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Impact of health systems strengthening on coverage of maternal health services in Rwanda, 2000–2010: a systematic review
Maurice Bucagu, Jean M. Kagubare, Paulin Basinga, Fidèle Ngabo, Barbara K Timmons & Angela C Lee
Reproductive Health Matters
(2012)
CC
From 2000 to 2010, Rwanda implemented comprehensive health sector reforms to strengthen the public health system, with the aim of reducing maternal and newborn deaths in line with Millennium Development Goal 5, among many other improvements in natio
...
nal health. Based on a systematic review of the literature, national policy documents and three Demographic & Health Surveys (2000, 2005 and 2010), this paper describes the reforms and the policies they were based on, and provides data on the extent of Rwanda’s progress in expanding the coverage of four key women’s health services. Progress took place in 2000–2005 and became more rapid after 2006, mostly in rural areas, when the national facility-based childbirth policy, performance-based financing, and community-based health insurance were scaled up. Between 2006 and 2010, the following increases in coverage took place as compared to 2000–2005, particularly in rural areas, where most poor women live: births with skilled attendance (77% increase vs. 26%), institutional delivery (146% increase vs. 8%), and contraceptive prevalence (351% increase vs. 150%). The primary factors in these improvements were increases in the health workforce and their skills, performance-based financing, community-based health insurance, and better leadership and governance. Further research is needed to determine the impact of these changes on health outcomes in women and children.
more
This publication presents guidance on good practice from the Ayeyarwaddy Delta in Myanmar, outlining the key factors which contributed to the successful implementation and outcome of a range of community-based Disaster Risk Reduction initiatives implemented by the Myanmar Consortium for Community Re
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silience (MCCR).
The content was developed over a period of two months between November-December 2015, involving a desk review of MCCR project documents including impact studies, monitoring reports and newsletters. Field visits were undertaken to the Ayeyarwaddy Delta to document the perspectives of key stakeholders at community level, including a total of 93 adults (men and women) and 57 children (girls and boys) from eight communities targeted under the DIPECHO IX project. more
The content was developed over a period of two months between November-December 2015, involving a desk review of MCCR project documents including impact studies, monitoring reports and newsletters. Field visits were undertaken to the Ayeyarwaddy Delta to document the perspectives of key stakeholders at community level, including a total of 93 adults (men and women) and 57 children (girls and boys) from eight communities targeted under the DIPECHO IX project. more
The report depicts the reality of forced displacement as a developing world crisis with implications for sustainable growth: 95 percent of the displaced live in developing countries and over half are in displacement for more than four years. To help
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the displaced, the report suggests ways to rebuild their lives with dignity through development support, focusing on their vulnerabilities such as loss of assets and lack of legal rights and opportunities. It also examines how to help host communities that need to manage the sudden arrival of large numbers of displaced people, under pressure to expand services, create jobs and address long-standing development issues.
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The mission of the Women’s Health Council is to inform and influence the development of health policy to ensure the maximum health and social gain for women in Ireland.
Its membership is representative of a wide range of expertise and interest in women’s health.
The Women’s Health Council
...
has five functions detailed in its Statutory Instruments:
1. Advising the Minister for Health and Children on all aspects of women’s health.
2. Assisting the development of national and regional policies
and strategies designed to increase health gain and social gain for women.
3. Developing expertise on women’s health within the health services.
4. Liaising with other relevant international bodies which have similar functions as the Council.
5. Advising other Government Ministers at their request.
more
Myanmar, as a country going through rapid socio-political transition and institutional development also suffers with a high burden of infectious disease. An ongoing challenge has been to effectively reach its 51 million population, most of whom battle tuberculosis, acute respiratory infections, diar
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rhoea and malaria including amongst under-five children.
Limited research data on the occurrence of resistant organisms in the nation have, makes it hard to estimate the exact antimicrobial resistance (AMR) scenario. Limited peer reviewed evidence indicates significant divergence from the average resistance trends in APAC region. Nevertheless, several key steps by Government of Myanmar have been instrumental in paving the way for the country to join other nations in the South East Asia Region to speed up its plan on addressing the AMR crisis. Combating antimicrobial resistance would, however, require highest political commitment, multi-sectoral coordination, sustained investment and technical assistance.
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Noncommunicable diseases (NCDs) such as cancer, cardiovascular disease, diabetes and chronic respiratory diseases and their risk factors are an increasing public health and development challenge in Kazakhstan. This report provides evidence through three analyses that NCDs reduce economic output and
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discusses potential options in response, outlining details of their relative returns on investment. An economic burden analysis shows that economic losses from NCDs (direct and indirect costs) comprise 2.3 trillion tenge, equivalent to 4.5% of gross domestic product in 2017. An intervention costing analysis provides an estimate of the funding required to implement a set of policy interventions for prevention and clinical interventions. A cost–benefit analysis compares these implementation costs with the estimated health gains and identifies which policy packages would give the greatest returns on investment. For example, the salt policy package achieved a benefit-to-cost ratio of 118.4 over 15 years, a return of more than 118 tenge for every 1 tenge invested.
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The Covid-19 pandemic has so far infected more than 30 million people in the world, having major impact on global health with collateral damage. In Mozambique, a public state of emergency was declared at the end of March 2020. This has limited people's movements and reduced public services, leading
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to a decrease in the number of people accessing health care facilities. An implementation research project, The Alert Community for a Prepared Hospital, has been promoting access to maternal and child health care, in Natikiri, Nampula, for the last four years. Nampula has the second highest incidence of Covid-19. The purpose of this study is to assess the impact of Covid-19 pandemic Government restrictions on access to maternal and child healthcare services. We compared health centres in Nampula city with healthcare centres in our research catchment area. We wanted to see if our previous research interventions have led to a more resilient response from the community.
METHODS: Mixed-methods research, descriptive, cross-sectional, retrospective, using a review of patient visit documentation. We compared maternal and child health care unit statistical indicators from March-May 2019 to the same time-period in 2020. We tested for significant changes in access to maternal and child health services, using KrushKall Wallis, One-way Anova and mean and standard deviation tests. We compared interviews with health professionals, traditional birth attendants and patients in the two areas. We gathered data from a comparable city health centre and the main city referral hospital. The Marrere health centre and Marrere General Hospital were the two Alert Community for a Prepared Hospital intervention sites.
RESULTS: Comparing 2019 quantitative maternal health services access indicators with those from 2020, showed decreases in most important indicators: family planning visits and elective C-sections dropped 28%; first antenatal visit occurring in the first trimester dropped 26%; hospital deliveries dropped a statistically significant 4% (p = 0.046), while home deliveries rose 74%; children vaccinated down 20%.
CONCLUSION: Our results demonstrated the negative collateral effects of Covid-19 pandemic Government restrictions, on access to maternal and child healthcare services, and highlighted the need to improve the health information system in Mozambique.
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Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection
recommended
The recommendations in these guidelines promote the use of simple, non-invasive diagnostic tests to assess the stage of liver disease and eligibility for treatment; prioritize treatment for those with most advanced liver disease and at greatest risk of mortality; and recommend the preferred use of n
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ucleos(t)ide analogues with a high barrier to drug resistance (tenofovir and entecavir, and entecavir in children aged 2–11 years) for first- and second-line treatment. Recommendations for the treatment of HBV/HIV-coinfected persons are based on the WHO 2013 Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection, which will be updated in 2015.
more
Zambia is facing a severe economic crisis marked by high inflation, increasing poverty and a heavy debt burden that is straining both its fiscal stability and progress in health outcomes. By 2020, the country's external debt reached United States dollars (USD) 12.7 billion, representing 108% of the
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country's gross domestic product (GDP). In 2020, Zambia sought assistance through the G20 Common Framework and the International Monetary Fund (IMF) Extended Credit Facility (ECF), securing a USD 1.7 billion loan over 5 years. IMF loans, however, come with austerity measures that prioritise fiscal discipline but could potentially exacerbate social inequalities. These measures, which include increasing consumer taxes on goods and services (value added taxes - VATs), electricity tariffs and fuel prices, disproportionately impact vulnerable populations, raising concerns about their long-term effects on essential services, especially accessible and good quality healthcare services.
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Lancet Infectious Diseases Volume 22, Issue 11e327-e335.
In February, 2022, WHO published new guidelines with six recommendations to update the global public health strategy against schistosomiasis, including expansion of preventive chemotherapy eligibility from the predominant group of school-age
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d children to all age groups (2 years and older), lowering the prevalence threshold for annual preventive chemotherapy, and increasing the frequency of treatment. This Review, written by the 2018-2022 Schistosomiasis Guidelines Development Group and its international partners, presents a summary of the new WHO guideline recommendations for schistosomiasis along with their historical context, supporting evidence, implications for public health implementation, and future research needs.
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Paying for performance (P4P) provides financial incentives for providers to increase the use and quality of care. P4P can affect health care by providing incentives for providers to put more effort into specific activities, and by increasing the amount of resources available to finance the delivery
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of services. This paper evaluates the impact of P4P on the use and quality of prenatal, institutional delivery, and child preventive care using data produced from a prospective quasi-experimental evaluation nested into the national rollout of P4P in Rwanda. Treatment facilities were enrolled in the P4P scheme in 2006 and comparison facilities were enrolled two years later. The incentive effect is isolated from the resource effect by increasing comparison facilities’ input-based budgets by the average P4P payments to the treatment facilities. The data were collected from 166 facilities and a random sample of 2158 households. P4P had a large and significant positive impact on institutional deliveries and preventive care visits by young children, and improved quality of prenatal care. The authors find no effect on the number of prenatal care visits or on immunization rates. P4P had the greatest effect on those services that had the highest payment rates and needed the lowest provider effort. P4P financial performance incentives can improve both the use of and the quality of health services. Because the analysis isolates the incentive effect from the resource effect in P4P, the results indicate that an equal amount of financial resources without the incentives would not have achieved the same gain in outcomes.
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Rabies is entirely preventable, and vaccines, medicines, tools and technologies have long been available to prevent people from dying of dog-mediated rabies. Nevertheless, rabies still kills about 60 000 people a year, of whom over 40% are children
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under 15, mainly in rural areas of economically disadvantaged countries in Africa and Asia. Of all human cases, up to 99% are acquired from the bite of an infected dog.
more
Rabies is entirely preventable, and vaccines, medicines, tools and technologies have long
been available to prevent people from dying of dog-mediated rabies. Nevertheless, rabies still
kills about 60 000 people a year, of whom over 40% are children
...
under 15, mainly in rural areas
of economically disadvantaged countries in Africa and Asia. Of all human cases, up to 99% are
acquired from the bite of an infected dog.
more
This country cooperation strategy (CCS) outlines how the World Health Organization (WHO) will work with the Lao People’s Democratic Republic over the next five years (2024–2028), supporting the implementation of the five-year health sector devel
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opment plans and the Health Sector Reform Strategy 2021–2030 to attain the Sustainable Development Goals (SDGs) by 2030.
The Lao People’s Democratic Republic experienced substantial economic growth in the 30 years prior to the coronavirus disease (COVID-19) pandemic, contributing to reduced poverty and significant progress toward the SDGs. However, the COVID-19 pandemic brought this development to a halt. It was anticipated that the COVID-19 recovery and the tremendous population growth in recent years would provide opportunities for a shift toward more sustainable and inclusive development in the years ahead. In 2023, however, the contrary was the case. Rural residents, including many ethnic minorities, continued to face marginalization because of limited access to education, health care and economic opportunities.
Despite the challenges of COVID-19 and other disease outbreaks, the country has made significant improvements in health. Nonetheless, progress has been uneven and not everyone has benefited from these achievements. In the mountainous region, many people lack access to quality health care because of the unequal distribution of well-trained health-care workers. Preventable deaths due to poor-quality health care for children and newborns, infants and mothers remain a concern, as do communicable diseases such as sexually transmitted infections and tuberculosis. The increasing burden of noncommunicable diseases and the health impact of worsening climate change further heighten the need for strengthened and resilient health systems, which are at risk due to an underfunded health sector and weak economy.
This CCS aims to address remaining and future challenges as well as health needs while creating an impact that is sustainable. It identifies three strategic priorities and nine deliverables (Table 1) to support the attainment of the national vision of Health for all by all, as articulated in the 9th Health Sector Development Plan 2021–2025. It contributes to the country’s goals to achieve universal health coverage, graduate from least developed country status by 2026 and attain SDGs by 2030.
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The achievable imperative for global progress
Recommended practices booklet (April 2020)
The set includes 10 Counselling Cards and a Recommended Practices Booklet. Infant and young child feeding (IYCF) counselling in the context of COVID-19 remains a critical nutrition intervention for the protection and support of pregnant women, caregivers,
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and their young children. WHO and UNICEF advise caregivers and families with suspected or confirmed COVID-19 to continue the recommended IYCF practices with the necessary hygiene precautions. It is therefore vital to ensure that communities and families around the world adopt these recommendations to help prevent the spread of the virus and care for those who are infected.
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Reference Guide Version 2. Revised. The Nutrition Program Design Assistant is a tool to help organizations design the nutrition component of their community-based maternal and child health, food security, or other development program. The tool focuses on prevention and also provides guidance on recu
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perative approaches that are needed when there is a high prevalence of acute malnutrition
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Women and children, especially pregnant girls and women, infants and young children and postpartum women, are populations that are extremely vulnerable in emergencies. Breastfeeding provides
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children with hydration, comfort, connection, high quality nutrition and protection against disease, shielding them from the worst of emergency conditions. This ability has been described as empowering and healing by some breastfeeding women.
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This manual provides practical guidelines for the management of children with severe malnutrition. It seeks to promote the best available therapy so as to reduce the risk of death, shorten the length of time spent in hospital, and facilitate rehabil
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itation and full recovery. Emphasis is given to the management of severely malnourished children in hospital and health centres; the management of severely malnourished children in disaster situations and refugee camps and of severely malnourished adolescents and adults is also considered briefly.
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A Joint Statement by the World Health Organization, the World Food Programme, the United Nations System Standing Committee on Nutrition and the United Nations Children’s Fund
