Barriers to implementation of emergency obstetric and neonatal care in rural Pakistan
Autoři:
Sajid Haider aff001; Rana Farhan Ali aff002; Munir Ahmed aff001; Asad Afzal Humayon aff001; Muhammad Sajjad aff001; Jamil Ahmad aff001
Působiště autorů:
Department of Management Sciences, COMSATS University Islamabad, Vehari, Pakistan
aff001; Health and Nutrition Supervisor, Chishtian, District Health Office, Bahawalnagar, Pakistan
aff002
Vyšlo v časopise:
PLoS ONE 14(11)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0224161
Souhrn
Background
Recognizing the need for improving maternal and newborn care, the Punjab public health department (Pakistan) launched emergency obstetric neonatal care (EmONC) services under WHO guideline. Unfortunately, the program implementation is facing some serious problems. The purpose of this study was to identify barriers to implementation of EmONC in district Bahawalnagar (Pakistan).
Methods
This study used sequential exploratory design. Specifically, a qualitative study was conducted to identify barriers to EmONC. Subsequently, the relative importance of these barriers was determined in a quantitative study. Participants were health service providers involved in 24-hours basic EmONC services in the basic health units of district Bahawalnagar (Pakistan). Qualitative data were gathered by interviewing the participants using key informant guide. Quantitative data were collected in a rank order survey of the same participants. The methodological quality was assessed using mixed methods appraisal tool (MMAT) version 2011.
Results
The results indicate that lack of teamwork, conflict management, communication, and improper power distribution are important interpersonal barriers. The significant organizational-level barriers include job insecurity, lack of organizational culture, human resource deployment issues, and lack of role clarity. Lack of target management, lack of resource availability, house job requirement, and dual practice issues were identified as major system-level barriers.
Conclusion
Barriers to EmONC implementation must be addressed for improving maternal and neonatal care in district Bahawalnagar.
Klíčová slova:
Death rates – Employment – Jobs – Labor and delivery – Neonatal care – Pakistan – Public and occupational health – Social communication
Zdroje
1. Ozimek JA, Kilpatrick SJ. Maternal mortality in the twenty-first century. Obstetrics and Gynecology Clinics. 2018; 45(2):175–186. doi: 10.1016/j.ogc.2018.01.004 29747724
2. World Health Organization (2018). Maternal Mortality Key Facts. Retrieved from https://www.who.int/en/news-room/fact-sheets/detail/maternal-mortality on August 22, 2019.
3. Kalisa R, Malande OO. Birth preparedness, complication readiness and male partner involvement for obstetric emergencies in rural Rwanda. The Pan African medical journal. 2016; 25.
4. Reinke E, Supriyatiningsih JH. Maternal mortality as a Millennium Development Goal of the United Nations: a systematic assessment and analysis of available data in threshold countries using Indonesia as example. Journal of global health. 2017; 7(1): 1–9.
5. Bohren MA, Vogel JP, Fawole B, Maya ET, Maung TM, Baldé MD, et al. Methodological development of tools to measure how women are treated during facility-based childbirth in four countries: labor observation and community survey. BMC medical research methodology. 2018; 18(1):132. doi: 10.1186/s12874-018-0603-x 30442102
6. Lyerly AD, Jaffe E, Little MO. Access to Pregnancy-Related Services: Public Health Ethics Issues. The Oxford Handbook of Public Health Ethics. 2019: 415.
7. Berhane B, Gebrehiwot H, Weldemariam S, Fisseha B, Kahsay S, Gebremariam A. Quality of basic emergency obstetric and newborn care (BEmONC) services from patients’ perspective in Adigrat town, Eastern zone of Tigray, Ethiopia. 2017: a cross sectional study. BMC pregnancy and childbirth. 2019; 19(1):190. doi: 10.1186/s12884-019-2307-6 31146729
8. Tiruneh GT, Karim AM, Avan BI, Zemichael NF, Wereta TG, Wickremasinghe D, et al. The effect of implementation strength of basic emergency obstetric and newborn care (BEmONC) on facility deliveries and the met need for BEmONC at the primary health care level in Ethiopia. BMC pregnancy and childbirth. 2018; 18(1):123. doi: 10.1186/s12884-018-1751-z 29720108
9. Paxton A, Bailey P, Lobis S. The United Nations Process Indicators for emergency obstetric care: Reflections based on a decade of experience. International Journal of Gynecology & Obstetrics. 2006; 95(2):192–208.
10. WHO UNICEF, UNFPA AMDD. Monitoring emergency obstetric care: a handbook. Geneva: World Health Organization; 2009.
11. Bureau-of-Statistics. Multiple Indicator Cluster Survey (MICS). Government of Punjab. 2017–18, Retrieved from http://https://bos.punjab.gov.pk/system/files/MICS%20SFR_Final_Vol2_0.pdf.
12. Abdullah MA. Structural Violence and Pakistan’s Health Situation. Journal of Islamabad Medical & Dental College. 2019; 8(1):1–2.
13. National Institute of Population Studies, Pakistan. Pakistan Demographic Health Survey (PDHS) 2017–18. http://nips.org.pk/abstract_files/PDHS%20-%202017-18%20Key%20indicator%20Report%20Aug%202018.pdf
14. Jehan I, Harris H, Salat S, Zeb A, Mobeen N, Pasha O, et al. Neonatal mortality, risk factors and causes: a prospective population-based cohort study in urban Pakistan. Bulletin of the world health organization. 2009; 87(2): 130–38. doi: 10.2471/BLT.08.050963 19274365
15. World Bank. 2013, Retrieved August, 24, 2017, from http://data.worldbank.org/indicator/SH.STA.BRTC.ZS
16. UNICEF (2016). Maternal and Newborn Health Disparities (Pakistan). Retrieved from https://data.unicef.org/resources/maternal-newborn-health-disparities-country-profiles/ on August 21, 2019.
17. Chi PC, Bulage P, Urdal H, Sundby J. A qualitative study exploring the determinants of maternal health service uptake in post-conflict Burundi and Northern Uganda. BMC pregnancy and childbirth. 2015; 15(1):18.
18. Prata N, Passano P, Sreenivas A, Gerdts CE. Maternal mortality in developing countries: challenges in scaling-up priority interventions. Women’s Health. 2010; 6(2):311–27. doi: 10.2217/whe.10.8 20187734
19. Smeele P, Kalisa R, van Elteren M, van Roosmalen J, van den Akker T. Birth preparedness and complication readiness among pregnant women admitted in a rural hospital in Rwanda. BMC pregnancy and childbirth. 2018; 18(1):190. doi: 10.1186/s12884-018-1818-x 29848311
20. Kalisa R, Smeele P, van Elteren M, van den Akker T, van Roosmalen J. Facilitators and barriers to birth preparedness and complication readiness in rural Rwanda among community health workers and community members: a qualitative study. Maternal health, neonatology and perinatology. 2018; 4(1):11.
21. Harris RD, Marks WM. Compact ultrasound for improving maternal and perinatal care in low-resource settings: review of the potential benefits, implementation challenges, and public health issues. Journal of Ultrasound in Medicine. 2009; 28(8):1067–1076. doi: 10.7863/jum.2009.28.8.1067 19643790
22. Munawar U, Akhter N. Reasons Behind the Selection of Open and Distance Learning by Women in Punjab Province of Pakistan. Journal of Educational Research (1027–9776). 2017; 20(2).
23. Naveed A, Khan SA. Widening Disparities: Public Sector Spending and Poverty Across Districts in Punjab. Retrieved from http://www.ppaf.org.pk/doc/PolicyBriefs/30.Widening%20Disparities_new.pdf on August 21, 2019.
24. Bureau-of-Statistics. Multiple Indicator Cluster Survey (MICS). Government of Punjab. 2014, Retrieved from http://www.bos.gop.pk/finalreport.
25. Bureau-of-Statistics. Multiple Indicator Cluster Survey (MICS). Government of Punjab. 2011, Retrieved from http://www.bos.gop.pk/publicationreports.
26. Ali M, Hotta M, Kuroiwa C, Ushijima H. Emergency obstetric care in Pakistan: potential for reduced maternal mortality through improved basic EmOC facilities, services, and access. International Journal of Gynecology & Obstetrics. 2005; 91(1):105–112.
27. Utz B, Zafar S, Arshad N, Kana T, Gopalakrishnan S, Van Den Broek N. Status of emergency obstetric care in four districts of Punjab, Pakistan–results of a baseline assessment. J Pak Med Assoc. 2015; 65(5):480–485. 26028380
28. EDO(H)-BWN. Office Order Number: 10343–46, Dated March 19, 2016. Health Department Bahawalnagar, Government of Punjab, Pakistan. (2016).
29. Haider S, de Pablos Heredero C, Ahmed M, Dustgeer S. Identifying Causes of Terrorism in Pakistan. Dialogue (Pakistan). 2015; 10(3).
30. Ather F, Sherin A. Health system financing in Pakistan: reviewing resources and opportunities. KMUJ: Khyber Medical University Journal. 2014; 6(2):53–5.
31. Bureau-of-Statistics. Punjab Development Statistics, Government of Punjab. 2015.
32. "DISTRICT WISE CENSUS RESULTS CENSUS 2017" (PDF). Pbscensus.gov.pk. Archived from the original (PDF) on 2017-08-29.
33. MDGs. Punjab Millennium Development Goals Report, 2011. Government of Punjab, Pakistan. (2011).
34. Pluye P, Robert E, Cargo M, et al. Proposal: A mixed methods appraisal tool for systematic mixed studies reviews. Montreal: McGill University; 2011 http://mixedmethodsappraisaltoolpublic.pbworks.com/w/file/fetch/84371689/MMAT%202011%20criteria%20and%20tutorial%202011-0629updated2014.08.21.pdf
35. Pullig C, Maxham JG III, Hair JF Jr. Salesforce automation systems: An exploratory examination of organizational factors associated with effective implementation and salesforce productivity. Journal of Business Research. 2002; 55(5):401–415.
36. Ducharme DR. Factors that Influence the Use of Qualitative Methods by Institutional Researchers (Doctoral dissertation, Johnson & Wales University).
37. Krippendorf K. Content analysis: an introduction to its methodology. Sage. Thousand Oaks, CA. 2004.
38. Mayring P. Qualitative content analysis. A companion to qualitative research. 2004; 1:159–176.
39. Konopásek Z. Making thinking visible with Atlas. ti: Computer assisted qualitative analysis as textual practices. Historical Social Research/HistorischeSozialforschung. Supplement. 2007: 276–298.
40. Friese S. ATLAS. ti 7 user manual. Berlin: ATLAS. ti Scientific Software Development GmbH. 2012.
41. Muhr T. Atlas. ti computer aided text interpretation and theory building. Berlin: User’s manual. 1994.
42. Haider S, Heredero CD, Fernandez-Ortiz A. Exploring organizational factors for the implementation of strategies to reduce door to balloon. 2014.
43. Hoegl M, Gemuenden HG. Teamwork quality and the success of innovative projects: A theoretical concept and empirical evidence. Organization science. 2001; 12(4):435–449.
44. Hong QN, Fàbregues S, Bartlett G, Boardman F, Cargo M, Dagenais P, et al. The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers. Education for Information. 2018 (Preprint):1–7.
45. Hoffer Gittell J. Coordinating mechanisms in care provider groups: Relational coordination as a mediator and input uncertainty as a moderator of performance effects. Management Science. 2002; 48(11):1408–1426.
46. Almost J. Conflict within nursing work environments: concept analysis. Journal of advanced nursing. 2006; 53(4):444–453. doi: 10.1111/j.1365-2648.2006.03738.x 16448487
47. Jormsri P. Moral conflict and collaborative mode as moral conflict resolution in health care. Nursing & health sciences. 2004; 6(3):217–221.
48. Brown J, Lewis L, Ellis K, Stewart M, Freeman TR, Kasperski MJ. Conflict on interprofessional primary health care teams–can it be resolved?. Journal of interprofessional care. 2011; 25(1):4–10. doi: 10.3109/13561820.2010.497750 20795830
49. Hecht ML. The conceptualization and measurement of interpersonal communication satisfaction. Human Communication Research. 1978; 4(3):253–264.
50. Steidle A, Werth L, Gockel C. Not motivated to act during goal pursuit: powerlessness blocks motivation transfer in goal systems. Basic and Applied Social Psychology. 2013; 35(5):477–486.
51. Georges JJ, Grypdonck M. Moral problems experienced by nurses when caring for terminally ill people: a literature review. Nursing ethics. 2002; 9(2):155–78. doi: 10.1191/0969733002ne495oa 11944206
52. Mauno S, Kinnunen U, Mäkikangas A, Nätti J. Psychological consequences of fixed-term employment and perceived job insecurity among health care staff. European Journal of work and organizational psychology. 2005; 14(3):209–37.
53. Barney JB. Organizational culture: can it be a source of sustained competitive advantage?. Academy of management review. 1986; 11(3):656–665.
54. Aarons GA, Sawitzky AC. Organizational climate partially mediates the effect of culture on work attitudes and staff turnover in mental health services. Administration and Policy in Mental Health and Mental Health Services Research. 2006; 33(3):289. doi: 10.1007/s10488-006-0039-1 16544205
55. Gerein N, Green A, Pearson S. The implications of shortages of health professionals for maternal health in sub-Saharan Africa. Reproductive health matters. 2006; 14(27):40–50. doi: 10.1016/S0968-8080(06)27225-2 16713878
56. Miles RH, Petty MM. Relationships between role clarity, need for clarity, and job tension and satisfaction for supervisory and nonsupervisory roles. Academy of Management Journal. 1975; 18(4):877–83.
57. Montgomery MA, Elimelech M. Water and sanitation in developing countries: including health in the equation: ACS Publications. 2007.
58. González P, Macho-Stadler I. A theoretical approach to dual practice regulations in the health sector. Journal of health economics. 2013; 32(1):66–87. doi: 10.1016/j.jhealeco.2012.08.005 23202256
59. Eggleston K, Bir A. Physician dual practice. Health policy. 2006; 78(2):157–66.
60. Huq Z, Martin TN. Workforce cultural factors in TQM/CQI implementation in hospitals. Health Care Management Review. 2000; 25(3):80–93. 10937339
61. Jaeger RG, Halliday TR. On confirmatory versus exploratory research. Herpetologica. 1998:S64–S66.
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PLOS One
2019 Číslo 11
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