“…This is partly due to the ongoing reforms and changes. For example for the Russian Federation, earlier studies reported substandard and outdated maternal care (Danichevski et al, 2008), while a more recent study reported on significant system changes and improvements in maternal care (Shuvalova et al, 2015). Furthermore, our review only included publications in English, so that relevant articles in other languages were not taken on board.…”
Section: Discussionmentioning
confidence: 99%
“…However, that maternal wards are well distributed throughout the entire territory of Serbia does not ensure that all services offered are adequate and of good quality. In Russia, although accessibility has improved, geographical access to care in rural areas can be difficult (Shuvalova et al, 2015). Women living in rural areas in Azerbaijan and Ukraine are often late in seeking maternal care due to transportation problems (Stepurko et al, 2013;Habibov, 2011).…”
Section: Availability Of Maternal Carementioning
confidence: 99%
“…Also in Russia, limits to women's knowledge due to a lack of information or generally low level of health literacy are reported as a barrier to accessing necessary maternal care (Graham et al, 2006). Even though the situation in Russia has improved, the most disadvantaged in this respect are the ones living in remote areas and/or being poor (Shuvalova et al, 2015).…”
Section: Approachability and Acceptability Of Maternal Carementioning
a b s t r a c tMaternal health outcomes in Central and Eastern Europe (CEE) compare unfavorable with those in Western Europe, despite macro-indicators that suggest well-designed maternal care systems. However, macro-indicators at the system level only capture capacity, funding and utilization of care and not the actual allocation of financial and human resources, the quality of care and access to it. It is these latter which are problematic in the CEE region. In this study service-related indicators of access to maternal care in CEE are examined. These include availability, appropriateness, affordability, approachability and acceptability of maternal care.This study uses a qualitative systematic literature review, analyzing information of peer-reviewed articles published since 2004. Other inclusion criteria included language, setting and publication purpose. The included articles were analyzed using a framework analysis technique and quality was assessed using standardized evaluation checklists.Results indicate improvements in maternal care. However, availability of care is limited by outdated equipment and training curricula, and the lack of professionals and pharmaceuticals. Geographical distance to healthcare institutions, inappropriate communication of providers and waiting times are the main approachability barriers. Some mothers are unaware of the importance of care or are discouraged to utilize healthcare services because of cultural aspects. Finally, a major barrier in accessing maternal care in the CEE is the inability to pay for it.Our findings indicate that major gaps in evidence exist and that more representative and better quality data should be collected. Governments in CEE countries need to establish a reliable system for measuring and monitoring a suitable set of indicators, as well as deal with the general social and economic problem of informality. Medical curricula in the CEE region need to be overhauled and there should be a focus on improving the allocation of medical staff and institutions as well as protecting vulnerable population groups to ensure universal access to care.
“…This is partly due to the ongoing reforms and changes. For example for the Russian Federation, earlier studies reported substandard and outdated maternal care (Danichevski et al, 2008), while a more recent study reported on significant system changes and improvements in maternal care (Shuvalova et al, 2015). Furthermore, our review only included publications in English, so that relevant articles in other languages were not taken on board.…”
Section: Discussionmentioning
confidence: 99%
“…However, that maternal wards are well distributed throughout the entire territory of Serbia does not ensure that all services offered are adequate and of good quality. In Russia, although accessibility has improved, geographical access to care in rural areas can be difficult (Shuvalova et al, 2015). Women living in rural areas in Azerbaijan and Ukraine are often late in seeking maternal care due to transportation problems (Stepurko et al, 2013;Habibov, 2011).…”
Section: Availability Of Maternal Carementioning
confidence: 99%
“…Also in Russia, limits to women's knowledge due to a lack of information or generally low level of health literacy are reported as a barrier to accessing necessary maternal care (Graham et al, 2006). Even though the situation in Russia has improved, the most disadvantaged in this respect are the ones living in remote areas and/or being poor (Shuvalova et al, 2015).…”
Section: Approachability and Acceptability Of Maternal Carementioning
a b s t r a c tMaternal health outcomes in Central and Eastern Europe (CEE) compare unfavorable with those in Western Europe, despite macro-indicators that suggest well-designed maternal care systems. However, macro-indicators at the system level only capture capacity, funding and utilization of care and not the actual allocation of financial and human resources, the quality of care and access to it. It is these latter which are problematic in the CEE region. In this study service-related indicators of access to maternal care in CEE are examined. These include availability, appropriateness, affordability, approachability and acceptability of maternal care.This study uses a qualitative systematic literature review, analyzing information of peer-reviewed articles published since 2004. Other inclusion criteria included language, setting and publication purpose. The included articles were analyzed using a framework analysis technique and quality was assessed using standardized evaluation checklists.Results indicate improvements in maternal care. However, availability of care is limited by outdated equipment and training curricula, and the lack of professionals and pharmaceuticals. Geographical distance to healthcare institutions, inappropriate communication of providers and waiting times are the main approachability barriers. Some mothers are unaware of the importance of care or are discouraged to utilize healthcare services because of cultural aspects. Finally, a major barrier in accessing maternal care in the CEE is the inability to pay for it.Our findings indicate that major gaps in evidence exist and that more representative and better quality data should be collected. Governments in CEE countries need to establish a reliable system for measuring and monitoring a suitable set of indicators, as well as deal with the general social and economic problem of informality. Medical curricula in the CEE region need to be overhauled and there should be a focus on improving the allocation of medical staff and institutions as well as protecting vulnerable population groups to ensure universal access to care.
“…Small-scale improvements in this direction are reported in other countries as well, for example in Serbia (Arsenijevic et al, 2014). Russia has undergone significant system changes and succeeded in improving maternal healthcare system with an increase in accessibility and quality evidenced by positive changes in maternal and child health (more than 50% decrease in MMR) (Shuvalova et al, 2015).…”
Section: Appropriateness Of Maternal Carementioning
confidence: 99%
“…However, that maternal wards are well distributed throughout the entire territory of Serbia does not ensure that all services offered are adequate and of good quality. In Russia, although accessibility has improved, geographical access to care in rural areas can be difficult (Shuvalova, 2015). Women living in rural areas in Azerbaijan and Ukraine are often late in seeking maternal care due to transportation problems (Stepurko et al, 2013;Habibov, 2011).…”
Maternal health outcomes in Central and Eastern Europe (CEE) compare unfavorable with those in Western Europe, despite macro-indicators that suggest well-designed maternal care systems. However, macro-indicators at the system level only capture capacity, funding and utilization of care and not the actual allocation of financial and human resources, the quality of care and access to it. It is these latter which are problematic in the CEE region. In this study service-related indicators of access to maternal care in CEE are examined. These include availability, appropriateness, affordability, approachability and acceptability of maternal care. This study uses a qualitative systematic literature review, analyzing information of peer-reviewed articles published since 2004. Other inclusion criteria included language, setting and publication purpose. The included articles were analyzed using a framework analysis technique and quality was assessed using standardized evaluation checklists. Results indicate improvements in maternal care. However, availability of care is limited by outdated equipment and training curricula, and the lack of professionals and pharmaceuticals. Geographical distance to healthcare institutions, inappropriate communication of providers and waiting times are the main approachability barriers. Some mothers are unaware of the importance of care or are discouraged to utilize healthcare services because of cultural aspects. Finally, a major barrier in accessing maternal care in the CEE is the inability to pay for it. Our findings indicate that major gaps in evidence exist and that more representative and better quality data should be collected. Governments in CEE countries need to establish a reliable system for measuring and monitoring a suitable set of indicators, as well as deal with the general social and economic problem of informality. Medical curricula in the CEE region need to be overhauled and there should be a focus on improving the allocation of medical staff and institutions as well as protecting vulnerable population groups to ensure universal access to care.
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