Evolution of assisted deliveries at primary healthcare centres in an unstable security context in Mali

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Study Justification:
– The study aims to address the lack of knowledge about the impact of conflict on maternal healthcare in Mali.
– It focuses on understanding how assisted deliveries are being reorganized at the health center level and how they are adapting to the security crisis.
Study Highlights:
– The study reveals a significant territorial heterogeneity in assisted deliveries in Mali.
– Health centers with high rates of assisted deliveries are mainly those with high-performance levels, likely due to population movement to less exposed areas.
– Health centers with low rates of assisted deliveries are those where qualified health workers refuse to practice, where populations have limited financial resources, and where travel is limited due to insecurity.
Study Recommendations:
– The study emphasizes the importance of combining methodological approaches to understand the local context and explain significant use.
– When analyzing the number of assisted deliveries in conflict zones, factors such as procedures, nearby security context, number of internally displaced persons, and presence of humanitarian programs in camps should be considered.
Key Role Players:
– Managers of primary healthcare centers (CsCOM)
– Agents of international institutions
Cost Items for Planning Recommendations:
– Training and capacity building for health workers
– Infrastructure improvements for health centers
– Security measures to ensure the safety of healthcare providers and patients
– Financial support for populations with limited resources to access maternal care
– Support for humanitarian programs in conflict-affected areas

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study utilizes both quantitative and qualitative approaches to analyze the reorganization of assisted deliveries in primary healthcare centers in Mali. The findings reveal important territorial heterogeneity and provide insights into the factors influencing the rates of assisted deliveries. However, the abstract does not provide specific details about the methodology, sample size, or statistical significance of the findings. To improve the strength of the evidence, the authors could consider providing more information about the study design, sample characteristics, and statistical analysis methods used.

Introduction In Mali, healthcare systems are severely affected by conflict. However, several studies suggest a lack of knowledge about its impact on maternal healthcare. Frequent and repeated attacks increase insecurity, limit access to maternal care, and thus represent a barrier to accessing care. The objective of this study is to understand how assisted deliveries are being reorganised at the health centre level, and how they are adapting to the security crisis. Method This is a mixed sequential and explanatory study. The quantitative approaches combine a spatial scan analysis of assisted deliveries by health centres, an analysis of health centre performance using an ascending hierarchical classification, and a spatial analysis of violent events in two health districts in central Mali: Mopti and Bandiagara. The qualitative phase analyses semidirective and targeted interviews with managers (n=22) of primary healthcare centres (CsCOM) and two agents of international institutions. Results The study reveals an important territorial heterogeneity of assisted deliveries. The primary health centres with high rates of assisted deliveries have mainly high-performance levels. This high level of use can be explained by the movement of the population to areas less exposed to attacks. The centres with low rates of assisted deliveries are those where qualified health workers refused to practice, where populations had few financial resources, and where they limited their travel to reduce their exposure to insecurity. Conclusion This study confirms that combining methodological approaches is essential to explain significant use in the local context. The analysis of the number of assisted deliveries in conflict zones must consider the number of procedures, the nearby security context, the number of internally displaced persons and the presence of camps in which humanitarian organisations offer programmes.

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Based on the provided description, here are some potential recommendations for innovations to improve access to maternal health in an unstable security context in Mali:

1. Mobile Health Clinics: Implementing mobile health clinics that can travel to areas affected by conflict and provide maternal healthcare services. These clinics can reach populations in remote or insecure areas, ensuring access to essential care.

2. Telemedicine: Introducing telemedicine services to enable remote consultations between healthcare providers and pregnant women. This can help overcome barriers to accessing care by allowing women to receive medical advice and support without having to travel to healthcare facilities.

3. Community Health Workers: Expanding the role of community health workers in providing maternal healthcare services. Training and equipping these workers to perform assisted deliveries and provide prenatal and postnatal care can help bridge the gap in areas where qualified health workers are unavailable or refuse to practice.

4. Security Escort Programs: Establishing security escort programs to accompany pregnant women to healthcare facilities. This can help ensure their safety during travel and increase their confidence in seeking care despite the security challenges.

5. Emergency Obstetric Care Training: Providing comprehensive emergency obstetric care training to healthcare providers in conflict-affected areas. This can enhance their skills and capacity to handle obstetric emergencies, reducing maternal mortality rates.

6. Awareness Campaigns: Conducting targeted awareness campaigns to educate pregnant women and their families about the importance of seeking maternal healthcare services and the available options for accessing care in conflict zones.

7. Collaboration with International Institutions: Strengthening collaboration with international institutions to provide resources, expertise, and support for improving maternal healthcare services in conflict-affected areas. This can include funding for infrastructure development, training programs, and technical assistance.

It is important to note that these recommendations are based on the provided description and may need to be further tailored and evaluated in the specific context of Mali.
AI Innovations Description
Based on the description provided, the recommendation to improve access to maternal health in an unstable security context in Mali is to develop innovative strategies that address the following key factors:

1. Security Measures: Implement security measures to ensure the safety of healthcare facilities and personnel. This can include strengthening security protocols, providing training on emergency response, and establishing partnerships with local security forces to ensure safe access to maternal healthcare services.

2. Recruitment and Retention of Qualified Health Workers: Address the issue of qualified health workers refusing to practice in certain areas due to security concerns. This can be done by providing incentives such as increased salaries, housing, and transportation allowances, as well as offering training and support to healthcare professionals working in conflict-affected areas.

3. Financial Support: Address the financial constraints faced by the population by implementing financial assistance programs or health insurance schemes specifically targeted towards maternal healthcare. This can help alleviate the financial burden on families and encourage them to seek maternal healthcare services.

4. Mobile Healthcare Units: Establish mobile healthcare units that can reach remote and insecure areas to provide maternal healthcare services. These units can be equipped with necessary medical equipment and staffed by qualified healthcare professionals who can conduct assisted deliveries and provide essential prenatal and postnatal care.

5. Collaboration with International Institutions and Humanitarian Organizations: Strengthen collaboration with international institutions and humanitarian organizations to leverage their expertise and resources in providing maternal healthcare services in conflict-affected areas. This can include partnering with organizations that have experience in delivering healthcare services in insecure environments and accessing funding for maternal health programs.

By implementing these recommendations, it is possible to develop innovative solutions that improve access to maternal health in Mali’s unstable security context.
AI Innovations Methodology
Based on the provided description, here are some potential recommendations for improving access to maternal health in an unstable security context in Mali:

1. Strengthening security measures: Implement measures to enhance security in conflict-affected areas, such as increasing the presence of security forces or establishing safe transportation routes for pregnant women to access healthcare facilities.

2. Training and incentivizing healthcare workers: Provide specialized training for healthcare workers on emergency obstetric care and encourage them to practice in conflict-affected areas by offering incentives such as higher salaries or additional benefits.

3. Mobile healthcare units: Establish mobile healthcare units equipped with necessary medical equipment and staffed by trained healthcare professionals. These units can travel to remote or insecure areas to provide maternal healthcare services.

4. Telemedicine and teleconsultation: Utilize telemedicine technologies to enable remote consultations between healthcare providers and pregnant women in conflict-affected areas. This can help overcome geographical barriers and provide access to expert advice.

5. Community-based interventions: Engage local communities and traditional birth attendants in promoting maternal health awareness and providing basic prenatal and postnatal care. This can help bridge the gap in access to formal healthcare services.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Data collection: Gather relevant data on the current state of maternal health access, including the number of assisted deliveries, healthcare facility performance, security incidents, population movement, and availability of resources.

2. Spatial analysis: Conduct a spatial scan analysis to identify areas with high rates of assisted deliveries and areas with low rates. This analysis can help identify patterns and spatial clusters that may be influenced by security conditions.

3. Performance analysis: Use an ascending hierarchical classification to analyze the performance of healthcare centers in providing assisted deliveries. This analysis can help identify factors contributing to high or low performance levels, such as security, availability of qualified health workers, and financial resources.

4. Qualitative analysis: Analyze the results of semidirective and targeted interviews with healthcare center managers and international institution agents. This qualitative analysis can provide insights into the specific challenges faced in accessing maternal healthcare in conflict-affected areas.

5. Simulation modeling: Develop a simulation model that incorporates the identified factors and their impact on access to maternal health. This model can simulate different scenarios based on the recommended interventions and assess their potential impact on improving access to maternal healthcare.

6. Evaluation and validation: Validate the simulation model by comparing its outputs with real-world data and expert opinions. Evaluate the effectiveness of the recommended interventions by comparing the simulated outcomes with the baseline scenario.

By following this methodology, policymakers and healthcare stakeholders can gain insights into the potential impact of different interventions on improving access to maternal health in an unstable security context in Mali.

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