Filling the human resource gap through public-private partnership: Can private, community-based skilled birth attendants improve maternal health service utilization and health outcomes in a remote region of Bangladesh?

English version

Autoři: Jahangir Hossain ^aff001; Anne Laterra ^aff002; Rina Rani Paul ^aff001; Ahsanul Islam ^aff001; Faisal Ahmmed ^aff003; Bidhan Krishna Sarker ^aff003
Působiště autorů: Health and Nutrition Team, CARE Bangladesh, Dhaka, Bangladesh ^aff001; Sexual Reproductive Health and Rights Team, CARE USA, Atlanta, Georgia, United States of America ^aff002; International Centre for Diaarrhoeal Disease Research, Dhaka, Bangladesh ^aff003
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0226923

Souhrn

Background

In Sunamganj there are fewer than four skilled providers per 10,000 population and just 27% of births are assisted by a skilled attendant. We evaluate a private community skilled birth attendant (P-CSBA) model, developed through the GSK-CARE Frontline Health Worker Programme, designed to address this gap and report on changes in service utilization and health outcomes from baseline to three years post-baseline.

Methods

This analysis presents the results of a pre-post cross sectional design. A baseline survey (n = 1800) was conducted using a multistage cluster sampling approach. Three years post-baseline a second cross-sectional survey (n = 1755) was conducted across the same project area. To describe demographic characteristics of the study participants descriptive statistical techniques were used as appropriate. Logistic and multiple logistic regression, controlling for a comprehensive set of covariates, were used to assess odds ratios for key maternal health behaviors and outcomes.

Results

Birth planning and the use of key maternal health services improved from baseline to follow-up. There was a dramatic increase in the proportion of respondents reporting skilled attendance at birth (aOR: 2.18, p = .001). Women also reported significantly fewer complications during the prenatal (aOR: .30, p<.001), labor and delivery (aOR: 0.41, p<.0001) and postnatal periods (aOR: 0.32, p<.0001).

Conclusion

Private-sector approaches, when coupled with robust efforts to strengthen and collaborate with the public sector, can work successfully to deliver services in underserved communities. The success of this model lends credence to the growing appreciation that reaching our development targets will require governments to work in partnership with private sector actors and highlights the potential of private-public partnerships as we drive towards universal health coverage.

Klíčová slova:

Antenatal care – Birth – Health systems strengthening – Labor and delivery – Local governments – Maternal health – Medical doctors – Pregnancy

Zdroje

1. World Health Organization, United Nations Population Fund. Trends in maternal mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015.

2. World Health Organization. SDG 3: Ensure healthy lives and promote wellbeing for all at all ages New York: United Nations; 2016 [https://www.who.int/sdg/targets/en/.

3. World Health Organization. Global strategy on human resources for health: Workforce 2030. Geneva: World Health Organization 2016.

4. World Health Organization. Health workforce requirements for universal health coverage and the Sustainable Development Goals. Human Resources for Health Observer. 2016;17.

5. World Health Organization. Working for health and growth:investing in health workforce. Report of the High-level Commission on Health Employment and Economic Growth. Geneva: World Health Organizations; 2016.

6. World Health Organization. Working together for health The world health report 2006. Geneva: World Health Organization; 2006.

7. Anand S, Barnighausen T. Human resources and health outcomes: cross-country econometric study. Lancet (London, England). 2004;364(9445):1603–9.

8. Anand S, Barnighausen T. Health workers and vaccination coverage in developing countries: an econometric analysis. Lancet (London, England). 2007;369(9569):1277–85.

9. Speybroeck N, Kinfu Y, Mario R, Evans D. Reassing the relationship between human resources for health, intervention coverage and health outcomes. Background paper prepared for The World Health Report 2006. Geneva: World Health Organization; 2006.

10. Gupta N, Maliqi B, Franca A, Nyonator F, Pate M, Sanders D, et al. Human resources for maternal, newborn and child health: from measurement and planning to performance for improved health outcomes. Human resources for health. 2011;9:16. doi: 10.1186/1478-4491-9-16 21702913

11. National Institute of Population Research and Training (NIPORT), MEASURE Evaluation, and icddr,b. Bangladesh Maternal Mortality and Health Care Survey 2010. Dhaka (Bangladesh): NIPORT, MEASURE Evaluation, and icddr,b; 2012.

12. National Institute of Population Research and Training (NIPORT), Mitra and Associates, and ICF International. Bangladesh Demographic and Health Survey 2014. Dhaka (Bangladesh) and Rockville (USA); 2016.

13. National Institute of Population Research and Training (NIPORT), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), and MEASURE Evaluation. Bangladesh Maternal Mortality and Health Care Survey 2016: Preliminary Report. Dhaka (Bangladesh) and Chapel Hill (USA): NIPORT, icddr,b, and MEASURE Evaluation; 2017.

14. Ahmed S, Hossain M, Rajachowdhury A, Bhuiya A. The health workforce crisis in Bangladesh: shortage, inappropriate skill-mix and inequitable distribution. Human resources for health. 2011;9:3. doi: 10.1186/1478-4491-9-3 21255446

15. World Health Organization. The Global Health Observatory Data

16. Cockcroft A, Andersson N, Milne D, Hossain M, Karim E. What did the public think of health services reform in Bangladesh? Three national community-based surveys 1999–2003. Health research policy and systems. 2007;5:1. doi: 10.1186/1478-4505-5-1 17324263

17. Ahmed S, Hossain M, Chowdhury M. Informal sector providers in Bangladesh: how equipped are they to provide rational health care? Health policy and planning. 2009;24(6):467–78. doi: 10.1093/heapol/czp037 19720721

18. Mahmood S, Iqbal M, Hanifi S, Wahed T, Bhuiya A. Are ‘Village Doctors’ in Bangladesh a curse or a blessing? BMC international health and human rights. 2010;10:18. doi: 10.1186/1472-698X-10-18 20602805

19. The World Bank Group. Universal Health Coverage for Inclusive and Sustainable Development Country Summary REport for Bangladesh 2014.

20. Directorate General of Health Services Bangladesh UNPFB. Evaluation of the Community Based Skilled Birth Attendant (CSBA) Programme-Bangladesh. Government of the People’s Republic of Bangladesh: Directorate General of Health Services, Ministry of Health and Family Welfare; 2011.

21. Islam N, Islam M, Yoshimura Y. Practices and determinants of delivery by skilled birth attendants in Bangladesh. Reproductive health. 2014;11:86. doi: 10.1186/1742-4755-11-86 25495451

22. Turkmani S, Gohar F. Community based skilled birth attendants programme in Bangladesh intervention towards improving maternal health. Journal of Asian Midwives. 2015 1(2):17–29.

23. Bhuiya A. Health for the rural masses insights from Chakaria. Dhaka (Bangladesh): icddr,b; 2009.

24. Sarker B, Rahman M, Rahman T, Hossain J, Reichenbach L, Mitra D. Reasons for Preference of Home Delivery with Traditional Birth Attendants (TBAs) in Rural Bangladesh: A Qualitative Exploration. PLoS One. 2016;11(1):e0146161. doi: 10.1371/journal.pone.0146161 26731276

25. Shankar A, Sebayang S, Guarenti L, Utomo B, Islam M, Fauveau V, et al. The village-based midwife programme in Indonesia. The Lancet. 2008;371(9620):1226–9.

26. Kamiya Y, Yoshimura Y, Islam M. An impact evaluation of the safe motherhood promotion project in Bangladesh: evidence from Japanese aid-funded technical cooperation. Social science & medicine (1982). 2013;83:34–41.

27. Story W, LeBan K, Altobelli L, Gebrian B, Hossain J, Lewis J, et al. Institutionalizing community-focused maternal, newborn, and child health strategies to strengthen health systems: A new framework for the Sustainable Development Goal era. Globalization and health. 2017;13(1):37. doi: 10.1186/s12992-017-0259-z 28651632

28. Tobe R, Islam M, Yoshimura Y, Hossain J. Strengthening the community support group to improve maternal and neonatal health seeking behaviors: A cluster-randomized controlled trial in Satkhira District, Bangladesh. PLoS One. 2019;14(2):e0212847. doi: 10.1371/journal.pone.0212847 30817784

29. National Institute of Population Research and Training (NIPORT), Measure Evaluation, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Bangladesh district level socio-demographic and health care utilization indicators. 2011.

30. UNICEF. Multiple-indicator survey handbook. New York: United Nationals; 1995.

31. World Health Organization. Expanded Programme on Immunisation The EPI coverage survey: training for middle-level managers: WHO/EPI/MLM/91.10. Geneva: World Health Organization 2017.

32. Rutstein S, Johnson K. The DHS Wealth Index. DHS Comparative Reports No.6. Calverton (USA): ORC Macro; 2004.

33. National Institute of Population Research and Training (NIPORT), Mitra and Associates, and Macro International. Bangladesh Demographic and Health Survey 2007. Dhaka (Bangladesh) and Calverton (USA): National Institute of Population Research and Training, Mitra and Associates, and Macro International; 2009.

34. Human Rights Watch. World Report 2017 Events of 2016. Human Rights Watch; 2017.

35. National Institute of Population Research and Training (NIPORT), Mitra and Associates, and ICF International. Bangladesh Demographic and Health Survey 2011. Dhaka (Bangladesh) and Calverton (USA): NIPORT, Mitra and Associates, and ICF International; 2013.

36. Hatt L, Stanton C, Makowiecka K, Adisasmita A, Achadi E, Ronsmans C. Did the strategy of skilled attendance at birth reach the poor in Indonesia? Bull World Health Organ. 2007;85(10):774–82. doi: 10.2471/BLT.06.033472 18038059

37. Mumtaz Z, Levay A, Jhangri G, Bhatti A. Coverage of private sector community midwife services in rural Punjab, Pakistan: development and demand. Health research policy and systems. 2015;13 Suppl 1:51.

38. Mumtaz Z, Levay A, Bhatti A. Successful Community Midwives in Pakistan: An Asset-Based Approach. PLOS ONE. 2015;10(9):e0135302. doi: 10.1371/journal.pone.0135302 26333067

39. Loevinsohn B, Harding A. Buying results? Contracting for health service delivery in developing countries. Lancet (London, England). 2005;366(9486):676–81.

40. Patouillard E, Goodman C, Hanson K, Mills A. Can working with the private for-profit sector improve utilization of quality health services by the poor? A systematic review of the literature. International journal for equity in health. 2007;6:17. doi: 10.1186/1475-9276-6-17 17988396

41. Bennett S, Kadama P, Montagu D. Working with the Non-State Sector to Achieve Public Health Goals Consultation on Priorities and Actions. Geneva; 2006.

42. Sekhri N. From Funding to Action: Strengthening Healthcare Systemss in Sub-Saharan Africa. Centre for Public-Private Partnership Global Health Initiative

43. Hanson K, Gilson L, Goodman C, Mills A, Smith R, Feachem R, et al. Is private health care the answer to the health problems of the world’s poor? PLoS Med. 2008;5(11):e233. doi: 10.1371/journal.pmed.0050233 19067483

44. Sarker B, Rahman M, Rahman T, Rahman T, Hasan M, Shahreen T, et al. End line assessment of GSK supported Community Health Workers (CHW) initiative in Sunamganj district, Bangladesh. Dhaka, Bangladesh: International centre for diarrhoeal disease research, Bangladesh; 2019.

Filling the human resource gap through public-private partnership: Can private, community-based skilled birth attendants improve maternal health service utilization and health outcomes in a remote region of Bangladesh?

Souhrn

Background

Methods

Results

Conclusion

Klíčová slova:

Zdroje

PLOS One

INSIGHTS from European Respiratory Congress

Současné pohledy na riziko v parodontologii

Svět praktické medicíny 3/2024 (znalostní test z časopisu)

Kardiologické projevy hypereozinofilií

Střevní příprava před kolonoskopií