Impact of macro-socioeconomic determinants on sustainable perinatal health care in Portugal: a qualitative study on the opinion of healthcare professionals and experts

Abstract

Background The WHO identified the importance of macro-socioeconomic determinants and political context as interlinked key factors affecting healthcare quality and health equity. As a response to the recent economic and financial crisis, Portugal approved in 2011 the Economic Adjustment Programme (EAP) to obtain financial assistance from the Troika in order to reduce public debt. This study aims to analyse the impact of the economic crisis and the EAP on perinatal healthcare quality for very preterm (VPT) and/or very low birth weight (VLBW) infants, as perceived by healthcare professionals and experts, within the health administrative regions of the two major metropolitan areas in Portugal. Methods A qualitative approach was applied to receive an in-depth understanding and accomplish perspective variability. A purposive sampling technique was used. Semi-structured interviews were conducted with twenty-one healthcare professionals and experts between October 2018–July 2019. Inductive thematic analysis was performed which encompassed a five-step categorization procedure. Data analysis was undertaken by utilizing Nvivo2011 software. Evolved themes were then associated with WHO’s Quality Standards on Maternal and New-born Care. A framework on the impact of macro-socioeconomic determinants on perinatal health care quality was developed. Results Although participants did not perceive the quality of perinatal care had deteriorated, the analysis of their accounts on work experience revealed that it was indeed adversely modified in all WHO Quality Standards. Health care provision was perceived as detrimental in five main areas: 1) Availability of human resources; 2) Functional referral systems; 3) Competent and motivated human resources; 4) Emotional support; and 5) Essential physical resources available. Policy reforms by the EAP resulted in reduced timeliness of care, increased waiting times, cuts in sequence and duration of consultations, and deficiencies in follow-up care for VPT/VLBW infants and their mothers. The EAP directly influenced working environment of healthcare professionals by causing stress, burnout, work absence, and brain drain. Conclusion An interrelation between macro-socioeconomic determinants and perinatal health care quality was disclosed. The economic crisis and EAP have adversely modified equitable perinatal health care quality for VPT/VLBW infants and their mothers. Our findings underlined the negative impact of austerity policies on vulnerable populations.

2008 economic crisis impact on perinatal and infant mortality in Southern European countries

“…Those factors have been associated with consequential risks posed to health, especially to child health,4 59 60 mental health61–63 and chronic illnesses,64 differing across socioeconomic groups,12 regions57 and time frames 4 10. The multifactorial impact of the Great Recession61 on maternal and perinatal health and mortality rates was observed in adverse socioeconomic consequences,11 61 65 altered motherhood,66 declining fertility and self-rated health,67 deteriorated mental health, especially for low-income groups,12 and lowered perceived social support during pregnancy 33…”

“…As described above, the diverse magnitude and duration of the socioeconomic effects of the recession and governmental response across European member states affected perinatal outcomes across the selected countries to a different extent 11. Austerity measures have been discussed to have harmed maternal and child health,33 93 perinatal healthcare quality,33 93 intensified health inequalities94 and increased material deprivation across Europe 59. However, other major contemporary events (eg, increased influenza and the 2015 heatwave in Spain) during the post-austerity period may have prevented identifying a possible delayed effect of austerity policies in slowing mortality decline 95.…”

“…As IMR and PMR are also considered standards to monitor the capacity of a country to provide social protection to its population under financial and social stress,32 33 we hypothesise that they may be associated with socioeconomic factors. Therefore, this study aims to assess time trend changes in PMR and IMR following the 2008 economic and financial crisis period, and its association with socioeconomic indicators (gross domestic product (GDP), gross household disposable income, long-term unemployment rate, unemployment rate, risk of poverty or social exclusion and the Gini coefficient) in Portugal, Greece, Italy and Spain.…”

“…As the Great Recession severely affected the economic situation of multiple EU countries when linked to the implementation of austerity measures (online supplemental tables 1 and 2),14 21–29 investigating the experiences of different member states may deliver valuable lessons for policy makers aiming for improving resilience strategies for healthcare systems 3. Though it is difficult to assess and measure healthcare systems’ performance and resilience,30 31 perinatal indicators (IMR and PMR) are central measures to observing healthcare quality and the responsiveness of a healthcare system 30 32 33…”

Spatial Access Matters: An Analysis of Policy Change and Its Effects on Avoidable Infant Mortality in Portugal

“…The demand and pressure of human resources is related to an aging workforce and the overall shortage of human resources, which remains a major obstacle to the optimal functioning of the NHS [29,31]. A recent study revealed that the 2008 economic crisis and austerity measures were perceived to have aggravated the deficiency in human resources in Portugal [32,33]. Confirming this, a study in 2016 reported that many medical doctors declared that they would opt to migrate due to a changed working environment induced by the crisis and austerity measures [34].…”