High coverage but low quality of maternal and newborn health services in the coverage cascade: who is benefitted and left behind in accessing better quality health services in Nepal?

Khatri, Resham Bahadur; Durham, Jo; Karkee, Rajendra; Assefa, Yibeltal

doi:10.1186/s12978-022-01465-z

Cited by 16 publications

(15 citation statements)

References 78 publications

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“…Qualitative studies show that access is also influenced by family relationships and gender norms which limit agency, access to resources, and restrict movement outside the home [ 18 , 19 ]. Health workers and FCHVs are responsible for nutrition counselling during ANC, but there are indications that the quality of this counselling may be sub-optimal [ 20 , 21 ]. Despite the following global guidance to address anaemia in pregnancy, anaemia is an intractable problem in Nepal.…”

Section: Introductionmentioning

confidence: 99%

Health worker perspectives on access to antenatal care in rural plains Nepal during the COVID-19 pandemic

et al. 2023

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The COVID-19 pandemic affected access to antenatal care in low and middle-income countries where anaemia in pregnancy is prevalent. We analyse how health workers provided antenatal care and the factors affecting access to antenatal care during the COVID-19 pandemic in Kapilvastu district in the western plains of Nepal. We used qualitative and quantitative methodologies, conducting eight semi-structured interviews with health workers who provided antenatal care during the pandemic, and a questionnaire containing open and closed questions with 52 female community health volunteers. Antenatal care was severely disrupted during the pandemic. Health workers had to find ways to provide care with insufficient personal protective equipment and guidance whilst facing extreme levels of stigmatisation which prevented them from providing outreach services. Pregnant women were fearful or unable to visit health institutions during the pandemic because of COVID-19 control measures. Pre-pandemic and during the pandemic health workers tried to contact pregnant and postpartum women and families over the phone, but this was challenging because of limited access to phones, and required pregnant women to make at least one antenatal care visit to give their phone number. The pandemic prevented new pregnancies from being registered, and therefore the possibilities to provide services over the phone for these pregnancies were limited. To reach the most marginalised during a pandemic or other health emergency, health volunteers and households need to exchange phone numbers, enabling proactive monitoring and care-seeking. Strengthening procurement and coordination between the municipal, provincial, and federal levels of government is needed to ensure adequacy of antenatal supplies, such as iron folic acid tablets, in health emergencies. Community engagement is important to ensure women and families are aware of the need to access antenatal care and iron folic acid, and to address stigmatisation of health workers.

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Section: Introductionmentioning

confidence: 99%

Health worker perspectives on access to antenatal care in rural plains Nepal during the COVID-19 pandemic

et al. 2023

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“…Therefore, it is imperative to reduce living standard related inequalities in Nepal so that a massive chunk of inequality in MCH services can be reduced. Privileged women in terms of living standards, education, access to financial institutions and other demographic characteristics are often found to utilize optimal quality Maternal and Newborn Health (MNH) services compared to their counterparts despite high coverage of such services [ 58 ].…”

Section: Discussionmentioning

confidence: 99%

Decomposing inequality in Maternal and Child Health (MCH) services in Nepal

G.C.

Adhikari

2023

BMC Public Health

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Background About 75.5% of women in Nepal’s urban areas receive at least four ANC visits, compared to 61.7% of women in the country’s rural areas. Similarly, just 34% of women in the lowest wealth quintile give birth in a medical facility compared to 90% of women in the richest group. As a result of this inequality, the poor in emerging nations suffer since those who are better off can make greater use of the healthcare than those who are less fortunate. This study aims to examine and decompose the contributions of various socioeconomic factors towards MCH service inequality in Nepal in the years 2011 and 2016. Methods Inequality in MCH services was estimated using concentration curves and their corresponding indices using data from Nepal Demographic Health Survey (NDHS) 2011 and 2016. We examined the inequality across three MCH service outcomes: less than 4 ANC visits, no postnatal checkups within 2 months of delivery and no SBA delivery and decomposed them across observed characteristics of the mothers aged between 15 and 49. Furthermore, Oaxaca-blinder decomposition approach was used to measure and decompose the inequality differential between two time periods. Results Inequality in MCH services was prevalent for all 3 MCH outcomes in 2011 and 2016, respectively. However, the concentration indices for <4 ANC visits, no SBA delivery, and no postnatal checkups within 2 months of birth increased from -0.2184, -0.1643, and -0.1284 to -0.1871, -0.0504, and -0.0218 correspondingly, showing the decrease in MCH services inequality over two time periods. Wealth index, women’s literacy, place of living, mother’s employment status, and problem of distance to reach nearest health facility were the main contributors. Conclusion We find that MCH services are clearly biased towards the women with higher living standards. National policies should focus on empowering women through education and employment, along with the creation of health facilities and improved educational institutions, in order to address inequalities in living standards, women’s education levels, and the problem of distance. Leveraging these factors can reduce inequality in MCH services.

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“…However, other ANC quality components have gotten little attention in many LMICs. Evidence suggested that only completion of 4ANC visits does not guarantee the uptake of recommended ANC interventions [ 124 ]. The provision of optimum quality care depends on the health system readiness (e.g., health workforce trained on ANC).…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, little research has been done on quality-adjusted coverage in LMICs [ 68 ]. As current literature focuses on the number of contacts as the quality of care, there is a need to measure quality-adjusted coverage using population-level household survey data such as demographic and health surveys [ 124 ]. Quality-adjusted coverage can be improved by focusing on care processes, especially technical quality.…”

Section: Discussionmentioning

confidence: 99%

Input, process, and output factors contributing to quality of antenatal care services: a scoping review of evidence

Khatri

Mengistu

Assefa

2022

BMC Pregnancy Childbirth

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Background High-quality antenatal care (ANC) provides a lifesaving opportunity for women and their newborns through providing health promotion, disease prevention, and early diagnosis and treatment of pregnancy-related health issues. However, systematically synthesised evidence on factors influencing the quality of ANC services is lacking. This scoping review aims to systematically synthesize the factors influencing in provision and utilisation of quality ANC services. Methods We conducted a scoping review of published evidence on the quality of ANC services. We searched records on four databases (PubMed, Scopus, Embase, and Google scholar) and grey literature from 1 to 2011 to 30 August 2021. We analysed data using Braun and Clarke’s thematic analysis approach. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guideline for the review. We explained themes using the Donabedian healthcare quality assessment model (input-process-output). Results Several inputs- and process-related factors contributed to suboptimal quality of ANC in many low and lower- or middle-income countries. Input factors included facility readiness (e.g., lack of infrastructure, provision of commodities and supplies, health workforce, structural and intermediary characteristics of pregnant women, and service delivery approaches). Processes-related factors included technical quality of care (e.g., lack of skilled adequate and timely care, and poor adherence to the guidelines) and social quality (lack of effective communication and poor client satisfaction). These input and process factors have also contributed to equity gaps in utilisation of quality ANC services. Conclusion Several input and process factors influenced the provision and utilization of optimum quality ANC services. Better health system inputs (e.g., availability of trained workforces, commodities, guidelines, context-specific programs) are essential to creating enabling facility environment for quality ANC services. Care processes can be improved by ensuring capacity-building activities for workforces (training, technical support visits), and mentoring staff working at peripheral facilities. Identifying coverage of quality ANC services among disadvantaged groups could be the initial step in designing and implementing targeted program approaches.

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High coverage but low quality of maternal and newborn health services in the coverage cascade: who is benefitted and left behind in accessing better quality health services in Nepal?

Cited by 16 publications

References 78 publications

Health worker perspectives on access to antenatal care in rural plains Nepal during the COVID-19 pandemic

Health worker perspectives on access to antenatal care in rural plains Nepal during the COVID-19 pandemic

Decomposing inequality in Maternal and Child Health (MCH) services in Nepal

Input, process, and output factors contributing to quality of antenatal care services: a scoping review of evidence

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