Interventions to increase facility births and provision of postpartum care in sub-Saharan Africa: a scoping review

Abstract

Background Most maternal deaths occur during the intrapartum and peripartum periods in sub-Saharan Africa, emphasizing the importance of timely access to quality health service for childbirth and postpartum care. Increasing facility births and provision of postpartum care has been the focus of numerous interventions globally, including in sub-Saharan Africa. The objective of this scoping review is to synthetize the characteristics and effectiveness of interventions to increase facility births or provision of postpartum care in sub-Saharan Africa. Methods We searched for systematic reviews, scoping reviews, qualitative studies and quantitative studies using experimental, quasi experimental, or observational designs, which reported on interventions for increasing facility birth or provision of postpartum care in sub-Saharan Africa. These studies were published in English or French. The search comprised six scientific literature databases (Pubmed, CAIRN, la Banque de Données en Santé Publique, the Cochrane Library). We also used Google Scholar and snowball or citation tracking. Results Strategies identified in the literature as increasing facility births in the sub-Saharan African context include community awareness raising, health expenses reduction (transportation or user fee), non-monetary incentive programs (baby kits), or a combination of these with improvement of care quality (patient’s privacy, waiting time, training of provider), and or follow-up of pregnant women to use health facility for birth. Strategies that were found to increase provision of postpartum care include improvement of care quality, community-level identification and referrals of postpartum problems and transport voucher program. Conclusions To accelerate achievements in facility birth and provision of postpartum care in sub-Saharan Africa, we recommend strategies that can be implemented sustainably or produce sustainable change. How to sustainably motivate community actors in health interventions may be particularly important in this respect. Furthermore, we recommend that more intervention studies are implemented in West and Central Africa, and focused more on postpartum. Plain English summary In in sub-Saharan Africa, many women die when giving or few days after birth. This happens because they do not have access to good health services in a timely manner during labor and after giving birth. Worldwide, many interventions have been implemented to Increase the number of women giving birth in a health facility or receiving care from health professional after giving birth. The objective of this study is to synthetize the characteristics and effectiveness of interventions that have been implemented in sub-Saharan Africa, aiming to increase the number of women giving birth in a health facility or receiving care from health professional after birth. To proceed with this synthesis, we did a review of studies that have reported on such interventions in sub-Saharan Africa. These studies were published in English or French. The interventions identified to increase the number of women giving birth in a health facility include community awareness raising, reduction of health expenses (transportation or user fee), non-monetary incentive programs (baby kits), or a combination of these with improvement of care quality (patient’s privacy, waiting time, training of provider), and or follow-up of pregnant women to use health facility for birth. Interventions implemented to increase the number women receiving care from a health professional after birth include improvement of care quality, transport voucher program and community-level identification and referrals to the health center of mothers’ health problems. In sub-Saharan Africa, to accelerate increase in the number of women giving birth in a health facility and receiving care from a health professional after, we recommend interventions that can be implemented sustainably or produce sustainable change. How to sustainably motivate community actors in health interventions may be particularly important in this respect. Furthermore, we recommend the conduct in West and Central Africa, of more studies targeting interventions to increase the number of women giving birth in a health facility and or receiving care from a health professional after birth.

Exploring and prioritising strategies for improving uptake of postnatal care services in Thyolo, Malawi: A qualitative study

“…Furthermore, another integrative review concluded that poorly trained HCWs deter the utilisation of PNC services because their clients lose trust [ 25 ]. The provision of training could be viewed as a quest to guarantee quality PNC services which is another strategy recommended in the literature and has yielded improved rates of PNC attendance [ 26 ]. These pieces of training could be embedded as part of continuous professional development (CPD) for the HCWs.…”

“…In this case, then, other women could be trained to support other postpartum women with prior training and boundaries set in advance. Evidence shows that community-based health workers (CHWs) are integral to the provision of PNC services and their participation in the delivery has increased uptake [ 26 ]. Adoption of community midwifery assistants in Malawi could be a link that can be strengthened while including CHWs as well to take up some of these roles [ 28 ] with prior training on the specific postpartum assessments they need to conduct for the mother and newborn [ 10 , 31 ].…”

Maternal Mortality in Africa: Regional Trends (2000–2017)

“…The highest proportion of deliveries in health facilities is in the North African region (84%), while the lower regions are the East and West African ones, with 51.2% and 51.4% deliveries at health institutions ( Table 4 ). In the West and Central African regions, the proportion of women receiving care from a professional at birth is also low [ 112 ]. Another problem in South and East Africa is the delay in accessing healthcare.…”

“…The lack of recourses to maternal health care and the acceptability and affordability of maternal health services are factors in MM in Sub-Saharan countries [ 112 ]. Nevertheless, the main problem in Sub-Saharan Africa is not so much the accessibility of health services but that women seek care late in pregnancy.…”

Integrating Client Tracker Tool Into Fistula Management: Experience From the Fistula Care Plus Project in the Democratic Republic of Congo, 2017 to 2019

“…First, the MoH must be fully involved in the scale-up and use of this tool at the national level. The State's adoption of a health intervention would better guarantee its sustainability; however, this guarantee may be mainly based on financial resources ( 16 – 18 ). In addition, to ensure CT sustainability for FGF management, it is crucial to address the workload related challenge.…”