Implementation outcomes of policy and programme innovations to prevent obstetric haemorrhage in low- and middle-income countries: a systematic review

Abstract

Globally, obstetric haemorrhage (OH) remains the leading cause of maternal mortality. Much of the associated mortality is ascribed to challenges surrounding deployment of innovations rather than lack of availability. In low- and middle-income countries (LMICs), where the burden is highest, there is a growing interest in implementation research as a means to bridge the ‘know–do’ gap between proven interventions and their reliable implementation at scale. In this systematic review, we identified and synthesized qualitative and quantitative data across the implementation outcomes of OH prevention innovations in LMICs using a taxonomy developed by Proctor et al. We also identified service outcomes for the included innovations, as well as implementation strategies and implementation facilitators and barriers. Eligible studies were empirical, focused on the implementation of OH prevention programmes or policies and occurred in an LMIC. Eight databases were searched. Two authors independently assessed studies for selection and extracted data; the first author resolved discrepancies. Narrative synthesis was used to analyse and interpret the findings. Studies were predominantly focused in Africa and on primary prevention. Interventions included prophylactic use of uterotonics (n = 7), clinical provider skills training (n = 4) and provision of clinical guidelines (n = 1); some (n = 3) were also part of a multi-component quality improvement bundle. Various barriers were reported, including challenges among intervention beneficiaries, providers and within the health system; however, studies reported the development and testing of practical implementation solutions. These included training and monitoring of implementers, community and stakeholder engagement and guidance by external mentors. Some studies linked successful delivery to implementation outcomes, most commonly adoption and acceptability, but also feasibility, penetration and sustainability. Findings suggest that innovations to prevent OH can be acceptable, appropriate and feasible in LMIC settings; however, more research is needed to better evaluate these and other under-reported implementation outcomes.

The Impact of Professional Midwives and Mentoring on the Quality and Availability of Maternity Care in Rural Government Hospitals in Bangladesh

“…This is notable in that the literature shows that companionship is not necessarily a common practice in African countries and there is a dearth of literature on frequency of labour companionship practices in Asia (40,41). Global literature on AMSTL re ects both gaps and implementation successes in LMICs (42). Apart from labour companionship and AMSTL, use of an ANC card and upright position for labor were seen 50% of the time in hospitals with no midwives.…”

Interventions to enhance healthcare utilisation among pregnant women to reduce maternal mortality in low- and middle-income countries: a review of systematic reviews

“…To accelerate progress towards this goal, simple, cost-effective interventions to increase healthcare utilisation among pregnant women must be implemented or scaled up in LMIC. Several systematic reviews have identi ed, evaluated, and summarised the ndings from relevant individual studies of effective interventions [18][19][20][21][22]. We aimed to synthesize evidence from systematic reviews on interventions to improve healthcare service utilisation among pregnant women in LMICs to reduce maternal mortality.…”