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Health system bottlenecks hindering provision of supportive and dignified maternity care in public health facilities

Mistreatment with women during childbirth is prevalent in many in low- and middle-income countries. There is dearth of evidence that informs development of health system interventions to promote supportive and respectful maternity care in facility-based settings. We examined health systems bottlenec...

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Autores principales: Hameed, Waqas, Khan, Bushra, Siddiqi, Sameen, Asim, Muhammad, Avan, Bilal Iqbal
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021678/
https://www.ncbi.nlm.nih.gov/pubmed/36962395
http://dx.doi.org/10.1371/journal.pgph.0000550
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author Hameed, Waqas
Khan, Bushra
Siddiqi, Sameen
Asim, Muhammad
Avan, Bilal Iqbal
author_facet Hameed, Waqas
Khan, Bushra
Siddiqi, Sameen
Asim, Muhammad
Avan, Bilal Iqbal
author_sort Hameed, Waqas
collection PubMed
description Mistreatment with women during childbirth is prevalent in many in low- and middle-income countries. There is dearth of evidence that informs development of health system interventions to promote supportive and respectful maternity care in facility-based settings. We examined health systems bottlenecks that impedes provision of supportive and respectful maternity care in secondary-level public healthcare system of Pakistan. Using a qualitative exploratory design, forty in-depth interviews conducted with maternity care staff of six public health facilities in southern Pakistan. Development of interview guide and data analyses were guided by the WHO’s six health system building blocks. A combination of inductive and deductive approach was used for data analyses. Our study identified range of bottlenecks impeding provision of RMC. In terms of leadership/governance, there was lack of institutional guidelines, supervision and monitoring, and patient feedback mechanism. No systematic mechanism existed to screen and record patient psychosocial needs. Health workforce lacked training opportunities on RMC that resulted in limited knowledge and skills; there were also concerns about lack of recognition from leadership for good performers, and poor relationship and coordination between clinical and non-clinical staff. Regarding the domain of service delivery, we found that patients were perceived as un-cooperative, non-RMC manifestations were acceptable and normalized under certain conditions, and restrictive policies for active engagement of companions. Finally, lack of cleanliness, curtains for privacy, seating arrangement for companion were the identified issues infrastructural issues. A service-delivery intervention package is needed that effectively uses all six components of the health system: from investments in capacity building of maternity teams to creating a conducive facility environment via proper governance and accountability mechanisms. Such interventions should not only focus on provision of maternity care in a respectful and dignified manner, but also ensure that care is responsive to the psychosocial needs of pregnant women without any discrimination.
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spelling pubmed-100216782023-03-17 Health system bottlenecks hindering provision of supportive and dignified maternity care in public health facilities Hameed, Waqas Khan, Bushra Siddiqi, Sameen Asim, Muhammad Avan, Bilal Iqbal PLOS Glob Public Health Research Article Mistreatment with women during childbirth is prevalent in many in low- and middle-income countries. There is dearth of evidence that informs development of health system interventions to promote supportive and respectful maternity care in facility-based settings. We examined health systems bottlenecks that impedes provision of supportive and respectful maternity care in secondary-level public healthcare system of Pakistan. Using a qualitative exploratory design, forty in-depth interviews conducted with maternity care staff of six public health facilities in southern Pakistan. Development of interview guide and data analyses were guided by the WHO’s six health system building blocks. A combination of inductive and deductive approach was used for data analyses. Our study identified range of bottlenecks impeding provision of RMC. In terms of leadership/governance, there was lack of institutional guidelines, supervision and monitoring, and patient feedback mechanism. No systematic mechanism existed to screen and record patient psychosocial needs. Health workforce lacked training opportunities on RMC that resulted in limited knowledge and skills; there were also concerns about lack of recognition from leadership for good performers, and poor relationship and coordination between clinical and non-clinical staff. Regarding the domain of service delivery, we found that patients were perceived as un-cooperative, non-RMC manifestations were acceptable and normalized under certain conditions, and restrictive policies for active engagement of companions. Finally, lack of cleanliness, curtains for privacy, seating arrangement for companion were the identified issues infrastructural issues. A service-delivery intervention package is needed that effectively uses all six components of the health system: from investments in capacity building of maternity teams to creating a conducive facility environment via proper governance and accountability mechanisms. Such interventions should not only focus on provision of maternity care in a respectful and dignified manner, but also ensure that care is responsive to the psychosocial needs of pregnant women without any discrimination. Public Library of Science 2022-07-08 /pmc/articles/PMC10021678/ /pubmed/36962395 http://dx.doi.org/10.1371/journal.pgph.0000550 Text en © 2022 Hameed et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Hameed, Waqas
Khan, Bushra
Siddiqi, Sameen
Asim, Muhammad
Avan, Bilal Iqbal
Health system bottlenecks hindering provision of supportive and dignified maternity care in public health facilities
title Health system bottlenecks hindering provision of supportive and dignified maternity care in public health facilities
title_full Health system bottlenecks hindering provision of supportive and dignified maternity care in public health facilities
title_fullStr Health system bottlenecks hindering provision of supportive and dignified maternity care in public health facilities
title_full_unstemmed Health system bottlenecks hindering provision of supportive and dignified maternity care in public health facilities
title_short Health system bottlenecks hindering provision of supportive and dignified maternity care in public health facilities
title_sort health system bottlenecks hindering provision of supportive and dignified maternity care in public health facilities
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021678/
https://www.ncbi.nlm.nih.gov/pubmed/36962395
http://dx.doi.org/10.1371/journal.pgph.0000550
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