Okeke Edward N, Pitchforth Emma, Exley Josephine, Glick Peter, Abubakar Isa Sadeeq, Chari Amalavoyal V, Bashir Usman, Gu Kun, Onwujekwe Obinna
RAND Corporation, 4570 Fifth Avenue, Pittsburgh, PA, 15213, USA.
RAND Europe, Cambridge, UK.
BMC Health Serv Res. 2017 May 18;17(1):356. doi: 10.1186/s12913-017-2284-2.
The lack of availability of skilled providers in low- and middle- income countries is considered to be an important barrier to achieving reductions in maternal and child mortality. However, there is limited research on programs increasing the availability of skilled birth attendants in developing countries. We study the implementation of the Nigeria Midwives Service Scheme, a government program that recruited and deployed nearly 2,500 midwives to rural primary health care facilities across Nigeria in 2010. An outcome evaluation carried out by this team found only a modest impact on the use of antenatal care and no measurable impact on skilled birth attendance. This paper draws on perspectives of policymakers, program midwives, and community residents to understand why the program failed to have the desired impact.
We conducted semi-structured interviews with federal, state and local government policy makers and with MSS midwives. We also conducted focus groups with community stakeholders including community leaders and male and female residents.
Our data reveal a range of design, implementation and operational challenges ranging from insufficient buy-in by key stakeholders at state and local levels, to irregular and in some cases total non-provision of agreed midwife benefits that likely contributed to the program's lack of impact. These challenges not only created a deep sense of dissatisfaction with the program but also had practical impacts on service delivery likely affecting households' uptake of services.
This paper highlights the challenge of effectively scaling up maternal and child health interventions. Our findings emphasize the critical importance of program design, particularly when programs are implemented at scale; the need to identify and involve key stakeholders during planning and implementation; the importance of clearly defining lines of authority and responsibility that align with existing structures; and the necessity for multi-faceted interventions that address multiple barriers at the same time.
在低收入和中等收入国家，缺乏熟练的医疗服务提供者被认为是实现孕产妇和儿童死亡率降低的一个重要障碍。然而，关于在发展中国家增加熟练接生员供应的项目的研究有限。我们研究了尼日利亚助产士服务计划的实施情况，这是一项政府计划，2010年招募并向尼日利亚各地农村初级卫生保健机构部署了近2500名助产士。该团队进行的一项结果评估发现，该计划对产前护理的使用仅有适度影响，对熟练接生服务没有可衡量的影响。本文借鉴政策制定者、项目助产士和社区居民的观点，以了解该计划为何未能产生预期影响。
我们对联邦、州和地方政府政策制定者以及助产士服务计划的助产士进行了半结构化访谈。我们还与社区利益相关者，包括社区领袖以及男性和女性居民进行了焦点小组讨论。
我们的数据揭示了一系列设计、实施和运营方面的挑战，从州和地方层面关键利益相关者的参与不足，到不定期且在某些情况下完全不提供商定的助产士福利，这些可能导致了该计划缺乏影响力。这些挑战不仅使人们对该计划深感不满，而且对服务提供产生了实际影响，可能影响家庭对服务的接受。
本文强调了有效扩大母婴健康干预措施的挑战。我们的研究结果强调了项目设计的至关重要性，尤其是在大规模实施项目时；在规划和实施过程中识别并让关键利益相关者参与的必要性；明确界定与现有结构相一致的权力和责任界限的重要性；以及同时应对多重障碍的多方面干预措施的必要性。
