Applying a Client-centered Approach to Maternal and Neonatal Networks of Care: Case Studies from Urban and Rural Nigeria

  • Health Systems and Reform, Volume 6, No. 2, Year 2020

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Study Justification:
– The study focuses on maternal and neonatal health Networks of Care (NOC) in Nigeria, which are crucial for reducing maternal and neonatal morbidity and mortality.
– It highlights the importance of tailoring healthcare services to different contexts and local needs.
– The study provides insights into the effectiveness of two different NOC models in Northern Nigeria and Lagos State.
– It aims to improve the reach, quality, and accessibility of routine and emergency maternal and neonatal health services.
Study Highlights:
– The NOC in Northern Nigeria was established through collaboration between the Clinton Health Access Initiative and the government. It aimed to improve the preparedness of health centers and communities in providing maternal and neonatal care.
– The NOC in Lagos State extended the reach of services through linkages among registered traditional birth attendant clinics, private and public sector facilities, and healthcare boards.
– Both NOC models brought services closer to the community, facilitated rapid referrals, and encouraged institutional delivery.
Study Recommendations:
– Strengthen agreements and create an enabling environment for effective collaboration between healthcare organizations, government agencies, and community stakeholders.
– Develop and implement operational standards to ensure consistent and high-quality maternal and neonatal healthcare services.
– Enhance the quality, efficiency, and responsibility of healthcare providers through training, empowerment, and equipping them to handle complications.
– Foster a culture of learning and adaptation within the NOC framework to continuously improve services based on local needs and feedback.
Key Role Players:
– Clinton Health Access Initiative
– Government agencies (e.g., Ministry of Health, Primary Healthcare Board, Traditional Medicine Board)
– Health centers and communities
– Traditional birth attendants
– Apex Community Health Officers
Cost Items for Planning Recommendations:
– Training programs for healthcare providers
– Equipment and supplies for health centers
– Data collection and review systems
– Monitoring and evaluation activities
– Support for traditional birth attendants and Apex Community Health Officers
– Community engagement and awareness campaigns

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The abstract provides a clear description of the two maternal and neonatal health Networks of Care (NOC) in Nigeria and how they were developed to address specific local needs. It highlights the collaboration between the Clinton Health Access Initiative, the government, and various healthcare providers. The abstract also mentions the positive outcomes of the NOC approach, such as improved access to maternal and neonatal care and rapid referrals. However, the abstract lacks specific quantitative data or statistical analysis to support the claims made. To improve the strength of the evidence, the authors could consider including data on the reduction of maternal and neonatal morbidity and mortality rates, as well as any comparative analysis between the NOC and traditional healthcare approaches. Additionally, providing more details on the methodology and study design would enhance the credibility of the evidence.

In Nigeria, two maternal and neonatal health Networks of Care (NOC) focus on extending the reach and quality of routine and emergency maternal and neonatal health services tailored to the different contexts. This paper uses the four domains of the NOC framework—Agreements and Enabling Environment, Operational Standards, Quality, Efficiency and Responsibility, and Learning and Adaptation—to describe the NOC, highlighting how each developed to address specific local needs. In Northern Nigeria, the NOC were established in collaboration among Clinton Health Access Initiative and the government to reduce maternal and neonatal morbidity and mortality. Health centers and communities in the network were supported to be better prepared to provide maternal and neonatal care, while birth attendants at all levels were empowered and equipped to stabilize and treat complications. The approach brought services closer to the community and facilitated rapid referrals. The NOC in Lagos State extended the reach of routine and emergency maternal and neonatal health services through organically developed linkages among registered traditional birth attendant clinics, private and public sector facilities, the Primary Healthcare Board, and the Traditional Medicine Board. Traditional birth attendants are registered, trained, and monitored by Apex Community Health Officers, whose responsibilities include collection and review of data and ensuring linkages to postpartum services, such as family planning and immunizations. While differing in their approaches, both NOC provide locally appropriate, pragmatic approaches to supporting women birthing in the community and encouraging institutional delivery to ensure that women and their babies have access to timely, appropriate, and safe services.

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The innovations described in the case studies include:

1. Establishing Networks of Care (NOC): The NOC framework was developed to improve access to maternal and neonatal health services in different contexts. These networks bring together various stakeholders, including government agencies, healthcare providers, and community members, to collaborate and address specific local needs.

2. Collaboration between Clinton Health Access Initiative and the government: In Northern Nigeria, the NOC was established through a partnership between the Clinton Health Access Initiative and the government. This collaboration aimed to reduce maternal and neonatal morbidity and mortality by improving the preparedness of health centers and communities to provide care, as well as empowering and equipping birth attendants to handle complications.

3. Bringing services closer to the community: The NOC approach in Northern Nigeria focused on bringing maternal and neonatal health services closer to the community. This involved supporting health centers and communities to be better prepared to provide care, as well as facilitating rapid referrals for complications.

4. Linkages among different healthcare providers: In Lagos State, the NOC extended the reach of maternal and neonatal health services through linkages among registered traditional birth attendant clinics, private and public sector facilities, the Primary Healthcare Board, and the Traditional Medicine Board. This collaboration ensured that women had access to a continuum of care, including postpartum services like family planning and immunizations.

5. Training and monitoring of traditional birth attendants: In Lagos State, traditional birth attendants were registered, trained, and monitored by Apex Community Health Officers. These officers were responsible for collecting and reviewing data, as well as ensuring linkages to postpartum services. This approach aimed to improve the quality and safety of care provided by traditional birth attendants.

Overall, these innovations aim to improve access to timely, appropriate, and safe maternal and neonatal health services by leveraging partnerships, community involvement, and the integration of different healthcare providers.
AI Innovations Description
The recommendation to improve access to maternal health is to apply a client-centered approach to maternal and neonatal networks of care. This approach involves establishing networks of care that focus on extending the reach and quality of routine and emergency maternal and neonatal health services tailored to different contexts.

In Nigeria, two networks of care (NOC) have been developed to address specific local needs. In Northern Nigeria, the NOC was established in collaboration between the Clinton Health Access Initiative and the government. The aim was to reduce maternal and neonatal morbidity and mortality by supporting health centers and communities to provide better maternal and neonatal care. Birth attendants at all levels were empowered and equipped to stabilize and treat complications, and rapid referrals were facilitated to bring services closer to the community.

In Lagos State, the NOC extended the reach of routine and emergency maternal and neonatal health services through organically developed linkages among registered traditional birth attendant clinics, private and public sector facilities, the Primary Healthcare Board, and the Traditional Medicine Board. Traditional birth attendants were registered, trained, and monitored by Apex Community Health Officers, who ensured linkages to postpartum services such as family planning and immunizations.

Both NOC approaches provide locally appropriate and pragmatic ways to support women birthing in the community and encourage institutional delivery. By applying a client-centered approach, these networks of care ensure that women and their babies have access to timely, appropriate, and safe services.
AI Innovations Methodology
Based on the provided description, here are two potential recommendations for improving access to maternal health:

1. Strengthening Community-Based Care: Implementing community-based care programs can improve access to maternal health services, especially in rural areas. This can involve training and empowering traditional birth attendants, as well as establishing linkages between community health centers and higher-level facilities. By providing essential maternal health services closer to the community, women can receive timely care and referrals when needed.

2. Enhancing Data Collection and Monitoring: Improving data collection and monitoring systems can help identify gaps in maternal health services and track progress towards improving access. This can involve implementing electronic health records, establishing regular reporting mechanisms, and conducting regular assessments to ensure that services are being delivered effectively and efficiently.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define the indicators: Identify key indicators that reflect access to maternal health services, such as the number of institutional deliveries, antenatal care coverage, and maternal mortality rates.

2. Collect baseline data: Gather existing data on the selected indicators to establish a baseline. This can be done through surveys, health facility records, and other relevant sources.

3. Introduce the recommendations: Implement the recommended interventions, such as strengthening community-based care and enhancing data collection and monitoring systems.

4. Monitor and collect data: Continuously monitor the implementation of the recommendations and collect data on the selected indicators. This can involve regular data collection from health facilities, community health workers, and other relevant stakeholders.

5. Analyze the data: Analyze the collected data to assess the impact of the recommendations on the selected indicators. Compare the post-intervention data with the baseline data to determine any improvements in access to maternal health services.

6. Evaluate and adjust: Evaluate the findings and identify areas for improvement. If necessary, make adjustments to the interventions based on the data analysis and feedback from stakeholders.

By following this methodology, it is possible to simulate the impact of the recommendations on improving access to maternal health and make informed decisions on how to further enhance maternal health services.


Statistics:
Citations: 3
Identifiers:
DOI: 10.1080/23288604.2020.1841450
ISSN: 23288604
Research Areas:
Community Interventions, Health System and Policy, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health
Study Countries:
Nigeria
Participants Gender:
Female
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