60 million non-facility births: Who can deliver in community settings to reduce intrapartum-related deaths?

Darmstadt, Gary L.; Lee, Anne C C; Cousens, Simon; Sibley, Lynn; Bhutta, Zulfiqar Ahmed; Osrin, David; Bang, Abhay; Kumar, Vishwajeet; Wall, Steven N.; Baqui, Abdullah H; Lawn, Joy E

doi:10.1016/j.ijgo.2009.07.010

Cited by 211 publications

(217 citation statements)

References 79 publications

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“…In particular, the fi ndings about the use of community workers to diagnose and treat common infectious diseases in neonates and under 5s are robust, with consistent improvements in various settings. [10][11][12][13][14][15][16][17] Additionally, shifting of delivery of a range of services from doctors to nurse practitioners, or from health workers to lay providers (who have received only short periods of formal training), can eff ectively expand coverage without jeopardising chil dren's survival, health, and nutrition. [29][30][31][32] These fi ndings are particularly important in view of the absence of robust evidence for interventions that aim to improve the distribution and retention of health professionals in rural areas, and are in line with the principle that services should be delivered at the lowest eff ective level of care.…”

Section: Discussionmentioning

confidence: 99%

“…For example, training of traditional birth attendants and other community-based workers to dispense simple immediate preventive and curative actions for neonate care, includ ing neonatal resuscitation and injectable antibiotics, has signifi cantly reduced stillbirths and perinatal mortality in various settings. 10,11 Additional evidence [12][13][14] suggests that community health workers can eff ectively provide treat ments and care to reduce morbidity and mortality perinatally and in under 5s. More recent evidence 15,16 for the eff ect of communitybased malaria treatment on child health outcomes suggests a reduction in malaria prevalence and a fall in under-5 mortality when combined with delivery of insecticide-treated nets and antimalarial chemoprophylaxis.…”

Section: Lay Health Workersmentioning

confidence: 99%

“…For example, reviews that considered strategies' eff ects on equity and found promising pro-poor eff ects included those assessing expanded roles for community health workers, 10,11,16 task shifting, 31,32 the expanded use of private service providers, 23,34 strategies to reduce fi nancial barriers to access, 37 and strategies to increase humanresource availability and geographical access. 38,39,43 The other paper in this Series 6 builds on our recommendations and uses data from 15 low-income and middleincome countries to describe how a UNICEF modelling team developed and applied a model that simulates the potential eff ect of implementation of the most promising of these strategies in the context of an equity-based approach to health and nutrition programming.…”

Section: Equity-focused Approachesmentioning

confidence: 99%

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Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition

et al. 2012

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Implementation of innovative strategies to improve coverage of evidence-based interventions, especially in the most marginalised populations, is a key focus of policy makers and planners aiming to improve child survival, health, and nutrition. We present a three-step approach to improvement of the eff ective coverage of essential interventions. First, we identify four diff erent intervention delivery channels-ie, clinical or curative, outreach, community-based preventive or promotional, and legislative or mass media. Second, we classify which interventions' deliveries can be improved or changed within their channel or by switching to another channel. Finally, we do a meta-review of both published and unpublished reviews to examine the evidence for a range of strategies designed to overcome supply and demand bottlenecks to eff ective coverage of interventions that improve child survival, health, and nutrition. Although knowledge gaps exist, several strategies show promise for improving coverage of eff ective interventionsand, in some cases, health outcomes in children-including expanded roles for lay health workers, task shifting, reduction of fi nancial barriers, increases in human-resource availability and geographical access, and use of the private sector. Policy makers and planners should be informed of this evidence as they choose strategies in which to invest their scarce resources.

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Section: Discussionmentioning

confidence: 99%

Section: Lay Health Workersmentioning

confidence: 99%

Section: Equity-focused Approachesmentioning

confidence: 99%

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Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition

et al. 2012

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“…2 A Lancet series on the Millennium Development Goals has argued that they will best be achieved "by adopting a core strategy of health center-based intrapartum care" (Filippi et al 2006). 3 This is important given that nearly 60 million births worldwide take place outside of health facilities (Darmstadt et al 2009). In Sub-Saharan Africa and South Asia, the two regions that account for most deaths, nearly 60 percent of all births take place at home (Montagu et al 2011).…”

Section: Introductionmentioning

confidence: 99%

Better Obstetrics in Rural Nigeria study: evaluating the Nigerian Midwives Service Scheme

Okeke¹,

Glick²,

Abubakar³

et al. 2017

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The International Initiative for Impact Evaluation (3ie) is an international grant-making NGO promoting evidence-informed development policies and programmes. We are the global leader in funding, producing and synthesising high-quality evidence of what works, how, why and at what cost. We believe that better and policy-relevant evidence will make development more effective and improve people's lives. 3ie impact evaluations3ie-supported impact evaluations assess the difference a development intervention has made to social and economic outcomes. 3ie is committed to funding rigorous evaluations that include a theory-based design, use the most appropriate mix of methods to capture outcomes and are useful in complex development contexts. About this report SummaryLimited availability of skilled providers, particularly in rural areas, is thought to be an important constraint to increasing rates of use of maternal and child health services in low-and middle-income countries. There are, however, few well-identified studies of the relationship between the supply of skilled workers and outcomes. In this project, we studied the effects of a government program in Nigeria that sought to alleviate supply-side constraints by deploying skilled midwives to primary health facilities in rural communities, to provide round-the-clock access to skilled care.We evaluate the impact of the Midwives Service Scheme (MSS), a government program introduced in 2009 to increase access to skilled care in underserved rural areas in Nigeria. At rollout, the MSS deployed nearly 2,500 midwives to 652 primary health care centers across 36 states. To evaluate the impact of the program, we surveyed 7,104 women with a birth within the preceding five years in 386 communities across 12 states. The intervention group consisted of communities that participated in the initial rollout; the comparison group consisted of communities that would receive the program approximately three years later. To understand implementation challenges and contextualize the quantitative results, we carried out a nested qualitative study in three states, consisting of in-depth interviews and focus group discussions with policymakers, providers, childbearing women, and community stakeholder groups.Overall, we found that the program's effects were smaller than anticipated. The main effect was a 7.3-percentage-point increase in antenatal care use in program clinics (about 12 percent relative to baseline levels) and a 5-percentage-point increase in overall use of antenatal care (6 percent relative to baseline levels) within the first year of the program. We found suggestive but not conclusive evidence of a small increase in skilled birth attendance, but this was confined to the south, where there were fewer challenges with midwife retention. We did not find any significant improvements in postnatal visits or child immunizations. Given this, it is not surprising that we did not find any evidence of improvements in maternal and child health.Our data allow us to shed some light on why ...

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“…7 Over 98% of perinatal deaths occur in low-and middle-income countries and more than two thirds occur in community settings, frequently at home. 8,9 These deaths that take place outside the formal health-care system are rarely included in the vital registers. 10,11 In fact, vital registration data are unavailable for over 97% of perinatal deaths, yet such data are necessary for designing measures to reduce perinatal mortality.…”

Section: Introductionmentioning

confidence: 99%

Birth attendants as perinatal verbal autopsy respondents in low- and middle-income countries: a viable alternative?

Engmann¹,

Garcés²,

Jehan³

et al. 2012

Bull World Health Org

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60 million non-facility births: Who can deliver in community settings to reduce intrapartum-related deaths?

Cited by 211 publications

References 79 publications

Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition

Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition

Better Obstetrics in Rural Nigeria study: evaluating the Nigerian Midwives Service Scheme

Birth attendants as perinatal verbal autopsy respondents in low- and middle-income countries: a viable alternative?

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