Quality care during labour and birth: a multi-country analysis of health system bottlenecks and potential solutions

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dc.contributor.authorSharma, Gauraven_ZA
dc.contributor.authorMathai, Matthewsen_ZA
dc.contributor.authorDickson, Kimen_ZA
dc.contributor.authorWeeks, Andrewen_ZA
dc.contributor.authorHofmeyr, Gen_ZA
dc.contributor.authorLavender, Tinaen_ZA
dc.contributor.authorDay, Louiseen_ZA
dc.contributor.authorMathews, Jijien_ZA
dc.contributor.authorFawcus, Sueen_ZA
dc.contributor.authorSimen-Kapeu, Alineen_ZA
dc.contributor.authorde Bernis, Lucen_ZA
dc.date.accessioned2015-12-07T08:49:19Z
dc.date.available2015-12-07T08:49:19Z
dc.date.issued2015en_ZA
dc.description.abstractBACKGROUND: Good outcomes during pregnancy and childbirth are related to availability, utilisation and effective implementation of essential interventions for labour and childbirth. The majority of the estimated 289,000 maternal deaths, 2.8 million neonatal deaths and 2.6 million stillbirths every year could be prevented by improving access to and scaling up quality care during labour and birth. METHODS: The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops engaged technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks", factors that hinder the scale up, of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for skilled birth attendance and basic and comprehensive emergency obstetric care. RESULTS: Across 12 countries the most critical bottlenecks identified by workshop participants for skilled birth attendance were health financing (10 out of 12 countries) and health workforce (9 out of 12 countries). Health service delivery bottlenecks were found to be the most critical for both basic and comprehensive emergency obstetric care (9 out of 12 countries); health financing was identified as having critical bottlenecks for comprehensive emergency obstetric care (9 out of 12 countries). Solutions to address health financing bottlenecks included strengthening national financing mechanisms and removing financial barriers to care seeking. For addressing health workforce bottlenecks, improved human resource planning is needed, including task shifting and improving training quality. For health service delivery, proposed solutions included improving quality of care and establishing public private partnerships. CONCLUSIONS: Progress towards the 2030 targets for ending preventable maternal and newborn deaths is dependent on improving quality of care during birth and the immediate postnatal period. Strengthening national health systems to improve maternal and newborn health, as a cornerstone of universal health coverage, will only be possible by addressing specific health system bottlenecks during labour and birth, including those within health workforce, health financing and health service delivery.en_ZA
dc.identifier.apacitationSharma, G., Mathai, M., Dickson, K., Weeks, A., Hofmeyr, G., Lavender, T., ... de Bernis, L. (2015). Quality care during labour and birth: a multi-country analysis of health system bottlenecks and potential solutions. <i>BMC Pregnancy and Childbirth</i>, http://hdl.handle.net/11427/15637en_ZA
dc.identifier.chicagocitationSharma, Gaurav, Matthews Mathai, Kim Dickson, Andrew Weeks, G Hofmeyr, Tina Lavender, Louise Day, et al "Quality care during labour and birth: a multi-country analysis of health system bottlenecks and potential solutions." <i>BMC Pregnancy and Childbirth</i> (2015) http://hdl.handle.net/11427/15637en_ZA
dc.identifier.citationSharma, G., Mathai, M., Dickson, K. E., Weeks, A., Hofmeyr, G. J., Lavender, T., ... & de Bernis, L. (2015). Quality care during labour and birth: a multi-country analysis of health system bottlenecks and potential solutions. BMC pregnancy and childbirth, 15(Suppl 2), S2.en_ZA
dc.identifier.ris TY - Journal Article AU - Sharma, Gaurav AU - Mathai, Matthews AU - Dickson, Kim AU - Weeks, Andrew AU - Hofmeyr, G AU - Lavender, Tina AU - Day, Louise AU - Mathews, Jiji AU - Fawcus, Sue AU - Simen-Kapeu, Aline AU - de Bernis, Luc AB - BACKGROUND: Good outcomes during pregnancy and childbirth are related to availability, utilisation and effective implementation of essential interventions for labour and childbirth. The majority of the estimated 289,000 maternal deaths, 2.8 million neonatal deaths and 2.6 million stillbirths every year could be prevented by improving access to and scaling up quality care during labour and birth. METHODS: The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops engaged technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks", factors that hinder the scale up, of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for skilled birth attendance and basic and comprehensive emergency obstetric care. RESULTS: Across 12 countries the most critical bottlenecks identified by workshop participants for skilled birth attendance were health financing (10 out of 12 countries) and health workforce (9 out of 12 countries). Health service delivery bottlenecks were found to be the most critical for both basic and comprehensive emergency obstetric care (9 out of 12 countries); health financing was identified as having critical bottlenecks for comprehensive emergency obstetric care (9 out of 12 countries). Solutions to address health financing bottlenecks included strengthening national financing mechanisms and removing financial barriers to care seeking. For addressing health workforce bottlenecks, improved human resource planning is needed, including task shifting and improving training quality. For health service delivery, proposed solutions included improving quality of care and establishing public private partnerships. CONCLUSIONS: Progress towards the 2030 targets for ending preventable maternal and newborn deaths is dependent on improving quality of care during birth and the immediate postnatal period. Strengthening national health systems to improve maternal and newborn health, as a cornerstone of universal health coverage, will only be possible by addressing specific health system bottlenecks during labour and birth, including those within health workforce, health financing and health service delivery. DA - 2015 DB - OpenUCT DO - 10.1186/1471-2393-15-S2-S2 DP - University of Cape Town J1 - BMC Pregnancy and Childbirth LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - Quality care during labour and birth: a multi-country analysis of health system bottlenecks and potential solutions TI - Quality care during labour and birth: a multi-country analysis of health system bottlenecks and potential solutions UR - http://hdl.handle.net/11427/15637 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15637
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2393-15-S2-S2
dc.identifier.vancouvercitationSharma G, Mathai M, Dickson K, Weeks A, Hofmeyr G, Lavender T, et al. Quality care during labour and birth: a multi-country analysis of health system bottlenecks and potential solutions. BMC Pregnancy and Childbirth. 2015; http://hdl.handle.net/11427/15637.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentDepartment of Obstetrics and Gynaecologyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2015 Sharma et al.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourceBMC Pregnancy and Childbirthen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcpregnancychildbirth/en_ZA
dc.subject.otherpregnancyen_ZA
dc.subject.otherchildbirthen_ZA
dc.subject.otherlabour interventionsen_ZA
dc.subject.otherchildbirth interventionsen_ZA
dc.titleQuality care during labour and birth: a multi-country analysis of health system bottlenecks and potential solutionsen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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