In low-and middle-income countries, is delivery in high-quality obstetric facilities geographically feasible?

  • Health Affairs, Volume 38, No. 9, Year 2019

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Study Justification:
– The study aims to address the issue of high maternal and neonatal mortality rates in low- and middle-income countries.
– It focuses on the effectiveness of delivering babies in high-quality obstetric facilities as a strategy to reduce mortality.
– The study also investigates the feasibility of shifting deliveries from primary care clinics to hospitals in six specific countries.
Highlights:
– Currently, 83-100 percent of pregnant women in the study countries have access to a delivery facility within two hours.
– The study found that a policy of redesigning service delivery to shift deliveries to hospitals would reduce two-hour access by a maximum of 10 percent.
– The reduction in access would range from 0.6 percent in Malawi to 9.9 percent in Tanzania.
– Relocating delivery services to hospitals would not significantly impede geographic access to care in the study countries.
Recommendations:
– The policy of redesigning service delivery to shift deliveries from primary care clinics to hospitals should be considered in low- and middle-income countries.
– This approach has the potential to effectively reduce maternal and newborn deaths.
Key Role Players:
– Ministry of Health or equivalent government department
– Health facility administrators and managers
– Obstetricians and gynecologists
– Nurses and midwives
– Community health workers
– Non-governmental organizations (NGOs) working in maternal and child health
Cost Items for Planning Recommendations:
– Infrastructure development and improvement of hospitals
– Training and capacity building for healthcare providers
– Equipment and supplies for obstetric facilities
– Outreach and awareness campaigns
– Monitoring and evaluation systems
– Research and data collection
– Collaboration with NGOs and other stakeholders

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Delivery in a health facility is a key strategy for reducing maternal and neonatal mortality, yet increasing use of facilities has not consistently translated into reduced mortality in low- and middle-income countries. In such countries, many deliveries occur at primary care facilities, where the quality of care is poor. We modeled the geographic feasibility of service delivery redesign that shifted deliveries from primary care clinics to hospitals in six countries: Haiti, Kenya, Malawi, Namibia, Nepal, and Tanzania. We estimated the proportion of women within two hours of the nearest delivery facility, both currently and under redesign. Today, 83-100 percent of pregnant women in the study countries have two-hour access to a delivery facility. A policy of redesign would reduce two-hour access by at most 10 percent, ranging from 0.6 percent in Malawi to 9.9 percent in Tanzania. Relocating delivery services to hospitals would not unduly impede geographic access to care in the study countries. This policy should be considered in low- and middle-income countries, as it may be an effective approach to reducing maternal and newborn deaths.

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The publication titled “In low-and middle-income countries, is delivery in high-quality obstetric facilities geographically feasible?” suggests a recommendation to shift deliveries from primary care clinics to hospitals in order to improve access to maternal health. The study conducted modeling in six countries (Haiti, Kenya, Malawi, Namibia, Nepal, and Tanzania) to assess the geographic feasibility of this service delivery redesign. The findings indicate that currently, 83-100 percent of pregnant women in these countries have two-hour access to a delivery facility. Implementing the policy of relocating delivery services to hospitals would reduce two-hour access by at most 10 percent, with the range varying from 0.6 percent in Malawi to 9.9 percent in Tanzania. Therefore, this policy is suggested as an effective approach to reducing maternal and newborn deaths in low- and middle-income countries. The publication also highlights the need for increased use of high-quality obstetric facilities to improve maternal and neonatal outcomes in these countries.
AI Innovations Description
The recommendation proposed in the publication “In low-and middle-income countries, is delivery in high-quality obstetric facilities geographically feasible?” is to shift deliveries from primary care clinics to hospitals in order to improve access to maternal health. The study modeled the geographic feasibility of this service delivery redesign in six countries: Haiti, Kenya, Malawi, Namibia, Nepal, and Tanzania. The findings indicate that currently, 83-100 percent of pregnant women in these countries have two-hour access to a delivery facility. Implementing the policy of relocating delivery services to hospitals would reduce two-hour access by at most 10 percent, with the range varying from 0.6 percent in Malawi to 9.9 percent in Tanzania. Therefore, this policy is suggested as an effective approach to reducing maternal and newborn deaths in low- and middle-income countries.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, the following methodology can be employed:

1. Data Collection: Gather data on the current distribution of primary care clinics and hospitals in the six countries: Haiti, Kenya, Malawi, Namibia, Nepal, and Tanzania. This includes the location, capacity, and services provided by each facility.

2. Geographic Information System (GIS) Mapping: Utilize GIS software to map the locations of primary care clinics and hospitals, as well as the population distribution in each country. This will help visualize the current accessibility of delivery facilities.

3. Two-Hour Access Calculation: Calculate the proportion of pregnant women who currently have two-hour access to a delivery facility in each country. This can be done by determining the population within a two-hour travel time from each facility.

4. Service Delivery Redesign: Simulate the impact of shifting deliveries from primary care clinics to hospitals by adjusting the facility locations in the GIS model. This can involve relocating primary care clinics to hospitals or closing certain clinics and expanding hospital capacity.

5. Two-Hour Access Comparison: Recalculate the proportion of pregnant women with two-hour access to a delivery facility under the redesigned service delivery model. Compare these results with the current access levels to determine the impact of the recommendations.

6. Analyze Results: Assess the changes in two-hour access to delivery facilities across the six countries. Evaluate the percentage reduction in access and the variation among countries to understand the feasibility of the proposed policy.

7. Interpretation and Recommendations: Based on the findings, interpret the results and draw conclusions regarding the impact of shifting deliveries to hospitals on improving access to maternal health. Provide recommendations on implementing this policy in low- and middle-income countries to reduce maternal and newborn deaths.

By following this methodology, researchers can simulate the impact of the recommendations proposed in the publication and gain insights into the potential benefits and challenges of implementing the service delivery redesign.


Statistics:
Citations: 29
Identifiers:
DOI: 10.1377/hlthaff.2018.05397
ISSN: 02782715
Research Areas:
Health System and Policy, Maternal and Child Health, Quality of Care, Social Determinants
Study Countries:
Kenya, Malawi, Multi-Countries, Namibia, Tanzania
Participants Gender:
Female
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