Effects of health-system strengthening on under-5, infant, and neonatal mortality: 11-year provincial-level time-series analyses in Mozambique

The Lancet Global Health, Volume 2, No. 8, Year 2014

Interpretation

Background: Knowledge of the relation between health-system factors and child mortality could help to inform health policy in low-income and middle-income countries. We aimed to quantify modifiable health-system factors and their relation with provincial-level heterogeneity in under-5, infant, and neonatal mortality over time in Mozambique. Methods: Using Demographic and Health Survey (2003 and 2011) and Multiple Indicator Cluster Survey (2008) data, we generated provincial-level time-series of child mortality in under-5 (ages 0-4 years), infant (younger than 1 year), and neonatal (younger than 1 month) age groups for 2000-10. We built negative binomial mixed models to examine health-system factors associated with changes in child mortality. Findings: Under-5 mortality rate was heterogeneous across provinces, with yearly decreases ranging from 11·1% (Nampula) to 1·9% (Maputo Province). Heterogeneity was greater for neonatal mortality rate, with only seven of 11 provinces showing significant yearly decreases, ranging from 13·6% (Nampula) to 4·2% (Zambezia). Health workforce density (adjusted rate ratio 0·94, 95% CI 0·90-0·98) and maternal and child health nurse density (0·96, 0·92-0·99) were both associated with reduced under-5 mortality rate, as were institutional birth coverage (0·94, 0·90-0·98) and government financing per head (0·80, 0·65-0·98). Higher population per health facility was associated with increased under-5 mortality rate (1·14, 1·02-1·28). Neonatal mortality rate was most strongly associated with institutional birth attendance, maternal and child nurse density, and overall health workforce density. Infant mortality rate was most strongly associated with institutional birth attendance and population per health facility. Interpretation: The large decreases in child mortality seen in Mozambique between 2000 and 2010 could have been partly caused by improvements in the public-sector health workforce, institutional birth coverage, and government health financing. Increased attention should be paid to service availability, because population per health facility is increasing across Mozambique and is associated with increased under-5 mortality. Investments in health information systems and new methods to track potentially increasing subnational health disparities are urgently needed. Funding: Doris Duke Charitable Foundation. © 2014 Fernandes et al. Open Access article distributed under the terms of CC BY-NC-SA.

AI Digest

Study Justification:

This study aimed to investigate the relationship between health-system factors and child mortality in Mozambique. Understanding these factors can help inform health policy in low-income and middle-income countries. The study focused on quantifying modifiable health-system factors and their impact on under-5, infant, and neonatal mortality rates at the provincial level over an 11-year period.

Study Highlights:

– The study found that under-5 mortality rates varied across provinces, with some provinces experiencing significant yearly decreases.
– Neonatal mortality rates also showed heterogeneity, with only seven out of 11 provinces showing significant yearly decreases.
– Health workforce density, maternal and child health nurse density, institutional birth coverage, and government financing per head were associated with reduced under-5 mortality rates.
– Higher population per health facility was associated with increased under-5 mortality rates.
– Neonatal mortality rates were strongly influenced by institutional birth attendance, maternal and child nurse density, and overall health workforce density.
– Infant mortality rates were strongly influenced by institutional birth attendance and population per health facility.

Study Recommendations:

– The study suggests that improvements in the public-sector health workforce, institutional birth coverage, and government health financing contributed to the significant decreases in child mortality in Mozambique.
– Attention should be given to service availability, as an increasing population per health facility is associated with increased under-5 mortality.
– Investments in health information systems and new methods to track subnational health disparities are urgently needed.

Key Role Players:

– Ministry of Health: Responsible for implementing and overseeing health-system strengthening initiatives.
– Health Workforce: Includes doctors, nurses, and other healthcare professionals who play a crucial role in delivering healthcare services.
– Maternal and Child Health Nurses: Specialized nurses who focus on providing care to mothers and children.
– Government: Responsible for allocating and managing health financing resources.
– Researchers and Academics: Conduct further research and provide evidence-based recommendations for policy-making.

Cost Items for Planning Recommendations:

– Health Workforce Training and Recruitment: Budget for training and hiring additional healthcare professionals.
– Infrastructure Development: Allocate funds for building and upgrading health facilities to accommodate the growing population.
– Health Information Systems: Invest in technology and systems to improve data collection, analysis, and reporting.
– Monitoring and Evaluation: Allocate resources for monitoring and evaluating the impact of health-system strengthening initiatives.
– Research and Development: Allocate funds for further research to identify and address emerging health challenges.
Please note that the cost items provided are general categories and not actual cost estimates.

Strength of Evidence

N/A

Abstract

Materials

N/A

Innovations

AI Innovations Description

Based on the research article titled “Effects of health-system strengthening on under-5, infant, and neonatal mortality: 11-year provincial-level time-series analyses in Mozambique,” there are several recommendations that can be developed into innovations to improve access to maternal health. These recommendations include:

1. Increase health workforce density: The study found that higher health workforce density was associated with reduced under-5 mortality rate. Therefore, one innovation could be to invest in training and deploying more healthcare professionals, such as doctors, nurses, and midwives, to areas with low workforce density.

2. Improve maternal and child health nurse density: The research showed that higher maternal and child health nurse density was associated with reduced under-5 mortality rate. To improve access to maternal health, innovative strategies could be implemented to increase the number of trained nurses specializing in maternal and child health.

3. Enhance institutional birth coverage: The study found that institutional birth coverage was associated with reduced under-5 mortality rate. To improve access to maternal health, innovative approaches could be implemented to increase the number of births taking place in healthcare facilities, ensuring that skilled attendants are available to provide necessary care during childbirth.

4. Increase government financing per head: The research showed that higher government financing per head was associated with reduced under-5 mortality rate. Therefore, an innovation could be to advocate for increased government investment in maternal health services, ensuring that sufficient funds are allocated to improve access and quality of care.

5. Address population per health facility: The study found that increased population per health facility was associated with increased under-5 mortality rate. To improve access to maternal health, innovative solutions could be developed to address the growing population and ensure that healthcare facilities are adequately distributed and accessible to all communities.

6. Invest in health information systems: The research highlighted the need for investments in health information systems to track and monitor health disparities. Innovations in technology and data collection could be implemented to improve the availability and accuracy of maternal health data, enabling policymakers to make informed decisions and allocate resources effectively.

Overall, these recommendations can serve as a basis for developing innovative solutions to improve access to maternal health in Mozambique and other low-income and middle-income countries.

AI Innovations Methodology

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

1. Data collection: Gather data on the current status of health workforce density, maternal and child health nurse density, institutional birth coverage, government financing per head, and population per health facility in Mozambique. This data can be obtained from government reports, surveys, and other relevant sources.

2. Baseline analysis: Analyze the existing data to establish a baseline for maternal health indicators such as under-5 mortality rate, infant mortality rate, and neonatal mortality rate. This will provide a starting point for comparison after implementing the recommendations.

3. Scenario development: Based on the recommendations, develop different scenarios that represent the potential impact of each recommendation on improving access to maternal health. For example, one scenario could simulate the effect of increasing health workforce density by a certain percentage, while another scenario could simulate the effect of improving institutional birth coverage.

4. Modeling and simulation: Use statistical modeling techniques to simulate the impact of each scenario on maternal health indicators. This can be done by applying the relevant coefficients from the research article to the baseline data and projecting the potential changes in maternal health indicators.

5. Sensitivity analysis: Conduct sensitivity analysis to assess the robustness of the results. This involves testing the impact of varying the input parameters within a certain range to see how sensitive the results are to changes in those parameters.

6. Evaluation and interpretation: Analyze the simulation results to evaluate the potential impact of each recommendation on improving access to maternal health. Compare the different scenarios to identify the most effective strategies for improving maternal health outcomes.

7. Policy implications: Based on the simulation results, provide recommendations and policy implications for policymakers and stakeholders. This can include prioritizing certain recommendations based on their potential impact and feasibility of implementation.

By following this methodology, policymakers and stakeholders can gain insights into the potential impact of implementing the recommendations from the research article and make informed decisions to improve access to maternal health in Mozambique.

Authors & Co-Authors

Statistics:

Citations: 48

Authors: 6

Identifiers:

DOI: 10.1016/S2214-109X(14)70276-1

Research Areas:

Disparities, Genetics and Genomics, Health System and Policy, Maternal and Child Health, Social Determinants

Study Countries:

Mozambique

Study Design:

Cross Sectional Study

Study Approach:

Quantitative