Challenges in postnatal care provision in Ethiopia

Frontiers in Public Health, Volume 10, Year 2022

Interpretation

Background: Most maternal deaths occur during the first 48 h after delivery; thus, a critical time for monitoring possible complications arising from the delivery. Quality postnatal care can contribute to a decrease in maternal mortality and morbidity rates. Despite the importance of postnatal care, it is generally a neglected aspect of maternal and child health services in most developing countries, including Ethiopia. Objectives: The objective of the study was to describe the challenges experienced by postnatal care providers and coordinators in providing postnatal care in the Ethiopian context. Methods: A quantitative cross-sectional descriptive study was conducted and data were gathered from 422 postnatal care providers and coordinators during November 2018. A simple random sampling technique was used to select the respondents and the data were gathered through a self-administered questionnaire. The data were cleaned, coded and entered into the Statistical Package for Social Sciences (SPSS) version 21 for analysis. Open-ended questions for qualitative enhancement were open-coded and thematically analyzed. Results: The findings revealed a lack of physical resources; infrastructure problems; cultural concerns; inadequate capacity building; inaccessibility of health services; unavailability of guidelines; a lack of communication with healthcare users and poor monitoring and evaluation as challenges. Conclusion: To improve postnatal care in Ethiopia and, ultimately, mother and child health, the challenges experienced by postnatal care providers and coordinators have to be dealt with. A strategic action plan with the active involvement of all stakeholders must be developed and implemented to deal with the challenges and improve postnatal care. The study was conducted in Oromia regional state in Ethiopia during the month of November 2018. Administratively, Oromia is divided into 18 zones that are divided into 309 districts (councils), 44 town administrations and 6,881 kebeles (subdivisions) (16). A quantitative cross-sectional descriptive study was conducted to identify challenges pertaining to postnatal care service delivery in Ethiopia. Data were gathered from a stratified random sample of a population of 2,925 postnatal care providers (2,865) and 60 coordinators at various health facilities, departments, health centers and hospitals and from district and regional health departments. A total sample of 422 respondents was determined, using the single population proportion formula n = Z (α/2)2*P (1-P)/d2 n = 1.962 1 (1–0.5)/0.052 n = 384 The assumptions under this formula were: • n = sample size • Z (α/2) = the value of normal distribution, representing a confidence level of 95% with a value of 1.96. • P = Proportion of the case • d = Margin of error—considering a non-response rate of 10%, the final sample size was 422. The first assumption was that no studies were conducted on the specific topic and the prevalence is considered to be 50% at 95% confidence interval, with a margin of error (confidence limit) of 5%. The other assumption was that there might be a 10% non-response rate. A self-developed questionnaire based on a thorough literature review was pre-tested and used for data gathering. Open-ended questions were included for qualitative enhancement to allow for personal opinions and views. The data collectors received a 3-day training course before the data collection process commenced. The data collectors and researchers distributed an information letter as well as the voluntary consent form among all selected respondents at the health facilities and postnatal care departments. After reading and understanding the information sheet, the volunteers signed the consent form, indicating their willingness to participate. This was followed by questionnaires administration to every consenting participant, requesting them to complete the questionnaire in private in their own time and return the completed questionnaire within 2 days. To enhance the validity and reliability of the instrument, a pre-test was conducted among 5% (21 pre-test respondents) of the sample size that had similar characteristics as the study participants but were selected from health facilities and departments located outside the study areas. Data were gathered by ten purposively selected data collectors. Data were cleaned, coded and captured from the 422 questionnaires into the Statistical Package for Social Sciences (SPSS) software programme (version 21) for analysis. The findings were summarized and presented in tables and pie-charts, using frequencies and percentages. The responses to open-ended questions were open-coded and thematically analyzed. Although the quantitative data obtained provided valuable insights into the challenges experienced, the narrative data that was thematically analyzed provided rich data to allow for a more comprehensive description of the study findings. Ethical approval was obtained from the Research Ethics Committee of the Department of Health Studies, University of South Africa (UNISA) to conduct the study. Permission letters to support the study and gain access into the field were received from the respective administrative offices of Oromia Regional State Health Bureau, from each health facility such as health centers, hospitals, district and regional health departments before involving the participants in the study. The participants received an information letter about the research, the objectives of the research and their right not to participate, not to answer a question or to withdraw from the study at any time during data collection without any negative consequences for them.

AI Digest

Study Justification:

– Postnatal care is a critical aspect of maternal and child health services.
– Quality postnatal care can contribute to a decrease in maternal mortality and morbidity rates.
– Despite its importance, postnatal care is generally neglected in developing countries, including Ethiopia.
– This study aims to describe the challenges faced by postnatal care providers and coordinators in Ethiopia.

Highlights:

– Lack of physical resources and infrastructure problems.
– Cultural concerns and inadequate capacity building.
– Inaccessibility of health services and unavailability of guidelines.
– Lack of communication with healthcare users and poor monitoring and evaluation.

Recommendations:

– Develop and implement a strategic action plan to address the challenges.
– Involve all stakeholders in the improvement of postnatal care.
– Allocate resources for improving physical infrastructure and providing necessary resources.
– Enhance capacity building programs for postnatal care providers.
– Improve accessibility of health services and develop guidelines for postnatal care.
– Strengthen communication with healthcare users and establish effective monitoring and evaluation systems.

Key Role Players:

– Ministry of Health: Responsible for policy development and implementation.
– Regional Health Bureaus: Oversee healthcare services at the regional level.
– District Health Departments: Responsible for healthcare services at the district level.
– Health Facilities: Provide postnatal care services.
– Postnatal Care Providers and Coordinators: Deliver postnatal care services.

Cost Items:

– Physical infrastructure improvement: Construction, renovation, and maintenance.
– Provision of necessary resources: Medical equipment, supplies, and medications.
– Capacity building programs: Training workshops, seminars, and educational materials.
– Accessibility improvement: Transportation services, mobile clinics, and outreach programs.
– Guideline development: Research, consultation, and dissemination.
– Communication enhancement: Information campaigns, community engagement activities.
– Monitoring and evaluation systems: Data collection tools, software, and analysis.
Please note that the provided cost items are general categories and not actual cost estimates. The actual cost will depend on various factors such as the scale of implementation and specific needs of the healthcare system in Ethiopia.

Strength of Evidence

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is based on a quantitative cross-sectional descriptive study conducted in Ethiopia. The study gathered data from 422 postnatal care providers and coordinators using a self-administered questionnaire. The data were analyzed using the Statistical Package for Social Sciences (SPSS) software. The study also included open-ended questions for qualitative enhancement, which were thematically analyzed. The findings identified several challenges in postnatal care provision in Ethiopia. The evidence is strong because it is based on a relatively large sample size and includes both quantitative and qualitative data. However, to improve the evidence, the study could have included a larger and more diverse sample, used a mixed-methods approach to gather more comprehensive data, and conducted follow-up interviews or observations to validate the findings.

Abstract

The study was conducted in Oromia regional state in Ethiopia during the month of November 2018. Administratively, Oromia is divided into 18 zones that are divided into 309 districts (councils), 44 town administrations and 6,881 kebeles (subdivisions) (16). A quantitative cross-sectional descriptive study was conducted to identify challenges pertaining to postnatal care service delivery in Ethiopia. Data were gathered from a stratified random sample of a population of 2,925 postnatal care providers (2,865) and 60 coordinators at various health facilities, departments, health centers and hospitals and from district and regional health departments. A total sample of 422 respondents was determined, using the single population proportion formula n = Z (α/2)2*P (1-P)/d2 n = 1.962 1 (1–0.5)/0.052 n = 384 The assumptions under this formula were: • n = sample size • Z (α/2) = the value of normal distribution, representing a confidence level of 95% with a value of 1.96. • P = Proportion of the case • d = Margin of error—considering a non-response rate of 10%, the final sample size was 422. The first assumption was that no studies were conducted on the specific topic and the prevalence is considered to be 50% at 95% confidence interval, with a margin of error (confidence limit) of 5%. The other assumption was that there might be a 10% non-response rate. A self-developed questionnaire based on a thorough literature review was pre-tested and used for data gathering. Open-ended questions were included for qualitative enhancement to allow for personal opinions and views. The data collectors received a 3-day training course before the data collection process commenced. The data collectors and researchers distributed an information letter as well as the voluntary consent form among all selected respondents at the health facilities and postnatal care departments. After reading and understanding the information sheet, the volunteers signed the consent form, indicating their willingness to participate. This was followed by questionnaires administration to every consenting participant, requesting them to complete the questionnaire in private in their own time and return the completed questionnaire within 2 days. To enhance the validity and reliability of the instrument, a pre-test was conducted among 5% (21 pre-test respondents) of the sample size that had similar characteristics as the study participants but were selected from health facilities and departments located outside the study areas. Data were gathered by ten purposively selected data collectors. Data were cleaned, coded and captured from the 422 questionnaires into the Statistical Package for Social Sciences (SPSS) software programme (version 21) for analysis. The findings were summarized and presented in tables and pie-charts, using frequencies and percentages. The responses to open-ended questions were open-coded and thematically analyzed. Although the quantitative data obtained provided valuable insights into the challenges experienced, the narrative data that was thematically analyzed provided rich data to allow for a more comprehensive description of the study findings. Ethical approval was obtained from the Research Ethics Committee of the Department of Health Studies, University of South Africa (UNISA) to conduct the study. Permission letters to support the study and gain access into the field were received from the respective administrative offices of Oromia Regional State Health Bureau, from each health facility such as health centers, hospitals, district and regional health departments before involving the participants in the study. The participants received an information letter about the research, the objectives of the research and their right not to participate, not to answer a question or to withdraw from the study at any time during data collection without any negative consequences for them.

Materials

N/A

Innovations

Based on the information provided, here are some potential innovations that can be used to improve access to maternal health in Ethiopia:

1. Mobile Health (mHealth) Solutions: Develop mobile applications or SMS-based platforms to provide information and reminders about postnatal care, including appointment reminders, breastfeeding support, and common postpartum complications.

2. Telemedicine: Implement telemedicine services to connect postnatal care providers and coordinators with healthcare users in remote areas. This can help overcome the challenge of inaccessibility of health services and improve access to timely care and advice.

3. Training and Capacity Building: Develop comprehensive training programs for postnatal care providers and coordinators to address the challenges of inadequate capacity building. This can include training on postnatal care guidelines, communication skills, and monitoring and evaluation techniques.

4. Community-Based Care: Establish community-based postnatal care programs to bring care closer to women and reduce the need for them to travel long distances to access services. This can involve training community health workers to provide basic postnatal care and support.

5. Strengthening Infrastructure: Invest in improving the physical resources and infrastructure of health facilities to ensure they have the necessary equipment and supplies for postnatal care. This can include providing essential medical equipment, improving facility infrastructure, and ensuring a reliable supply chain for medications and supplies.

6. Cultural Sensitivity: Develop culturally sensitive approaches to postnatal care that take into account the cultural concerns identified in the study. This can involve working closely with communities to understand their beliefs and practices related to postnatal care and adapting services accordingly.

7. Monitoring and Evaluation Systems: Establish robust monitoring and evaluation systems to track the quality and effectiveness of postnatal care services. This can help identify areas for improvement and ensure that interventions are having the desired impact on maternal and child health outcomes.

It is important to note that these recommendations are based on the challenges identified in the specific study conducted in Ethiopia. Further research and contextual analysis may be needed to tailor these innovations to the specific needs and context of different regions or countries.

AI Innovations Description

Based on the description provided, here is a recommendation that can be developed into an innovation to improve access to maternal health:

1. Develop a mobile health (mHealth) application: Create a user-friendly mobile application that provides essential information and resources for postnatal care. This application can include guidelines for healthcare providers, educational materials for mothers, and a platform for communication between healthcare providers and users.

Benefits of the innovation:

– Increased accessibility: The mobile application can be easily accessed by healthcare providers and mothers, even in remote areas with limited healthcare facilities.
– Timely information: The application can provide real-time updates on postnatal care guidelines and best practices, ensuring that healthcare providers have the most up-to-date information.
– Improved communication: The platform can facilitate communication between healthcare providers and mothers, allowing for remote consultations, appointment scheduling, and follow-up care.
– Enhanced monitoring and evaluation: The application can include features for tracking and monitoring postnatal care services, enabling healthcare providers to identify gaps and improve the quality of care.

To implement this innovation, the following steps can be taken:

1. Collaborate with stakeholders: Engage with healthcare providers, coordinators, and relevant organizations to gather input and ensure the application meets their needs.
2. Design and develop the application: Work with a team of developers and designers to create a user-friendly and intuitive mobile application.
3. Pilot testing: Conduct a pilot test of the application in selected healthcare facilities to gather feedback and make necessary improvements.
4. Training and implementation: Provide training to healthcare providers on how to effectively use the application and integrate it into their daily practice.
5. Scale-up and evaluation: Expand the implementation of the mobile application to more healthcare facilities, continuously evaluate its impact, and make adjustments as needed.

By implementing this innovation, it is expected that access to postnatal care in Ethiopia will be improved, leading to a decrease in maternal mortality and morbidity rates.

AI Innovations Methodology

Based on the provided description, here are some potential recommendations to improve access to maternal health:

1. Increase physical resources: Address the lack of essential medical equipment, supplies, and facilities in postnatal care centers. This can be achieved through increased investment in healthcare infrastructure and ensuring the availability of necessary resources.

2. Improve infrastructure: Address infrastructure problems such as inadequate facilities, lack of electricity, and poor sanitation in postnatal care centers. This can be done by renovating existing facilities, constructing new ones, and ensuring basic amenities are available.

3. Address cultural concerns: Develop culturally sensitive approaches to postnatal care that respect the beliefs and practices of the local community. This can involve training healthcare providers to understand and accommodate cultural preferences, as well as involving community leaders and traditional birth attendants in the provision of care.

4. Enhance capacity building: Provide comprehensive training programs for postnatal care providers to improve their knowledge and skills in delivering quality care. This can include training on postnatal complications, newborn care, breastfeeding support, and communication skills.

5. Improve accessibility of health services: Address the issue of limited access to postnatal care services by increasing the number of healthcare facilities, particularly in rural areas. This can involve establishing mobile clinics, expanding outreach programs, and improving transportation infrastructure.

6. Develop guidelines: Create and disseminate clear guidelines for postnatal care to ensure standardized and evidence-based practices. These guidelines should cover various aspects of care, including assessment, monitoring, and management of postnatal complications.

7. Enhance communication with healthcare users: Improve communication between healthcare providers and postnatal care recipients to ensure better understanding, trust, and engagement. This can involve implementing patient education programs, utilizing local languages, and promoting participatory decision-making.

8. Strengthen monitoring and evaluation: Establish robust monitoring and evaluation systems to track the quality and effectiveness of postnatal care services. This can involve regular assessments, data collection, and feedback mechanisms to identify areas for improvement and measure progress.

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

1. Define the indicators: Identify specific indicators that reflect access to maternal health, such as the number of postnatal care visits, the percentage of women receiving timely care, or the availability of essential resources.

2. Collect baseline data: Gather data on the current status of access to maternal health services, including the identified indicators. This can involve surveys, interviews, or analysis of existing data sources.

3. Develop a simulation model: Create a simulation model that incorporates the identified recommendations and their potential impact on the selected indicators. This model should consider factors such as population demographics, healthcare infrastructure, and resource allocation.

4. Input data and parameters: Input the collected baseline data and relevant parameters into the simulation model. This can include information on population size, healthcare facility locations, resource availability, and implementation timelines for the recommendations.

5. Run simulations: Run the simulation model using different scenarios that reflect the implementation of the recommendations. This can involve adjusting parameters such as the number of healthcare facilities, resource allocation, or training coverage.

6. Analyze results: Analyze the simulation results to assess the potential impact of the recommendations on improving access to maternal health. This can involve comparing the indicators between different scenarios and identifying the most effective strategies.

7. Refine and validate the model: Refine the simulation model based on the analysis results and validate its accuracy by comparing the simulated outcomes with real-world data, if available.

8. Communicate findings: Present the findings of the simulation study, including the potential impact of the recommendations on improving access to maternal health. This can involve visualizing the results through charts, graphs, or maps to facilitate understanding and decision-making.

By following this methodology, policymakers and stakeholders can gain insights into the potential benefits of implementing the recommended innovations and make informed decisions to improve access to maternal health services.

Author


Dima Health

Identifiers:

DOI: 10.3389/fpubh.2022.922933

Research Areas:

Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants, Workforce

Study Countries:

Ethiopia, Multi-Countries, South Africa

Study Design:

Cross Sectional Study, Grounded Theory, Narrative Study

Study Approach:

Mixed-methods, Qualitative, Quantitative, Systematic Review