Emergency obstetrical care in Benin referral hospitals: ‘Near miss’ patients’ views

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Study Justification:
This study aimed to evaluate emergency obstetric care and gather the perspectives and expectations of women who experienced “near miss” events in Benin. The goal was to improve maternal health in the country by identifying areas of improvement in the current maternal care system.
Highlights:
– The study surveyed 557 women who had near miss events in seven hospitals in Benin.
– The women were interviewed in the hospital and later at home through semi-structured individual interviews.
– The study assessed various aspects of care, including provided care, accommodation, facilities, costs, recovery modalities, hygiene, staff expertise, social support, and staff behavior and attitude.
– Women interviewed in the hospital expressed satisfaction with physical access, organization, functioning, and environment.
– However, women interviewed at home criticized excessive costs, coercive recovery of expenses, failure of the referral system, lack of empathy and discrimination by nursing staff, lack of resources for emergencies, and lack of hygiene and comfort in the premises.
Recommendations:
– The current maternal care system in Benin needs to be better resourced to effectively deal with obstetric complications.
– It should be made more easily available and affordable for women.
– The system should take into account the needs and perspectives of women to ensure patient-centered care.
Key Role Players:
– Ministry of Health: Responsible for policy-making and resource allocation.
– Hospital Administrators: Responsible for implementing changes within the hospitals.
– Obstetricians and Gynecologists: Provide expertise and guidance in improving emergency obstetric care.
– Nursing Staff: Play a crucial role in providing compassionate and non-discriminatory care.
– Community Leaders and Advocacy Groups: Can raise awareness and advocate for improved maternal health services.
Cost Items for Planning Recommendations:
– Increased staffing: Hiring additional healthcare professionals to improve care.
– Training and education: Providing ongoing training for healthcare providers to enhance their skills.
– Infrastructure improvements: Upgrading facilities to ensure hygiene and comfort.
– Equipment and supplies: Ensuring availability of necessary resources for emergencies.
– Referral system improvements: Investing in systems to ensure smooth and efficient referrals.
– Public awareness campaigns: Allocating funds for raising awareness about maternal health and available services.
Please note that the cost items mentioned are for planning purposes and do not represent actual costs.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is rated 7 because it provides qualitative survey results from a study conducted in seven hospitals in Benin. The study evaluates emergency obstetric care and includes the perceptions and expectations of women who experienced ‘near miss’ events. The sample size is relatively large with 557 women interviewed in hospital and 42 women interviewed at home. The abstract provides a summary of the criteria used to express patients’ satisfaction and highlights both positive and negative aspects of the care provided. However, the abstract does not provide specific details about the methodology used or the analysis of the data. To improve the evidence, the abstract could include more information about the study design, sampling methods, and the specific findings related to the evaluation of emergency obstetric care and women’s perceptions and expectations. Additionally, including information about the limitations of the study would also be helpful.

OBJECTIVE: To evaluate emergency obstetric care and the perceptions and expectations of women who experienced ‘near miss’ events to improve maternal health in Benin. METHODS: Qualitative survey in seven hospitals at the three referral levels of the health pyramid from July to October 2003. We used two methods: 557 women with near miss events were interviewed in hospital and a standard questionnaire completed; then semi-structured individual interviews were conducted at home with 42 of these 557 women. RESULTS: Provided care, accommodation, facilities, costs and modalities of recovery, hygiene of the premises, dynamism, expertise, social support, behaviours and attitude of staff were the criteria used to express patients’ satisfaction. Most women interviewed in hospital were happy with physical access, organization, functioning and environment. However, excessive costs and coercive recovery of the expenses, failure of the referral system, lack of empathy and discrimination of the nursing staff, lack of resources for emergencies, lack of hygiene and comfort of the premises were criticized by the women interviewed at home. CONCLUSION: The current maternal care system fails to effectively deal with obstetric complications. It needs to be better resourced, more easily available, cheaper and taking into account the women’s needs. © 2006 Blackwell Publishing Ltd.

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Based on the study titled “Emergency obstetrical care in Benin referral hospitals: ‘Near miss’ patients’ views,” several innovations can be developed to improve access to maternal health in Benin. These innovations include:

1. Strengthening the referral system: Enhance the effectiveness of the referral system by establishing clear communication channels between primary healthcare centers and referral hospitals. This can be achieved through the use of technology, such as mobile phones or telemedicine, to facilitate timely communication and coordination between healthcare providers.

2. Implementing community-based health insurance schemes: Introduce community-based health insurance schemes specifically targeted at pregnant women to reduce financial barriers. This would help ensure that pregnant women have access to affordable emergency obstetric care without incurring excessive costs.

3. Upgrading healthcare facilities: Invest in upgrading the infrastructure, equipment, and resources of referral hospitals to improve the quality of care provided. This includes ensuring the availability of essential medical equipment, medications, and skilled healthcare professionals to handle obstetric emergencies effectively.

4. Training healthcare providers on empathy and non-discriminatory care: Provide training programs for healthcare providers to enhance their empathy and sensitivity towards pregnant women. This training should emphasize the importance of treating all patients with respect and dignity, regardless of their socioeconomic background or ethnicity.

5. Strengthening emergency response capacity: Allocate sufficient resources, including medical supplies, medications, and skilled healthcare professionals, to handle obstetric emergencies effectively. This may involve recruiting and training additional staff, ensuring the availability of essential drugs and equipment, and establishing protocols for emergency obstetric care.

By implementing these innovations, the healthcare system in Benin can work towards improving access to maternal health and reducing maternal mortality rates.
AI Innovations Description
Based on the study titled “Emergency obstetrical care in Benin referral hospitals: ‘Near miss’ patients’ views,” the following recommendation can be developed into an innovation to improve access to maternal health:

1. Improve the referral system: Enhance the effectiveness of the referral system to ensure that pregnant women with obstetric complications can access emergency obstetric care promptly. This can be achieved by establishing clear communication channels between primary healthcare centers and referral hospitals, implementing standardized protocols for referrals, and providing training to healthcare providers on the importance of timely referrals.

2. Reduce financial barriers: Address the issue of excessive costs associated with maternal healthcare by implementing financial assistance programs or health insurance schemes specifically targeted at pregnant women. This would help alleviate the financial burden on women seeking emergency obstetric care and ensure that cost does not become a barrier to accessing necessary healthcare services.

3. Enhance healthcare facilities: Invest in improving the infrastructure, hygiene, and comfort of referral hospitals to create a more conducive environment for women seeking emergency obstetric care. This includes ensuring the availability of necessary medical equipment, maintaining cleanliness and hygiene standards, and providing comfortable accommodation for patients and their families.

4. Empathy and non-discriminatory care: Train healthcare staff to provide empathetic and non-discriminatory care to pregnant women. This involves sensitizing healthcare providers about the importance of treating all patients with respect and dignity, regardless of their socioeconomic background or ethnicity. Implementing regular training programs and monitoring systems can help ensure that healthcare providers adhere to these principles.

5. Increase resources for emergencies: Allocate sufficient resources, including medical supplies, medications, and skilled healthcare professionals, to handle obstetric emergencies effectively. This may involve recruiting and training additional staff, ensuring the availability of essential drugs and equipment, and establishing protocols for emergency obstetric care.

By implementing these recommendations, the healthcare system in Benin can work towards improving access to maternal health and reducing maternal mortality rates.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, a mixed-methods approach can be used. This would involve both quantitative and qualitative data collection and analysis. Here is a brief methodology:

1. Quantitative data collection: Conduct a survey among pregnant women in Benin to assess their knowledge, attitudes, and practices related to maternal healthcare. This can be done through structured questionnaires administered at primary healthcare centers and referral hospitals. The survey should include questions related to the referral system, financial barriers, healthcare facilities, and experiences with healthcare providers.

2. Quantitative data analysis: Analyze the survey data using statistical methods to determine the current state of access to maternal health and identify any significant barriers or gaps. This analysis will provide quantitative insights into the effectiveness of the current system and the potential impact of the proposed recommendations.

3. Qualitative data collection: Conduct in-depth interviews or focus group discussions with pregnant women who have experienced obstetric complications or near-miss events. These interviews should explore their perceptions, experiences, and expectations regarding emergency obstetric care. The interviews can be conducted at both primary healthcare centers and referral hospitals to capture a comprehensive view.

4. Qualitative data analysis: Analyze the qualitative data using thematic analysis to identify common themes and patterns related to the main recommendations. This analysis will provide qualitative insights into the specific challenges faced by pregnant women and the potential benefits of implementing the recommendations.

5. Simulation modeling: Use the quantitative and qualitative findings to develop a simulation model that can estimate the potential impact of implementing the recommendations on improving access to maternal health. The model can consider factors such as the number of timely referrals, reduction in financial barriers, improvements in healthcare facilities, and changes in healthcare provider behavior. The model can project outcomes such as reduced maternal mortality rates, improved patient satisfaction, and increased access to emergency obstetric care.

6. Sensitivity analysis: Conduct sensitivity analysis to assess the robustness of the simulation model and explore different scenarios. This can help identify the key drivers of change and understand the potential variations in outcomes based on different assumptions or parameters.

By following this methodology, policymakers and healthcare stakeholders can gain valuable insights into the potential impact of the recommendations and make informed decisions about implementing interventions to improve access to maternal health in Benin.

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