Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 2. maternal health findings

Abstract

BackgroundWe summarize the findings of assessments of projects, programs, and research studies (collectively referred to as projects) included in a larger review of the effectiveness of community–based primary health care (CBPHC) in improving maternal, neonatal and child health (MNCH). Findings on neonatal and child health are reported elsewhere in this series.MethodsWe searched PUBMED and other databases through December 2015, and included assessments that underwent data extraction. Data were analyzed to identify themes in interventions implemented, health outcomes, and strategies used in implementation.Results152 assessments met inclusion criteria. The majority of assessments were set in rural communities. 72% of assessments included 1–10 specific interventions aimed at improving maternal health. A total of 1298 discrete interventions were assessed. Outcome measures were grouped into five main categories: maternal mortality (19% of assessments); maternal morbidity (21%); antenatal care attendance (50%); attended delivery (66%) and facility delivery (69%), with many assessments reporting results on multiple indicators. 15 assessments reported maternal mortality as a primary outcome, and of the seven that performed statistical testing, six reported significant decreases. Seven assessments measured changes in maternal morbidity: postpartum hemorrhage, malaria or eclampsia. Of those, six reported significant decreases and one did not find a significant effect. Assessments of community–based interventions on antenatal care attendance, attended delivery and facility–based deliveries all showed a positive impact. The community–based strategies used to achieve these results often involved community collaboration, home visits, formation of participatory women’s groups, and provision of services by outreach teams from peripheral health facilities.ConclusionsThis comprehensive and systematic review provides evidence of the effectiveness of CBPHC in improving key indicators of maternal morbidity and mortality. Most projects combined community– and facility–based approaches, emphasizing potential added benefits from such holistic approaches. Community–based interventions will be an important component of a comprehensive approach to accelerate improvements in maternal health and to end preventable maternal deaths by 2030.

Can people-centered community-oriented interventions improve skilled birth attendance? Evidence from a quasi-experimental study in rural communities of Cambodia, Kenya, and Zambia

“…Despite the expansion of primary health care systems, CHW activities and service delivery vary greatly across and even within countries [18,38]. Location and frequency of CHW visits during the antenatal period, and the number and content of counseling messages delivered can vary even within large-scale integrated CHW programs [18,39]. This is likely due to the lack of standardization and sparse data on optimizing CHW service delivery.…”

Mobile clinics in humanitarian emergencies: a systematic review

“…For example, revitalising disrupted or dormant networks of community health workers by providing them with supplies and supervision to carry out community case management of key acute illnesses; establishing simple fixed health posts with mobile teams instead serving a resupply, supervisory, or referral/ambulance function; or directly addressing barriers to accessing existing fixed facilities (e.g. through cash transfers for community transport) [29,30].…”

Can people-centered community-oriented interventions improve skilled birth attendance? Evidence from a quasi-experimental study in rural communities of Cambodia, Kenya, and Zambia

“…Despite the expansion of primary health care systems, CHW activities and service delivery varies greatly across and even within countries [22,34]. Location and frequency of CHW visits during the antenatal period and the number and content of counseling messages delivered can vary even with large-scale integrated CHW programs in place [22,35]. This is likely due to the lack of standardization and sparse data on optimizing CHW service delivery.…”