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Characteristics of successful integrated family planning and maternal and child health services: Findings from a mixed-method, descriptive evaluation.

ABSTRACT: Background: Most postpartum women in low- and middle-income countries want to delay or avoid future pregnancies but are not using modern contraception. One promising strategy for increasing the use of postpartum family planning (PPFP) is integration with maternal, newborn and child health (MNCH) services. However, there is limited evidence on effective service integration strategies. We examine facilitators of and barriers to effective PPFP integration in MNCH services in Kenya and India. Methods: We conducted a cross-sectional, mixed-method study in two counties in Kenya and two states in India. Data collection included surveying 215 MNCH clients and surveying or interviewing 82 health care providers and managers in 15 health facilities across the four sites. We analyzed data from each country separately. First, we analyzed quantitative data to assess the extent to which PPFP was integrated within MNCH services at each facility. Then we analyzed qualitative data and synthesized findings from both data sources to identify characteristics of well and poorly integrated facilities. Results: PPFP integration success varied by service delivery area, health facility, and country. Issues influencing the extent of integration included availability of physical space for PPFP services, health workforce composition and capacity, family planning commodities availability, duration and nature of support provided. Conclusions: Although integration level varied between health facilities, factors enabling and hindering PPFP integration were similar in India and Kenya. Better measures are needed to verify whether services are integrated as prescribed by national policies.

SUBMITTER: Pfitzer A

PROVIDER: S-EPMC6993833 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Characteristics of successful integrated family planning and maternal and child health services: Findings from a mixed-method, descriptive evaluation.

Pfitzer Anne A Maly Christina C Tappis Hannah H Kabue Mark M Mackenzie Devon D Healy Sadie S Srivastava Vineet V Ndirangu Gathari G

F1000Research 20190228

<b>Background:</b> Most postpartum women in low- and middle-income countries want to delay or avoid future pregnancies but are not using modern contraception. One promising strategy for increasing the use of postpartum family planning (PPFP) is integration with maternal, newborn and child health (MNCH) services. However, there is limited evidence on effective service integration strategies. We examine facilitators of and barriers to effective PPFP integration in MNCH services in Kenya and India. ...[more]

PMID: 32047599

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Project description:IntroductionThis study aimed to build the emergent body of evidence of family planning and maternal and child health (FPMCH) service integration benefits that can be useful in reaching the target of sustainable development goals (SDGs).MethodsWe utilized data from the 2015 Nepal Health Facility Survey and used the World Health Organization service readiness manual for defining the service readiness indicator score of all services related to FPMCH integration. Composite readiness index for all services including family planning, antenatal care service, delivery and newborn service readiness index, and curative child care service readiness index was considered for the integration of all services (i.e. readiness for FPMCH). Multivariable linear regression models were fitted to examine the association between covariates and readiness score to provide integrated services.ResultsThe mean readiness score of integrated services in health facilities in Nepal was 52.1%. The services in private hospitals and peripheral health facilities had significantly lower readiness scores of integrated services compared to government hospitals. Compared to Province 3(Province 3 holds the national capital), Province 2 had significantly lower and Province 7 had significantly higher readiness scores. There is a marginally significantly higher readiness score of integrated services in the facilities where management meetings are held compared to where management meetings are never conducted. Interestingly, health facilities where external supervision occurred in the last 4 months had better service readiness of integrated services compared with those facilities with no external supervision. Similarly, the facilities that performed the routine quality assurance activities and facilities having a system for collecting opinion and being reviewed had a higher integrated services readiness score than their counterparts.ConclusionThis study found a scope of improvement in management practices in the health sector of Nepal especially for supportive supervision, quality assurance (QA) activities, monthly management meetings, and a system of collecting and reviewing opinions from the clients. Strengthening management practices especially, promoting supportive supervision and adhering to QA protocols may improve HF readiness to implement integrated FPMCH in Nepal. Being low readiness, there is an urgent need for policy reform to improve the integrated service readiness, particularly in Province 2.

Project description:BackgroundThe Covid-19 pandemic has so far infected more than 30 million people in the world, having major impact on global health with collateral damage. In Mozambique, a public state of emergency was declared at the end of March 2020. This has limited people's movements and reduced public services, leading to a decrease in the number of people accessing health care facilities. An implementation research project, The Alert Community for a Prepared Hospital, has been promoting access to maternal and child health care, in Natikiri, Nampula, for the last four years. Nampula has the second highest incidence of Covid-19. The purpose of this study is to assess the impact of Covid-19 pandemic Government restrictions on access to maternal and child healthcare services. We compared health centres in Nampula city with healthcare centres in our research catchment area. We wanted to see if our previous research interventions have led to a more resilient response from the community.MethodsMixed-methods research, descriptive, cross-sectional, retrospective, using a review of patient visit documentation. We compared maternal and child health care unit statistical indicators from March-May 2019 to the same time-period in 2020. We tested for significant changes in access to maternal and child health services, using KrushKall Wallis, One-way Anova and mean and standard deviation tests. We compared interviews with health professionals, traditional birth attendants and patients in the two areas. We gathered data from a comparable city health centre and the main city referral hospital. The Marrere health centre and Marrere General Hospital were the two Alert Community for a Prepared Hospital intervention sites.ResultsComparing 2019 quantitative maternal health services access indicators with those from 2020, showed decreases in most important indicators: family planning visits and elective C-sections dropped 28%; first antenatal visit occurring in the first trimester dropped 26%; hospital deliveries dropped a statistically significant 4% (p = 0.046), while home deliveries rose 74%; children vaccinated down 20%.ConclusionOur results demonstrated the negative collateral effects of Covid-19 pandemic Government restrictions, on access to maternal and child healthcare services, and highlighted the need to improve the health information system in Mozambique.

Project description:BACKGROUND:Family planning (FP) needs among postpartum women in low- and middle-income countries remain largely unmet. Integrating FP with childhood immunisation services could partially reduce this unmet need by creating multiple opportunities for timely contact with FP services during the 12?months following childbirth. METHODS:A realist evaluation of an intervention integrating FP and childhood immunisation services in routine outreach clinics in two rural districts of Malawi was conducted. A Context-Mechanism-Outcome (CMO) framework was used to describe the drivers of the intervention. A detailed programme theory was developed based on the analysis of semi-structured interviews and focus group discussions with 50 stakeholders. RESULTS:A total of 9 core mechanisms were identified, which centred on constructs of access. Findings revealed that on the demand side, women were motivated to attend outreach clinics due to shorter travel distances; they felt confident they could access FP services and use contraceptive methods covertly if needed; and when supported by their husband, they were empowered to take up the use of contraceptive methods. On the supply side, providers were empowered through the training they received to provide integrated services; they were confident in their ability to provide essential services; and they were motivated by teamwork and by the recognition they received for their work. Additionally, some providers were found to be unwilling to walk long distances to reach remote clinics, which was seen to negatively affect the availability of services. CONCLUSIONS:The delivery of integrated FP and childhood immunisation services in the context of routine outreach clinics in rural Malawi was seen to trigger mechanisms of accessibility and to improve the acceptability and availability of FP services. However, further research is needed to understand how the integration of these services in a routine outreach clinic setting may affect other dimensions of accessibility, including the approachability, appropriateness and affordability of services.

Project description:BackgroundUnmet need for postpartum contraception is high. Integration of family planning with routine child immunization services may help to satisfy unmet need. However, evidence about the determinants and effects of integration has been inconsistent, and more evidence is required to ascertain whether and how to invest in integration. In this study, facility-level family planning and immunization integration index scores are used to: (1) determine whether integration changes over time and (2) identify whether facility-level characteristics, including exposure to the Nigerian Urban Reproductive Health Initiative (NURHI), are associated with integration across facilities in six urban areas of Nigeria.MethodsThis study utilizes health facility data collected at baseline (n = 400) and endline (n = 385) for the NURHI impact evaluation. Difference-in-differences models estimate the associations between facility-level characteristics, including exposure to NURHI, and Provider and Facility Integration Index scores. The two outcome measures, Provider and Facility Integration Index scores, reflect attributes that support integrated service delivery. These indexes, which range from 0 (low) to 10 (high), were constructed using principal component analysis. Scores were calculated for each facility. Independent variables are (1) time period, (2) whether the facility received the NURHI intervention, and (3) additional facility-level characteristics.ResultsWithin intervention facilities, mean Provider Integration Index scores were 6.46 at baseline and 6.79 at endline; mean Facility Integration Index scores were 7.16 (baseline) and 7.36 (endline). Within non-intervention facilities, mean Provider Integration Index scores were 5.01 at baseline and 6.25 at endline; mean Facility Integration Index scores were 5.83 (baseline) and 6.12 (endline). Provider Integration Index scores increased significantly (p = 0.00) among non-intervention facilities. Facility Integration Index scores did not increase significantly in either group. Results identify facility-level characteristics associated with higher levels of integration, including smaller family planning client load, family planning training among providers, and public facility ownership. Exposure to NURHI was not associated with integration index scores.ConclusionPrograms aiming to increase integration of family planning and immunization services should monitor and provide targeted support for the implementation of a well-defined integration strategy that considers the influence of facility characteristics and concurrent initiatives.

Project description:BackgroundSocial capital has become an important concept in the field of public health, and is associated with improved health services uptake. This study aimed to systematically review the available literature on the role of social capital on the utilization of maternal and child health services in low- and middle-income countries (LMICs).MethodsMixed-methods research review and synthesis using three databases PubMed, Scopus, and Science Direct for peer-reviewed literature and Google Scholar and Google search engines for gray literature were performed. Both quantitative and qualitative studies conducted in LMICs, published in English and in grey literature were considered. Prior to inclusion in the review methodological quality was assessed using a standardized critical appraisal instrument.ResultsA total of 1,545 studies were identified, of which 13 records were included after exclusions of studies due to duplicates, reading titles, abstracts, and full-text reviews. Of these eligible studies, six studies were included for quantitative synthesis, and seven were included for qualitative synthesis. Of the six quantitative studies, five of them addressed the association between social capital and health facility delivery. Women who lived in communities with higher membership in groups that helps to form intergroup bridging ties had higher odds of using antenatal care services. Synthesized qualitative findings revealed that women received some form of emotional, informational, and instrumental support from their network members. Receiving health information from trusted people and socio-cultural factors influenced the use of maternal and child health services.ConclusionsSocial capital has a great contribution to improve maternal and child health services. Countries aiming at improving maternal and child health services can be benefited from adapting existing context-specific social networks in the community. This review identified limited available evidence examining the role of social capital on maternal and child health services uptake and future studies may be required for an in-depth understanding of how social capital could improve maternal and child health services.Systematic review registrationPROSPERO CRD42021226923.

Project description:OBJECTIVES:Maternal, newborn and child health (MNCH) services represent opportunities to integrate postpartum family planning (PPFP). Objectives were to determine levels of MNCH-family planning (FP) integration and associations between integration, client characteristics and service delivery factors in facilities that received programmatic PPFP support. DESIGN AND SETTING:Cross-sectional client flow assessment conducted during May-July 2014, over 5?days at 10 purposively selected public sector facilities in India (4 hospitals) and Kenya (2 hospitals and 4 health centres). PARTICIPANTS:2158 client visits tracked (1294 India; 864 Kenya). Women aged 18 or older accessing services while pregnant and/or with a child under 2?years. INTERVENTIONS:PPFP/postpartum intrauterine device-Bihar, India (2012-2013); Jharkhand, India (2009-2014); Embu, Kenya (2006-2010). Maternal, infant and young child nutrition/FP integration-Bondo, Kenya (2011-2014). PRIMARY OUTCOME MEASURES:Proportion of visits where clients received integrated MNCH-FP services, client characteristics as predictors of MNCH-FP integration and MNCH-FP integration as predictor of length of time spent at facility. RESULTS:Levels of MNCH-FP integration varied widely across facilities (5.3% to 63.0%), as did proportion of clients receiving MNCH-FP integrated services by service area. Clients travelling 30-59?min were half as likely to receive integrated services versus those travelling under 30?min (OR 0.5, 95% CI 0.4 to 0.7, P<0.001). Clients receiving MNCH-FP services (vs MNCH services only) spent an average of 10.5?min longer at the facility (95%?CI -0.1 to 21.9, not statistically significant). CONCLUSIONS:Findings suggest importance of focused programmatic support for integration by MNCH service area. FP integration was highest in areas receiving specific support. Integration does not seem to impose an undue burden on clients in terms of time spent at the facility. Clients living furthest from facilities are least likely to receive integrated services.

Dataset Information

Characteristics of successful integrated family planning and maternal and child health services: Findings from a mixed-method, descriptive evaluation.

Publications

Characteristics of successful integrated family planning and maternal and child health services: Findings from a mixed-method, descriptive evaluation.

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