Health facility preparedness of maternal and neonatal health services: a survey in Jumla, Nepal

Tamang, Pasang; Simkhada, Padam; Bissell, Paul; Teijlingen, Edwin Roland Van; Khatri, Rose; Stephenson, John

doi:10.1186/s12913-021-07054-3

Cited by 7 publications

(8 citation statements)

References 12 publications

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“…poor general readiness were consistent with the previous study conducted in Karnali province, which showed shortage of medicine for women and newborns [43] and many low and low income countries of South Asia and Africa [44]. Competent staff and equipment availability are important components of health facility readiness for quality service delivery [45].…”

Section: Plos Global Public Healthsupporting

confidence: 86%

“…These are crucial to identifying and managing potential pregnancy and childbirth complications. In addition, availability of trained workforces, equipment, and laboratory services helps build trust with the health system and increase the service users' engagement with the system [43,49]. Thus, local health system authorities need to identify competent staff and equipment availability in their catchment health facilities and ensure optimal health system readiness.…”

Section: Plos Global Public Healthmentioning

confidence: 99%

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Assessment of health system readiness for routine maternal and newborn health services in Nepal: Analysis of a nationally representative health facility survey, 2015

Khatri

Assefa

Durham

2022

PLOS Glob Public Health

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Access to and utilisation of routine maternal and newborn health (MNH) services, such as antenatal care (ANC), and perinatal services, has increased over the last two decades in Nepal. The availability, delivery, and utilisation of quality health services during routine MNH visits can significantly impact the survival of mothers and newborns. Capacity of health facility is critical for the delivery of quality health services. However, little is known about health system readiness (structural quality) of health facilities for routine MNH services and associated determinants in Nepal. Data were derived from the Nepal Health Facility Survey (NHFS) 2015. Total of 901 health facilities were assessed for structural quality of ANC services, and 454 health facilities were assessed for perinatal services. Adapting the World Health Organization’s Service Availability and Readiness Assessment manual, we estimated structural quality scores of health facilities for MNH services based on the availability and readiness of related subdomain-specific items. Several health facility-level characteristics were considered as independent variables. Logistic regression analyses were conducted, and the odds ratio (OR) was reported with 95% confidence intervals (CIs). The significance level was set at p-value of <0.05. The mean score of the structural quality of health facilities for ANC, and perinatal services was 0.62, and 0.67, respectively. The average score for the availability of staff (e.g., training) and guidelines-related items in health facilities was the lowest (0.37) compared to other four subdomains. The odds of optimal structural quality of health facilities for ANC services were higher in private health facilities (adjusted odds ratio (aOR) = 2.65, 95% CI: 1.48, 4.74), and health facilities supervised by higher authority (aOR = 1.96; CI: 1.22, 3.13) while peripheral health facilities had lower odds (aOR = 0.13; CI: 0.09, 0.18) compared to their reference groups. Private facilities were more likely (aOR = 1.69; CI:1.25, 3.40) to have optimal structural quality for perinatal services. Health facilities of Karnali (aOR = 0.29; CI: 0.09, 0.99) and peripheral areas had less likelihood (aOR = 0.16; CI: 0.10, 0.27) to have optimal structural quality for perinatal services. Provincial and local governments should focus on improving the health system readiness in peripheral and public facilities to deliver quality MNH services. Provision of trained staff and guidelines, and supply of laboratory equipment in health facilities could potentially equip facilities for optimal quality health services delivery. In addition, supervision of health staff and facilities and onsite coaching at peripheral areas from higher-level authorities could improve the health management functions and technical capacity for delivering quality MNH services. Local governments can prioritise inputs, including providing a trained workforce, supplying equipment for laboratory services, and essential medicine to improve the quality of MNH services in their catchment.

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Section: Plos Global Public Healthsupporting

confidence: 86%

Section: Plos Global Public Healthmentioning

confidence: 99%

Assessment of health system readiness for routine maternal and newborn health services in Nepal: Analysis of a nationally representative health facility survey, 2015

Khatri

Assefa

Durham

2022

PLOS Glob Public Health

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“…Like Madhesh province, previous studies showed that women of Karnali province had poor access to health services and received poor quality of care from the health facilities [ 78 – 80 ]. Karnali province is geographically inaccessible with difficult geographic terrain and transportation system, poor health infrastructure for better health services delivery [ 79 ]. Contrarily, our analysis revealed that health facilities of Gandaki province provided better quality antenatal care services.…”

Section: Discussionmentioning

confidence: 99%

Investigation of technical quality of antenatal and perinatal services in a nationally representative sample of health facilities in Nepal

2022

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Background Access to routine antenatal and perinatal services is improved in the last two decades in Nepal. However, gaps remain in coverage and quality of care delivered from the health facilities. This study investigated the delivery of technical quality antenatal and perinatal services from health facilities and their associated determinants in Nepal. Methods Data for this study were derived from the Nepal Health Facility Survey 2015. The World Health Organization's Service Availability and Readiness Assessment framework was adopted to assess the technical quality of antenatal and perinatal services of health facilities. Outcome variables included technical quality scores of i) 269 facilities providing antenatal services and ii) 109 facilities providing childbirth and postnatal care services (perinatal care). Technical quality scores of health facilities were estimated adapting recommended antenatal and perinatal interventions. Independent variables included locations and types of health facilities and their management functions (e.g., supervision). We conducted a linear regression analysis to identify the determinants of better technical quality of health services in health facilities. Beta coefficients were exponentiated into odds ratios (ORs) and reported with 95% confidence intervals (CIs). The significance level was set at p-value < 0.05. Results The mean score of the technical quality of health facilities for each outcome variable (antenatal and perinatal services) was 0.55 (out of 1.00). Compared to province one, facilities of Madhesh province had 4% lower odds (adjusted OR = 0.96; 95%CI: 0.92, 0.99) of providing better quality antenatal services, while health facilities of Gandaki province had higher odds of providing better quality antenatal services (aOR = 1.05; 95% CI: 1.01, 1.10). Private facilities had higher odds (aOR = 1.13; 95% CI: 1.03, 1.23) of providing better quality perinatal services compared to public facilities. Conclusions Private facilities provide better quality antenatal and perinatal health services than public facilities, while health facilities of Madhesh province provide poor quality perinatal services. Health system needs to implement tailored strategies, including recruiting health workers, supervision and onsite coaching and access to necessary equipment and medicine in the facilities of Madhesh province. Health system inputs (trained human resources, equipment and supplies) are needed in the public facilities. Extending the safe delivery incentive programme to the privately managed facilities could also improve access to better quality health services in Nepal.

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“…The WHO has emphasised on infrastructural development, supply of essential drugs and equipment, skilled health workforce and guideline-based management for improving the quality of care in the facilities (34,35) . To that end, provision of essential medicines, a stock of necessary equipment and supplies, development of existing infrastructure and appropriate training of healthcare staff may help to overcome the gaps in relation to facility preparedness (29,36) .…”

Section: Discussionmentioning

confidence: 99%

A qualitative assessment of facility readiness and barriers to the facility-based management of childhood severe acute malnutrition in the public healthcare settings in Bangladesh

Fahim

Islam

Rasul

et al. 2022

Public Health Nutr.

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Objective: To assess facility readiness and identify barriers to the facility-based management of childhood severe acute malnutrition (SAM) in public healthcare settings. Design: Qualitative methods were applied to assess readiness and identify different perspectives on barriers to the facility-based management of children with SAM. Data collection was done using in-depth interviews, key informant interviews, exit interviews, and pre-tested observation tools. Settings: Two tertiary care and four district hospitals in Rangpur and Sylhet Divisions of Bangladesh. Participants: Healthcare professionals and caregivers of children with SAM. Results: Anthropometric tools, glucometer, medicines, F-75, F-100, and national guidelines for facility-based management of childhood SAM were found unavailable in some of the hospitals. Sitting and sleeping arrangements for the caregivers were absent in all of the chosen facilities. We identified a combination of health system and contextual barriers that inhibited the facility-based management of SAM. The health system barriers include inadequate manpower, rapid turnover of staff, increased workload, lack of training, and lack of adherence to management protocol. The major facility barriers were insufficient space and unavailability of required equipment, medicines, and foods for hospitalized children with SAM. The reluctance of caregivers to complete the treatment regimen, their insufficient knowledge regarding proper feeding, increased number of attendants, and poverty of parents were the principal contextual barriers. Conclusions: The study findings provide insights on barriers that are curbing the facility-based management of SAM and emphasize policy efforts to develop feasible interventions to reduce the barriers and ensure the preparedness of the facilities for effective service delivery.

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Health facility preparedness of maternal and neonatal health services: a survey in Jumla, Nepal

Cited by 7 publications

References 12 publications

Assessment of health system readiness for routine maternal and newborn health services in Nepal: Analysis of a nationally representative health facility survey, 2015

Assessment of health system readiness for routine maternal and newborn health services in Nepal: Analysis of a nationally representative health facility survey, 2015

Investigation of technical quality of antenatal and perinatal services in a nationally representative sample of health facilities in Nepal

A qualitative assessment of facility readiness and barriers to the facility-based management of childhood severe acute malnutrition in the public healthcare settings in Bangladesh

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