Program assessment of efforts to improve the quality of postpartum counselling in health centers in Morogoro region, Tanzania

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dc.contributor.authorLeFevre, Amnesty
dc.contributor.authorMpembeni, Rose
dc.contributor.authorKilewo, Charles
dc.contributor.authorYang, Ann
dc.contributor.authorAn, Selena
dc.contributor.authorMohan, Diwakar
dc.contributor.authorMosha, Idda
dc.contributor.authorBesana, Giulia
dc.contributor.authorLipingu, Chrisostom
dc.contributor.authorCallaghan-Koru, Jennifer
dc.contributor.authorSilverman, Marissa
dc.contributor.authorWinch, Peter J
dc.contributor.authorGeorge, Asha S
dc.date.accessioned2018-07-10T13:10:11Z
dc.date.available2018-07-10T13:10:11Z
dc.date.issued2018-07-04
dc.date.updated2018-07-08T03:42:23Z
dc.description.abstractBackground The postpartum period represents a critical window where many maternal and child deaths occur. We assess the quality of postpartum care (PPC) as well as efforts to improve service delivery through additional training and supervision in Health Centers (HCs) in Morogoro Region, Tanzania. Methods Program implementers purposively selected nine program HCs for assessment with another nine HCs in the region remaining as comparison sites in a non-randomized program evaluation. PPC quality was assessed by examining structural inputs; provider and client profiles; processes (PNC counselling) and outcomes (patient knowledge) through direct observations of equipment, supplies and infrastructure (n = 18) and PPC counselling (n = 45); client exit interviews (n = 41); a provider survey (n = 62); and in-depth provider interviews (n = 10). Results While physical infrastructure, equipment and supplies were comparable across study sites (with water and electricity limitations), program areas had better availability of drugs and commodities. Overall, provider availability was also similar across study sites, with 63% of HCs following staffing norms, 17% of Reproductive and Child Health (RCH) providers absent and 14% of those providing PPC being unqualified to do so. In the program area, a median of 4 of 10 RCH providers received training. Despite training and supervisory inputs to program area HCs, provider and client knowledge of PPC was low and the content of PPC counseling provided limited to 3 of 80 PPC messages in over half the consultations observed. Among women attending PPC, 29 (71%) had delivered in a health facility and sought care a median of 13 days after delivery. Barriers to PPC care seeking included perceptions that PPC was of limited benefit to women and was primarily about child health, geographic distance, gaps in the continuity of care, and harsh facility treatment. Conclusions Program training and supervision activities had a modest effect on the quality of PPC. To achieve broader transformation in PPC quality, client perceptions about the value of PPC need to be changed; the content of recommended PPC messages reviewed along with the location for PPC services; gaps in the availability of human resources addressed; and increased provider-client contact encouraged.
dc.identifier.apacitationLeFevre, A., Mpembeni, R., Kilewo, C., Yang, A., An, S., Mohan, D., ... George, A. S. (2018). Program assessment of efforts to improve the quality of postpartum counselling in health centers in Morogoro region, Tanzania. <i>BMC Pregnancy and Childbirth</i>, http://hdl.handle.net/11427/28285en_ZA
dc.identifier.chicagocitationLeFevre, Amnesty, Rose Mpembeni, Charles Kilewo, Ann Yang, Selena An, Diwakar Mohan, Idda Mosha, et al "Program assessment of efforts to improve the quality of postpartum counselling in health centers in Morogoro region, Tanzania." <i>BMC Pregnancy and Childbirth</i> (2018) http://hdl.handle.net/11427/28285en_ZA
dc.identifier.citationLeFevre, A., Mpembeni, R., Kilewo, C., Yang, A., An, S., Mohan, D., ... & Silverman, M. (2018). Program assessment of efforts to improve the quality of postpartum counselling in health centers in Morogoro region, Tanzania. BMC Pregnancy and Childbirth, 18(1), 282.
dc.identifier.ris TY - Journal Article AU - LeFevre, Amnesty AU - Mpembeni, Rose AU - Kilewo, Charles AU - Yang, Ann AU - An, Selena AU - Mohan, Diwakar AU - Mosha, Idda AU - Besana, Giulia AU - Lipingu, Chrisostom AU - Callaghan-Koru, Jennifer AU - Silverman, Marissa AU - Winch, Peter J AU - George, Asha S AB - Background The postpartum period represents a critical window where many maternal and child deaths occur. We assess the quality of postpartum care (PPC) as well as efforts to improve service delivery through additional training and supervision in Health Centers (HCs) in Morogoro Region, Tanzania. Methods Program implementers purposively selected nine program HCs for assessment with another nine HCs in the region remaining as comparison sites in a non-randomized program evaluation. PPC quality was assessed by examining structural inputs; provider and client profiles; processes (PNC counselling) and outcomes (patient knowledge) through direct observations of equipment, supplies and infrastructure (n = 18) and PPC counselling (n = 45); client exit interviews (n = 41); a provider survey (n = 62); and in-depth provider interviews (n = 10). Results While physical infrastructure, equipment and supplies were comparable across study sites (with water and electricity limitations), program areas had better availability of drugs and commodities. Overall, provider availability was also similar across study sites, with 63% of HCs following staffing norms, 17% of Reproductive and Child Health (RCH) providers absent and 14% of those providing PPC being unqualified to do so. In the program area, a median of 4 of 10 RCH providers received training. Despite training and supervisory inputs to program area HCs, provider and client knowledge of PPC was low and the content of PPC counseling provided limited to 3 of 80 PPC messages in over half the consultations observed. Among women attending PPC, 29 (71%) had delivered in a health facility and sought care a median of 13 days after delivery. Barriers to PPC care seeking included perceptions that PPC was of limited benefit to women and was primarily about child health, geographic distance, gaps in the continuity of care, and harsh facility treatment. Conclusions Program training and supervision activities had a modest effect on the quality of PPC. To achieve broader transformation in PPC quality, client perceptions about the value of PPC need to be changed; the content of recommended PPC messages reviewed along with the location for PPC services; gaps in the availability of human resources addressed; and increased provider-client contact encouraged. DA - 2018-07-04 DB - OpenUCT DP - University of Cape Town J1 - BMC Pregnancy and Childbirth LK - https://open.uct.ac.za PB - University of Cape Town PY - 2018 T1 - Program assessment of efforts to improve the quality of postpartum counselling in health centers in Morogoro region, Tanzania TI - Program assessment of efforts to improve the quality of postpartum counselling in health centers in Morogoro region, Tanzania UR - http://hdl.handle.net/11427/28285 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12884-018-1906-y
dc.identifier.urihttp://hdl.handle.net/11427/28285
dc.identifier.vancouvercitationLeFevre A, Mpembeni R, Kilewo C, Yang A, An S, Mohan D, et al. Program assessment of efforts to improve the quality of postpartum counselling in health centers in Morogoro region, Tanzania. BMC Pregnancy and Childbirth. 2018; http://hdl.handle.net/11427/28285.en_ZA
dc.language.isoen
dc.publisherBioMed Central
dc.publisher.departmentDepartment of Public Health and Family Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rights.holderThe Author(s).
dc.sourceBMC Pregnancy and Childbirth
dc.source.urihttps://bmcpregnancychildbirth.biomedcentral.com/
dc.subject.otherPostnatal care
dc.subject.otherCounselling
dc.subject.otherPostpartum care
dc.subject.otherPrimary health care
dc.subject.otherTanzania
dc.titleProgram assessment of efforts to improve the quality of postpartum counselling in health centers in Morogoro region, Tanzania
dc.typeJournal Article
uct.type.filetypeText
uct.type.filetypeImage
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