation to the SDN. Examples of barriers included lack of knowledge of protocols and guidelines, lack of coordination between facilities, poor data management, inadequate capacity building opportunities, and constantly changing political landscape and policies. Conclusions. The study is the first to explore barriers to effective service delivery network in maternal health in the country. Findings from the study provide significant insight to areas of improvement in the SDN that must be addressed to strengthen local health systems, especially with the country’s movement towards Universal Health Care where local health systems play a key role.
Background. One of the strategies adopted by the Department of Health (DOH) to improve maternal outcomes is the systems approach which means understanding extensively how the system operates to determine factors affecting the delivery of services. In 2014, Albay province responded by adapting and implementing the Maternal, Newborn and Child Health, and Nutrition (MNCHN) Service Delivery Network Guidelines. However, no external monitoring and evaluation have been done to assess the compliance of birthing facilities to these guidelines. Objectives. To determine Legazpi city’s obstetric service delivery network functionality and to compare government and private primary level birthing facilities in terms of 1) governance; 2) human resources; 3) protocols; 4) transportation and communication; and 5) emergency drugs and equipment. Materials and Methods. A cross-sectional study using the referral system assessment (RSA) questionnaire translated into a scorecard with a review of secondary data on high-risk pregnancies, referral rates, and maternal mortalities was done on eight facilities in Legazpi City. Results: Overall, none of the health facilities assessed were fully-functional. Privately owned facilities scored highest in emergency drugs and equipment (83.3%) and lowest in human resources (38.9%). Government facilities scored highest in emergency drugs and equipment (88.9%) but lowest in transportation and communication (44.4%). Statistically significant differences were observed for human resources (p-value=0.0180), wherein public facilities garnered higher scores, and in transportation and communication (p-value=0.0294), private facilities showed better scores. Only one maternal death in 418 referrals was reported. Conclusion. Overall, the health facilities varied in the level of functionality in terms of SDN guidelines.
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