In Low- And Middle-Income Countries, Is Delivery In High-Quality Obstetric Facilities Geographically Feasible?

Gage, Anna; Carnes, Fei; Blossom, Jeff; Aluvaala, Jalemba; Amatya, Archana; Mahat, Kishori; Malata, Address; Roder‐DeWan, Sanam; Twum-Danso, Nana A.Y.; Yahya, Talhiya; Kruk, Margaret E

doi:10.1377/hlthaff.2018.05397

Cited by 58 publications

(56 citation statements)

References 28 publications

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“…A recent study in Haiti, Kenya, Malawi, Namibia, Nepal and Tanzania found that the vast majority of women now live within 2 hours of a hospital and that shifting all deliveries to hospital would reduce 2-hour access between 0.6% and 10%, depending on country. 34 For many, though not all, women, hospitals are closer than 2 hours: the average travel time to hospitals in the study varied from 22 min in Haiti to 82 min in Tanzania. The finding is consistent with previous studies of access to advanced care.…”

Section: Assumption 3: Emergency Referral Is An Effective Response Tomentioning

confidence: 84%

Health system redesign for maternal and newborn survival: rethinking care models to close the global equity gap

Roder‐DeWan¹,

Nimako

Twum-Danso

et al. 2020

BMJ Glob Health

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Large disparities in maternal and neonatal mortality exist between low- and high-income countries. Mothers and babies continue to die at high rates in many countries despite substantial increases in facility birth. One reason for this may be the current design of health systems in most low-income countries where, unlike in high-income countries, a substantial proportion of births occur in primary care facilities that cannot offer definitive care for complications. We argue that the current inequity in care for childbirth is a global double standard that limits progress on maternal and newborn survival. We propose that health systems need to be redesigned to shift all deliveries to hospitals or other advanced care facilities to bring care in line with global best practice. Health system redesign will require investing in high-quality hospitals with excellent midwifery and obstetric care, boosting quality of primary care clinics for antenatal, postnatal, and newborn care, decreasing access and financial barriers, and mobilizing populations to demand high-quality care. Redesign is a structural reform that is contingent on political leadership that envisions a health system designed to deliver high-quality, respectful care to all women giving birth. Getting redesign right will require focused investments, local design and adaptation, and robust evaluation.

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Section: Assumption 3: Emergency Referral Is An Effective Response Tomentioning

confidence: 84%

Health system redesign for maternal and newborn survival: rethinking care models to close the global equity gap

Roder‐DeWan¹,

Nimako

Twum-Danso

et al. 2020

BMJ Glob Health

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“…10 Several studies have described substantial variation in individual behavior across different health systems, particularly with regard to childbirth facilities. [4][5][6]11,14,17,[20][21][22][23][24][25][26][27][28][29][30][31][32][33] There is limited evidence characterizing the extent of primary health care bypass in Ghana and West Africa in general. A better understanding of these bypass behaviors may provide insights into local primary health care improvement efforts for policy makers and facility managers.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Bypass of the Nearest Primary Health Care Facility Among Women in Ghana

Bell

Macarayan²,

Ratcliffe

et al. 2020

JAMA Netw Open

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IMPORTANCE Recent reports have highlighted that expanding access to health care is ineffective at meeting the goal of universal health coverage if the care offered does not meet a minimum level of quality. Health care facilities nearest to patient's homes that are perceived to offer inadequate or inappropriate care are frequently bypassed in favor of more distant private or tertiary-level hospital facilities that are perceived to offer higher-quality care. OBJECTIVE To estimate the frequency with which women in Ghana bypass the nearest primary health care facility and describe patient experiences, costs, and other factors associated with this choice. DESIGN, SETTING, AND PARTICIPANTS This nationally representative survey study was conducted in 2017 and included 4203 households to identify women in Ghana aged 15 to 49 years (ie, reproductive age) who sought primary care within the last 6 months. Women who sought care within the past 6 months were included in the study. Data were analyzed from 2018 to 2019. EXPOSURES Bypass was defined as a woman's report that she sought care at a health facility other than the nearest facility. MAIN OUTCOMES AND MEASURES Sociodemographic characteristics, reasons why women sought care, reasons why women bypassed their nearest facility, ratings for responsiveness of care, patient experience, and out-of-pocket costs. All numbers and percentages were survey-weighted to account for survey design. RESULTS A total of 4289 women met initial eligibility criteria, and 4207 women (98.1%) completed the interview. A total of 1993 women reported having sough health care in the past 6 months, and after excluding those who were ineligible and survey weighting, the total sample included 1946 women. Among these, 629 women (32.3%) reported bypassing their nearest facilities for primary care. Women who bypassed their nearest facilities, compared with women who did not, were more likely to visit a private facility (152 women [24.5%] vs 202 women [15.6%]) and borrow money to pay for their care (151 women [24.0%] vs 234 women [17.8%]). After adjusting for covariates, women who bypassed reported paying a mean of 107.2 (95% CI, 79.1-135.4

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“…• High-income countries, as defined by the World Bank 29 ; given the large discrepancies in pregnancy outcomes and care structures between high, and low and middle-income countries 30,31…”

Section: Country Of Publicationmentioning

confidence: 99%

A protocol for a systematic review of clinical practice guidelines for recurrent miscarriage

et al. 2020

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Recurrent miscarriage (RM) was recently re-defined by the European Society of Human Reproduction and Embryology (ESHRE) as the loss of two or more consecutive pregnancies. Before this, and indeed still in some countries, RM was defined as three or more consecutive pregnancy losses. While the incidence of RM depends on the definition employed and population studied, it is generally accepted to affect 1-6% of women of reproductive age. Clinical practice guidelines (CPGs) for RM have been published by some professional organisations. While there are CPGs on miscarriage in Ireland, there are none concerning RM specifically. The aim of this systematic review is to identify, appraise and describe published CPGs for the management, investigation and/or follow-up of RM within high-income countries. Electronic databases (MEDLINE (Ovid®; 1946), Embase® (Elsevier; 1980), CINAHL Complete (EBSCOhost; 1994), Web of Science™ (Thomson Reuters), Scopus (Elsevier; 2004), and Open Grey (INIST-CNRS; 2011)), selected guideline repositories, and the websites of professional societies will be searched to identify CPGs, published within the last 20 years, for potential inclusion. Two reviewers will review abstracts and full texts independently against the eligibility criteria. Characteristics and recommendations of included CPGs will be extracted by one reviewer and double-checked by another. Two reviewers will use the Appraisal of Guidelines for Research and Evaluation version 2 (AGREE II) instrument independently to assess the quality of the included CPGs. Narrative synthesis will be conducted to appraise and compare CPGs and their recommendations or guidance therein. The identification, appraisal and description of published CPGs in other high-income countries will be a valuable first step in informing efforts to promote the optimisation and standardisation of RM care.

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In Low- And Middle-Income Countries, Is Delivery In High-Quality Obstetric Facilities Geographically Feasible?

Cited by 58 publications

References 28 publications

Health system redesign for maternal and newborn survival: rethinking care models to close the global equity gap

Health system redesign for maternal and newborn survival: rethinking care models to close the global equity gap

Assessment of Bypass of the Nearest Primary Health Care Facility Among Women in Ghana

A protocol for a systematic review of clinical practice guidelines for recurrent miscarriage

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