Utilization and management of maternal and child health funds in rural Nepal.
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ABSTRACT:
SUBMITTER: Morrison J
PROVIDER: S-EPMC5562271 | biostudies-other | 2010 Jan
REPOSITORIES: biostudies-other
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Project description:BackgroundThis study seeks to understand distance from health facilities as a barrier to maternal and child health service uptake within a rural Liberian population. Better understanding the relationship between distance from health facilities and rural health care utilization is important for post-Ebola health systems reconstruction and for general rural health system planning in sub-Saharan Africa.MethodsCluster-sample survey data collected in 2012 in a very rural southeastern Liberian population were analyzed to determine associations between quartiles of GPS-measured distance from the nearest health facility and the odds of maternal (ANC, facility-based delivery, and PNC) and child (deworming and care seeking for ARI, diarrhea, and fever) service use. We estimated associations by fitting simple and multiple logistic regression models, with standard errors adjusted for clustered data.FindingsLiving in the farthest quartile was associated with lower odds of attending 1-or-more ANC checkup (AOR?=?0.04, P?<?0.001), 4-or-more ANC checkups (AOR?=?0.13, P?<?0.001), delivering in a facility (AOR?=?0.41, P?=?0.006), and postnatal care from a health care worker (AOR?=?0.44, P?=?0.009). Children living in all other quartiles had lower odds of seeking facility-based fever care (AOR for fourth quartile?=?0.06, P?<?0.001) than those in the nearest quartile. Children in the fourth quartile were less likely to receive deworming treatment (AOR?=?0.16, P?<?0.001) and less likely (but with only marginal statistical significance) to seek ARI care from a formal HCW (AOR?=?0.05, P?=?0.05). Parents in distant quartiles more often sought ARI and diarrhea care from informal providers.ConclusionsWithin a rural Liberian population, distance is associated with reduced health care uptake. As Liberia rebuilds its health system after Ebola, overcoming geographic disparities, including through further dissemination of providers and greater use of community health workers should be prioritized.
| S-EPMC4512264 | biostudies-literature
Project description:BackgroundTimely tracking of health outcomes is difficult in low- and middle-income countries without comprehensive vital registration systems. Community health workers (CHWs) are increasingly collecting vital events data while delivering routine care in low-resource settings. It is necessary, however, to assess whether routine programmatic data collected by CHWs are sufficiently reliable for timely monitoring and evaluation of health interventions. To study this, we assessed the consistency of vital events data recorded by CHWs using two methodologies-routine data collected while delivering an integrated maternal and child health intervention, and data from a birth history census approach at the same site in rural Nepal.MethodsWe linked individual records from routine programmatic data from June 2017 to May 2018 with those from census data, both collected by CHWs at the same site using a mobile platform. We categorized each vital event over a one-year period as 'recorded by both methods,' 'census alone,' or 'programmatic alone.' We further assessed whether vital events data recorded by both methods were classified consistently.ResultsFrom June 2017 to May 2018, we identified a total of 713 unique births collectively from the census (birth history) and programmatic maternal 'post-delivery' data. Three-fourths of these births (n = 526) were identified by both. There was high consistency in birth location classification among the 526 births identified by both methods. Upon including additional programmatic 'child registry' data, we identified 746 total births, of which 572 births were identified by both census and programmatic methods. Programmatic data (maternal 'post-delivery' and 'child registry' combined) captured more births than census data (723 vs. 595). Both methods consistently classified most infants as 'living,' while infant deaths and stillbirths were largely classified inconsistently or recorded by only one method. Programmatic data identified five infant deaths and five stillbirths not recorded in census data.ConclusionsOur findings suggest that data collected by CHWs from routinely tracking pregnancies, births, and deaths are promising for timely program monitoring and evaluation. Despite some limitations, programmatic data may be more sensitive in detecting vital events than cross-sectional census surveys asking women to recall these events.
| S-EPMC9327361 | biostudies-literature
Project description:INTRODUCTION:A multi-strategy community intervention known as the National Rural Health Mission (NRHM) was implemented in India from 2005 to 2012 in an attempt to reduce maternal and child mortality. OBJECTIVE:This study examined the extent to which the NRHM's maternal and child health (MCH) sector plans were implemented. We observed trends in how intergovernmental (use of central government funds by state governments) budgets were allocated and used to implement MCH plans in Haryana, India. METHODS:We conducted a retrospective assessment of programme implementation plans, MCH budget allocation and expenditure and financial monitoring reports during the NRHM implementation period. The yearly budget utilization rate was calculated for each MCH strategy implemented. On the basis of this budget utilization rate, we classed the extent of MCH strategy implementation as fully, partially or not implemented. The status of MCH indicators before, during and after the NRHM period was obtained from national demographic surveys. The budget utilization rate was correlated with MCH outcomes. RESULTS:The overall budget allocated for MCH plans increased from $US6.6 million during the 2005-2006 period to $US66.7 million in the 2012-2013 period. The rate of budget utilization increased from 20.6% in 2007-2008 to 89% in 2012-2013. Expenditure exceeded the initially allocated budget for patient referral services (111.5%), human resources (110.1%), drugs and logistics (170%), accredited social health activists (133.3%) and immunization (106.4%). Additional budget was obtained from the state health budget. Plans for referral services, human resources, drug provision, accredited social health activists and immunization were fully implemented, few schemes (<1%) were not implemented, and all other schemes were only partially implemented. MCH indicators improved significantly (p < 0.05). The rate of institutional childbirth was highly and positively correlated with rates of budget utilization for implementing accredited social health activists (r = 0.96) and financial incentives for hospital delivery schemes (r = 0.5). CONCLUSIONS:The trend for increasing use of the allocated budget for MCH strategies, improvement in MCH indicators and their positive correlation indicate better and more effective implementation of NRHM MCH strategies than in the past in Haryana, India. However, overall, the NRHM was only partially implemented.
| S-EPMC5711747 | biostudies-literature
Project description:BackgroundReliable basic infrastructure, particularly electricity, is a critical enabling factor in improving health systems and consequently achieving the health sustainable development goals (SDGs). Yet, there is no systematic and rigorous study examining the effect of reliable electricity on health systems in a developing country context. In this study, we examine the effect of Jyotigram Yojana (JGY), a rural electrification program providing 24-h electricity to rural non-agricultural users in Gujarat, India, on core components of health systems including health facilities, health information, and health services utilization.MethodsWe match data from the District Level Household and Facility Survey (DLHS-II and DLHS-III) and administrative data from electricity distribution companies on JGY implementation. Matching survey data with administrative data allows us to precisely identify the relevant sample from Gujarat for our data analysis. We then apply a difference-in-differences framework to address potential bias in JGY implementation by comparing the sample from Gujarat (treatment group) with that from Maharashtra (control group). Our key independent variable is a dummy indicating JGY implementation, which operationalizes access to reliable electricity. It takes value 1 if the PHC/eligible woman/child is located or residing in the state of Gujarat and 0 if located or residing in the state of Maharashtra. Our outcome variables cover three core components of health systems-health facilities, health information, and child and maternal health services utilization. Each outcome is a binary variable. We therefore estimate probit models with appropriate control variables.ResultsWe find that JGY implementation significantly improved the operational capacity of health facilities, in particular primary health centers (PHCs), by increasing the availability and functionality of a wide range of essential devices and equipment. JGY also significantly increased access to health information through television. Further, JGY increased utilization of health services; in particular, it increased the probability of children receiving critical vaccinations and pregnant women receiving antenatal care. Our results are robust to alternate specifications and analysis using alternate data.ConclusionReliable electricity can be an effective tool in improving core components of health systems. In addition to targeting direct factors within the health systems such as health workforce and health financing, investments in supporting infrastructure are warranted to achieve the health SDGs.
| S-EPMC6381650 | biostudies-literature
Project description:Engaging community health volunteers and community health workers to provide maternal and child health (MCH) care services in resource-poor settings is one of the global and widely used concepts. Despite a great role of female community health volunteers (FCHVs) in MCH services in Nepal, few research studies have been performed in this area. Our research aimed to assess the knowledge and performance of FCHVs on MCH services associated with their sociodemographic characteristics.A cross-sectional survey was conducted to assess the knowledge and performance on selected MCH services of FCHVs using structured questionnaire in 16 village development committees of Dhanusha district, Southern Terai, Nepal, from the first of January to the end of February of 2014. A total of 138 FCHVs were selected by using multistage random sampling technique. Logistic regression was employed to examine the association between selected sociodemographic characteristics and knowledge and performance on MCH services of FCHVs after adjusting for significant variables associated with knowledge and performance and within-cluster effect.Our findings demonstrated that sociodemographic characteristics were associated independently with good knowledge of FCHVs on MCH services: education level secondary and above (adjusted odds ratio [aOR] 5.2; 95% confidence interval [CI] 2.2-12.2); residing in Mother and Infant Research Activities, nongovernmental organization working area (aOR 3.7; 95% CI 1.5-8.8); and middle caste (aOR 3.3; 95% CI 1.0-10.3). Similarly, satisfactory performance of FCHVs significantly associated with MCH services were education level secondary and above (aOR 8.9; 95% CI 3.2-24.3) and residing in Mother and Infant Research Activities working areas (aOR 9.0; 95% CI 3.5-22.6).The study recommends considering education level while recruiting rural FCHVs and capacity enhancement through additional training and development programs in collaboration with developmental partner.
| S-EPMC4807928 | biostudies-literature
Project description:A range of demographic and socioeconomic factors are known to account for enormous disparities in the uptake of maternal health care in low- and middle-income countries. In contrast, contextual factors such as child marriage are far less explored as a deterrent to the uptake of maternal health care. The present study aimed to assess the total effect of child marriage on the utilization of maternal health services in Nepal. This study drew on data from the Nepal Demographic and Health Survey 2016. The study restricted its analysis to a subsample of 3,970 currently married women of reproductive age who had at least one live birth in the five years preceding the survey. After descriptive analysis, logistic regression models were constructed to estimate adjusted odds ratios. The results of logistic regression controlling for confounders suggested child marriage decreased the likelihood of antenatal care visits (AOR 0.74; 95% CI 0.63-0.86), skilled attendance at delivery (AOR 0.66; 95% CI 0.56-0.78), facility-based delivery (AOR 0.65; 95% CI 0.56-0.77), and postnatal care use (AOR 0.80; 95% CI 0.67-0.96). The findings of this study reinforced the existing evidence for the adverse effect of child marriage on maternal health-seeking behaviors. Women's restricted access to household resources, limited autonomy in decision-making, social isolation, and the dominant power of husbands and mothers-in-law may play a role in the findings. Addressing women's social vulnerability as a barrier to accessing health care may help to increase the uptake of maternal health services.
| S-EPMC6752778 | biostudies-literature
Project description:BackgroundCapacity development of health volunteers and text messaging to pregnant women through mobile phones have shown improved maternal and child health (MCH) outcomes and is associated with increased utilisation of MCH services. However, such interventions are uncommon in Nepal. We aim to carry out an intervention with the hypothesis that capacity building and text messaging intervention will increase the MCH service utilisation.Method/designMATRI-SUMAN is a 12-month cluster randomized controlled trial (RCT). The trial involves pregnant women from 52 clusters of six village development committees (VDCs) covering 66,000 populations of Dhanusha district of Nepal. In the intervention clusters, Female Community Health Volunteers (FCHVs) will receive capacity development skills through reinforcement training, supervision and monitoring skills for the promotion of health seeking behaviour among pregnant women and study participants will receive periodic promotional text messaging service about MCH components through mobile phones. A sample of 354with equal numbers in each study arm is estimated using power calculation formula. The primary outcomes of this study are the rate of utilization of skilled birth attendants and consumption of a specified diversified meal. The secondary outcomes are: four antenatal (ANC) visits, weight gain of women during pregnancy, delivery of a baby at the health facility, postnatal care (PNC) visits, positive changes in child feeding practices among mothers, performance of FCHVs in MCH service utilization.DiscussionThe intervention is designed to enhance the capacity of health volunteers for the promotion of health seeking behaviour among pregnant women and text messaging through a mobile phone to expecting mothers to increase MCH service utilization. The trial if proven effective will have policy implications in poor resource settings.Trial registrationISRCTN60684155, ( https://doi.org/10.1186/ISRCTN60684155 ). The trial was registered retrospectively.
| S-EPMC6001039 | biostudies-literature
Project description:Using principal component analysis (PCA) and integrating both individual and household factors, we had previously derived and proposed 3 socioeconomic indices (namely, wealth index, educational index, and housing quality index) that can be used to classify rural Yemeni women into different socioeconomic statuses (SES). In the current article, we examined whether the PCA-derived indices can be used to predict the use of maternal and child health care services in rural Yemen. We used data from subnational representative multistage sampling cross-sectional household survey conducted in rural Yemen in 2008-2009 among women (N = 6907) who had given birth. The resulting component scores for each SES index were divided into tertiles. Logistic regression was used to study the associations between the SES indices and 4 indicators of maternal health care use. Higher tertiles of each socioeconomic index increased the likelihood of adequate antenatal care use, delivery assistance, and contraceptive use, but decreased the likelihood of unmet need for contraception. Key maternal health indicators can be determined by socioeconomic indicators. Therefore, in planning maternal and child health interventions, considering disparities of care by socioeconomic factors should be taken into account.
| S-EPMC6686312 | biostudies-literature
Project description:Objective:To assess neonatal and under-five mortality and the health situation for children in Dolpa, a remote rural area of Nepal. Study design:Mixed methods: quantitative (retrospective cross sectional) and qualitative (semistructured interviews). Rationale:Progress in reducing child and newborn mortality in Nepal has reached the remote areas to a limited extent. Furthermore, there may be substantial under-reporting and data may be unreliable. Setting and participants:The population of Dolpa district is approximately 35 000. We visited 10 randomly selected villages (plus one settlement) with approximately 12 000 inhabitants. Methodology:Records of the number of deliveries, neonatal and under-five deaths were collected. 100 children (10 different villages) were evaluated for common diseases present during the month prior to the investigation. 20 interviews were conducted about the cultural perceptions of neonatal death and morbidity; in each village at least one interview was undertaken. Results:The population of the 10 villages (plus one settlement) under investigation was 12 287. 300 deliveries have taken place during the last 12 months before the study. There were 30 children reported to have died; out of those 20 were in the neonatal period. This reflects an estimated neonatal mortality rate in Dolpa district of 67/1000 live births (95% CI 41-101/1000) and an estimated under-five mortality rate of 100/1000 (95% CI 70-140/1000). In the previous month, out of 100 children surveyed there had been 11 cases of acute lower respiratory infection (ALRI), 7 cases of diarrhoea, 3 cases of isolated malnutrition and 5 cases of malnutrition combined with ALRI or diarrhoea.Based on qualitative interviews traditional beliefs still play a major role, and are partly a hindrance to progress in health. There is also mistrust in the health services and misconceptions about 'modern' medicine and treatment facilities. Conclusion:Despite progress in child morbidity and mortality in Nepal, some areas remain underserved by health services and neonatal mortality is far above the Nepalese average, which is 29/1000 live births. There is a substantial need to increase and train health staff. Health promotion should be encouraged but cultural perceptions have to be understood if positive behavioural change is to be achieved.
| S-EPMC6782127 | biostudies-other
Project description:BackgroundThe persistence of rural-urban disparities in child nutrition outcomes in developing countries alongside rapid urbanisation and increasing incidence of child malnutrition in urban areas raises an important health policy question - whether fundamentally different nutrition policies and interventions are required in rural and urban areas. Addressing this question requires an enhanced understanding of the main drivers of rural-urban disparities in child nutrition outcomes especially for the vulnerable segments of the population. This study applies recently developed statistical methods to quantify the contribution of different socio-economic determinants to rural-urban differences in child nutrition outcomes in two South Asian countries - Bangladesh and Nepal.MethodsUsing DHS data sets for Bangladesh and Nepal, we apply quantile regression-based counterfactual decomposition methods to quantify the contribution of (1) the differences in levels of socio-economic determinants (covariate effects) and (2) the differences in the strength of association between socio-economic determinants and child nutrition outcomes (co-efficient effects) to the observed rural-urban disparities in child HAZ scores. The methodology employed in the study allows the covariate and coefficient effects to vary across entire distribution of child nutrition outcomes. This is particularly useful in providing specific insights into factors influencing rural-urban disparities at the lower tails of child HAZ score distributions. It also helps assess the importance of individual determinants and how they vary across the distribution of HAZ scores.ResultsThere are no fundamental differences in the characteristics that determine child nutrition outcomes in urban and rural areas. Differences in the levels of a limited number of socio-economic characteristics - maternal education, spouse's education and the wealth index (incorporating household asset ownership and access to drinking water and sanitation) contribute a major share of rural-urban disparities in the lowest quantiles of child nutrition outcomes. Differences in the strength of association between socio-economic characteristics and child nutrition outcomes account for less than a quarter of rural-urban disparities at the lower end of the HAZ score distribution.ConclusionsPublic health interventions aimed at overcoming rural-urban disparities in child nutrition outcomes need to focus principally on bridging gaps in socio-economic endowments of rural and urban households and improving the quality of rural infrastructure. Improving child nutrition outcomes in developing countries does not call for fundamentally different approaches to public health interventions in rural and urban areas.
| S-EPMC3729423 | biostudies-literature