Background
Methods
Results
Health system building block | Geographic region | Setting (urban, rural) | Type of study | Level of evidencea |
---|---|---|---|---|
Health service delivery | South Asia (26 %) | n = 74 | Interrupted time series- 5 | SIGN level 1: n = 18 |
Eastern and Southern Africa (23 % ) | Cross-sectional- 4 | |||
West Africa (14 %) | Rural (34 %) | Pre-post- 7 | SIGN level 2: n = 1 | |
East Asia and Pacific (11 %) | Urban (24 %) | Pre-post with control area- 1 | ||
Latin America and Caribbean (9 %) | Rural and urban (1 %) | Report- 1 | SIGN level 3: n = 40 | |
North Africa and Middle East (8 %) | Unspecified (41 %) | Case study- 5 | ||
Unspecified (9 %) | RCT- 11 | SIGN level 4: n = 11 | ||
cRCT- 1 | ||||
Qualitative study- 4 | B: n = 1 | |||
Costing study- 1 | ||||
Literature review- 1 | C: n = 3 | |||
Mixed methods study- 2 | ||||
Medical products and health technologies | South Asia (6 %) | n = 35 | Pre-post- 4 | SIGN level 1: n = 6 |
Eastern and Southern Africa (11 %) | Narrative review- 9 | |||
North Africa and Middle East (6 %) | Rural (9 %) | Interrupted time series on | SIGN level 3: n = 4 | |
Unspecified (77 %) | Urban (6 %) | acceptance- 1 | ||
Unspecified (86 %) | Systematic review- 5 | SIGN level 4: n = 25 | ||
RCT- 1 | ||||
Health workforce | South Asia (31 %), | n = 59 | Pre-post- 17 | SIGN level 1: n = 11 |
East and Southern Africa (29 %) | Pre-post with control group- 4 | |||
Latin America and Caribbean (10 %) | Rural (46 %) | Narrative description, feedback- 1 | SIGN level 3: n = 35 | |
East Asia and Pacific (7 %) | Urban (24 %) | |||
West Africa (7 %) | Unspecified (31 %) | RCT-2 | SIGN level 4: n = 13 | |
Central and Eastern Europe (3 %) | cRCT- 1 | |||
Unspecified (14 %) | Systematic review- 6 | |||
Case study- 1 | ||||
Cross-sectional- 6 | ||||
Cross-sectional survey on satisfaction- 1 | ||||
Cross-sectional survey with control group- 1 | ||||
Costing study- 1 | ||||
Narrative review- 13 | ||||
Report- 2 | ||||
Interrupted time series- 1 | ||||
Study protocol- 1 | ||||
Health financing | South Asia (41 %) | n = 32 | Case study- 2 | SIGN level 1: n = 7 |
West and Central Africa (28 %) | Interrupted time series and | |||
East and Southern Africa (19 %) | Rural (25 %) | qualitative- 1 | SIGN level 2: n = 1 | |
East Asia and Pacific (13 %) | Urban (6 %) | Protocol- 3 | ||
Rural and urban (59 %) | Cross sectional- 3 | SIGN level 3: n = 17 | ||
Unspecified (9 %) | Cross sectional and qualitative- 1 | |||
RCT- 1 | SIGN level 4: n = 4 | |||
cRCT- 1 | ||||
Pre-post with control- 2 | A: n = 1 | |||
Pre-post- 1 | ||||
Qualitative- 3 | B: n = 1 | |||
Non-random controlled trial- 2 | ||||
Non-random controlled quasi experimental trial- 1 | C: n = 1 | |||
Interrupted time series- 7 | ||||
Interrupted time series with controls; and qualitative- 1 | ||||
Systematic review- 1 | ||||
Narrative review- 2 | ||||
Community ownership and participation | South Asia (66 %) | n = 35 | cRCT- 8 | SIGN level 1: n = 9 |
Eastern and Southern Africa (14 %) | Narrative review- 6 | |||
East Asia and Pacific (11 %) | Rural (86 %) | Qualitative study- 4 | SIGN level 3: n = 13 | |
Latin America and the Caribbean (3 %) | Urban (11 %) | Systematic literature review- 1 | ||
West and Central Africa (3 %), | Unspecified (3 %) | Pre-post with control- 2 | SIGN level 4: n = 9 | |
Unspecified (3 %) | Pre-post- 6 | |||
Commentary- 1 | B: n = 1 | |||
Cross sectional survey and qualitative- 1 | C: n = 3 | |||
Study protocol- 2 | ||||
Cross sectional study- 2 | ||||
Leadership and governance | South Asia (38 %) | n = 24 | Pre-post- 1 | SIGN level 3: n = 5 |
East Asia and Pacific (17 %) | Pre-post with comparison areas- 1 | |||
Eastern and Southern Africa (13 %) | Rural (33 %), | SIGN level 4: n = 17 | ||
Latin America and the Caribbean (13 %) | Urban (4 %) | Narrative review- 3 | ||
North Africa and Middle East (8 %) | Unspecified (63 %) | Policy analysis- 7 | B: n = 2 | |
West and Central Africa (8 %), | Case study- 10 | |||
Unspecified (4 %) | Report- 1 | |||
Qualitative study- 1 |
Health system building block | Innovative Approaches/Strategies |
---|---|
Health service delivery | Quality improvement |
• Management and leadership skills development activities • Safe childbirth checklist, a standardized protocol for MNH care • Implementation of redesigned care model/protocol based on selected evidence-based recommendations and women’s views • Collaborative quality improvement of a network of sites working together • Comprehensive intervention packages based on quality improvement approaches (including certifications, delivery of services, incentives, promotion, etc.) • UNICEF Safe motherhood programme • Special care newborn units to provide high quality care • Infection control programme to reduce nosocomial infections • Package of MNH interventions at institutional level • Mental health care for pregnant women using existing primary care resources • Provision of equipment and training to facilities • Community education on maternal health • Application of quality of care model from family planning to EmOC | |
Skin-to-skin care / kangaroo mother care | |
• Community-based kangaroo mother care • Kangaroo mother care implementation tool to monitor progress • Implementation of kangaroo mother care in government hospitals • Use of facilitation to implement kangaroo mother care in hospitals | |
MNH nutrition | |
• New micronutrient supplementation programs (e.g. zinc, iron, calcium) • Positive deviance approach to improve antenatal nutrition | |
Breastfeeding | |
• Innovative promotion strategies (e.g. postnatal visits, counselling by community volunteers, mass media) and delivery systems (e.g. baby-friendly hospitals, peer facilitators) including mainstreaming breastfeeding into the scale-up of MNH | |
Prenatal care | |
• Maternity waiting homes, some combined with MCH services and income generation activities • Yoga for high risk pregnancies • Education for first time childbearing women • Group prenatal care | |
Medical products and health technologies | Maternal |
• Non-pneumatic anti-shock garment to stabilize and resuscitate hypovolemic shock • Automated blood pressure devices for low resource settings • Single use obstetric emergency kits • Misoprostol for community-based use, storage and application system for oxytocin delivery and balloon condom catheter to treat intractable uterine bleeding • Foilized polyethylene pouch to store neviparine • Low-cost, low-tech devices: portable OB ultrasound and Doppler, simplified partograph, vacuum delivery/EmOC devices, birth simulator, cell-phone-based malaria diagnostics, hemoglobinmeter, EmOC transporter (eRanger) • Clean delivery kits | |
Neonatal | |
• Low-cost devices: ventilator support, temperature measurement, pulse oximeter and phototherapy • Devices to prevent PMTCT (e.g. breastfeeding shields) • Application of chlorhexidine for umbilical cord care • Topical application of emollients to reduce nosocomial infections and mortality • Thermoprotection mechanisms: cot-nursing using heated water-filled mattress, infant warmers, wraps and foils | |
Health workforce | Training |
• E-learning via internet and phone text messages • Training of community health worker cadres in tasks previously not assigned: antenatal care, safe delivery, neonatal resuscitation, essential newborn care and PMTCT care, IMNCI • Low-technology obstetric and neonatal resuscitation simulation training (e.g. Helping Babies Breathe Programme) • Training programs/courses for trainers and providers in antenatal care, EmOC, essential newborn care and neonatal resuscitation: Making Pregnancy Safer, Promoting Effective Perinatal Care, WHO Essential Newborn Care, acute care of at-risk newborns, Perinatal Continuing Education Programme, Essential Surgical Skills Emergency MCH Programme • Partnering international professional organizations for training of providers • Training TBAs in antenatal care, safe delivery, neonatal resuscitation and essential newborn care, use of delivery mat and misoprostol • Training of nurses: quality improvement tools, oxytocin use | |
Task-shifting to non-physicians | |
• Non-physician clinicans to provide EmOC • Anaesthesia services provided by mid-level cadres • NICU newborn aides to help staffing problems • Pictorial job aids used by providers | |
Health financing | Enhancing demand for MNH services |
• Conditional cash transfers • Cash incentives for skilled delivery at facility • Vouchers for maternal health services and related costs (e.g. transport costs and cash payment for delivery at facility) • Community-based health or obstetric insurance • Abolition or reduction of user fees | |
Incentives for health workers to increase supply and quality of services | |
• Performance-based payment • Free reimbursement for training and costs | |
Community ownership and participation | Women’s groups and community-based intervention packages |
• Women’s groups convened by female facilitators to identify problems and formulate solutions • Female community health worker outreach • Community/home-based intervention packages including pregnancy, delivery and ENC components | |
Linkage between community and facility | |
• Integration of newborn care into existing community-based package and national health system • Creating a network of providers/CHWs | |
Community mobilisation | |
• Community-based quality improvement process involving learning and problem-solving cycle • Home-based care and linkages to facility based services including distribution and use of misoprostol, recognition of danger signs, improvements in transport • Community participatory learning activities • Positive deviance behavior change activities | |
Leadership and governance | Partnerships |
• Public-private partnerships, international/regional partnerships and inter-agency task teams to create capacity for MNH care | |
National MNH policies | |
• Health system reforms • Use of research, data and policies to develop community-based newborn care package/national newborn strategy and influence high-profile champions to act • Integration of skilled birth attendance into national plan/policy • Increase in political commitment • Rights-based programming and micro-planning strategy to increase access, coverage and quality of MNH care • Use of situation analysis to develop newborn action plan |