Impact of the roll out of comprehensive emergency obstetric care on institutional birth rate in rural Nepal

Maru, Duncan Smith-Rohrberg; Bangura, Alex Harsha; Mehta, Pooja; Bista, Deepak; Borgatta, Lynn; Pande, Sami; Citrin, David; Khanal, Sumesh; Banstola, Amrit; Maru, Duncan

doi:10.1186/s12884-017-1267-y

Cited by 7 publications

(8 citation statements)

References 19 publications

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“…Following the introduction of comprehensive emergency obstetric services at Bayalpata Hospital via the partnership, we previously reported an increase in institutional birth rate from 30% to 78% over a two-year period. 21 These results provide encouraging evidence that the application of an accountable care framework in resource-limited areas can lead to improved access as well as more efficient and higher quality care, and thus better outcomes.…”

Section: Discussionmentioning

confidence: 79%

Accountable Care Reforms Improve Women’s And Children’s Health In Nepal

Maru

Nirola

et al. 2017

Health Affairs

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Over the last decade, the Ministry of Health of Nepal and the non-profit Possible have partnered to deliver primary and secondary healthcare via a public-private partnership. We apply an accountable care framework we previously developed to describe the delivery of their integrated reproductive, maternal, newborn, and child health services in the Achham district in rural Nepal. In a prospective pre-post study (n=682 pregnancies at baseline and 541 pregnancies in follow-up over the course of 18 months), we find an improvement in population-level indicators linked to maternal and infant mortality reduction: the attendance of four antenatal care visits (83% to 90%); institutional birth rate (81% to 93%); and postpartum contraceptive prevalence (19% to 47%). The intervention cost $3.40 per capita and $185 total per pregnant woman. This study provides new analysis and evidence on the implementation of innovative care and financing models in limited-resource settings.

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Section: Discussionmentioning

confidence: 79%

Accountable Care Reforms Improve Women’s And Children’s Health In Nepal

Maru

Nirola

et al. 2017

Health Affairs

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Section: Introductionmentioning

confidence: 99%

“…In 2012, Bayalpata Hospital implemented comprehensive emergency obstetric care services and found that the institutional birth rate in the catchment area population significantly increased from 30 to 77% [7]. Qualitative data showed that targeting social support, birth planning, and resources may be important for reaching the remaining group of women not accessing services [7,8]. The success of CenteringPregnancy in high-resource settings [9,10], and participatory action women's groups in low-resource settings [11,12], suggested that these group care models may promote women's empowerment and social support network development to address resource and sociocultural barriers to care.…”

Section: Introductionmentioning

confidence: 99%

Measuring fidelity, feasibility, costs: an implementation evaluation of a cluster-controlled trial of group antenatal care in rural Nepal

et al. 2020

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Background: Access to high-quality antenatal care services has been shown to be beneficial for maternal and child health. In 2016, the WHO published evidence-based recommendations for antenatal care that aim to improve utilization, quality of care, and the patient experience. Prior research in Nepal has shown that a lack of social support, birth planning, and resources are barriers to accessing services in rural communities. The success of CenteringPregnancy and participatory action women's groups suggests that group care models may both improve access to care and the quality of care delivered through women's empowerment and the creation of social networks. We present a group antenatal care model in rural Nepal, designed and implemented by the healthcare delivery organization Nyaya Health Nepal, as well as an assessment of implementation outcomes. Methods: The study was conducted at Bayalata Hospital in Achham, Nepal, via a public private partnership between the Nepali non-profit, Nyaya Health Nepal, and the Ministry of Health and Population, with financial and technical assistance from the American non-profit, Possible. We implemented group antenatal care as a prospective non-randomized cluster-controlled, type I hybrid effectiveness-implementation study in six village clusters. The implementation approach allows for iterative improvement in design, making changes to improve the quality of the intervention. Assessments of implementation process and model fidelity were undertaken using a mobile checklist completed by nurse supervisors, and observation forms completed by program leadership. We evaluated data quarterly using descriptive statistics to identify trends. Qualitative interviews and team communications were analyzed through immersion crystallization to identify major themes that evolved during the implementation process.

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“…Possible’s experience in improving RMNCH in rural Nepal initially centered on facility-based expansion of services and quality improvement. A survey conducted from 2011 to 2013 showed a steep increase in utilization of birth services, with institutional birth rising from 30 to 77% [ 25 , 26 ]. Logistic regression revealed that the presence of comprehensive obstetric services, belief that the hospital is the safest birth location, safety prioritization in decision-making, and higher average income all significantly contributed to this change [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

“…A survey conducted from 2011 to 2013 showed a steep increase in utilization of birth services, with institutional birth rising from 30 to 77% [ 25 , 26 ]. Logistic regression revealed that the presence of comprehensive obstetric services, belief that the hospital is the safest birth location, safety prioritization in decision-making, and higher average income all significantly contributed to this change [ 26 ]. With 23% of women still delivering outside of a facility, and minimal reach into the community, Possible embarked on designing a community-based strategy for RMNCH [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

An integrated community health worker intervention in rural Nepal: a type 2 hybrid effectiveness-implementation study protocol

Maru¹,

Nirola

Thapa³

et al. 2018

Implementation Sci

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BackgroundEvidence-based medicines, technologies, and protocols exist to prevent many of the annual 300,000 maternal, 2.7 million neonatal, and 9 million child deaths, but they are not being effectively implemented and utilized in rural areas. Nepal, one of South Asia’s poorest countries with over 80% of its population living in rural areas, exemplifies this challenge. Community health workers are an important cadre in low-income countries where human resources for health and health care infrastructure are limited. As local women, they are uniquely positioned to understand and successfully navigate barriers to health care access. Recent case studies of large community health worker programs have highlighted the importance of training, both initial and ongoing, and accountability through structured management, salaries, and ongoing monitoring and evaluation. A gap in the evidence regarding whether such community health worker systems can change health outcomes, as well as be sustainably adopted at scale, remains. In this study, we plan to evaluate a community health worker system delivering an evidence-based integrated reproductive, maternal, newborn, and child health intervention as it is scaled up in rural Nepal.MethodsWe will conduct a type 2 hybrid effectiveness-implementation study to test both the effect of an integrated reproductive, maternal, newborn, and child health intervention and the implementation process via a professional community health worker system. The intervention integrates five evidence-based approaches: (1) home-based antenatal care and post-natal care counseling and care coordination; (2) continuous surveillance of all reproductive age women, pregnancies, and children under age 2 years via a mobile application; (3) Community-Based Integrated Management of Newborn and Childhood Illness; (4) group antenatal and postnatal care; and 5) the Balanced Counseling Strategy to post-partum contraception. We will evaluate effectiveness using a pre-post quasi-experimental design with stepped implementation and implementation using the RE-AIM framework.DiscussionThis is the first hybrid effectiveness-implementation study of an integrated reproductive, maternal, newborn, and child health intervention in rural Nepal that we are aware of. As Nepal takes steps towards achieving the Sustainable Development Goals, the data from this three-year study will be useful in the detailed planning of a professionalized community health worker cadre delivering evidence-based reproductive, maternal, newborn, and child health interventions to the country’s rural population.Trial registrationClinicalTrials.gov Identifier: NCT03371186, registered 04 December 2017, retrospectively registered.Electronic supplementary materialThe online version of this article (10.1186/s13012-018-0741-x) contains supplementary material, which is available to authorized users.

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Impact of the roll out of comprehensive emergency obstetric care on institutional birth rate in rural Nepal

Cited by 7 publications

References 19 publications

Accountable Care Reforms Improve Women’s And Children’s Health In Nepal

Accountable Care Reforms Improve Women’s And Children’s Health In Nepal

Measuring fidelity, feasibility, costs: an implementation evaluation of a cluster-controlled trial of group antenatal care in rural Nepal

An integrated community health worker intervention in rural Nepal: a type 2 hybrid effectiveness-implementation study protocol

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