Erim Daniel O, Offiong Harrison E, Kim Christine, Bello Folasade A, Moulton Jeremy, Wheeler Stephanie B, Thirumurthy Harsha
Department of Health Policy and Management, the University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
University Hospitals of Leicester NHS Trust, Leicester, UK.
BMC Health Serv Res. 2018 Apr 23;18(1):295. doi: 10.1186/s12913-018-3106-x.
The Nigerian Midwives Service Scheme (MSS) increased use of antenatal services at rural public sector clinics. However, it is unclear if women who would not have otherwise sought care, or those who would have sought care in rural private sector clinics caused this change. Additionally, it is also unclear if the reported midwife attrition was associated with a spillover of the scheme's effect on urban areas. We sought to answer these two questions using data from two nationally representative surveys.
We used an interrupted time series model to assess trends in the use of obstetric (i.e. antenatal and delivery) services among rural and urban respondents in the 2008 and 2013 Nigerian demographic and health surveys.
We found that the MSS led to a 5-percentage point increase in the use of antenatal services at rural public sector clinics, corroborating findings from a previous study. This change was driven by women who would not have sought care otherwise. We also found that there was a 4-percentage point increase in the use of delivery services at urban public sector clinics, and a concurrent 4-percentage point decrease in urban home deliveries. These changes are most likely explained by midwives' attrition and exemplify a spillover of the scheme's effect.
Midwife attrition from the Nigerian MSS was associated with a spillover of the scheme's effect on the use of delivery services, on urban areas.
尼日利亚助产士服务计划（MSS）增加了农村公共部门诊所产前服务的使用率。然而，尚不清楚那些原本不会寻求护理的女性，或者那些原本会在农村私立部门诊所寻求护理的女性是否导致了这一变化。此外，报告的助产士流失是否与该计划对城市地区的影响外溢有关也不清楚。我们试图利用两项全国代表性调查的数据来回答这两个问题。
我们使用中断时间序列模型来评估2008年和2013年尼日利亚人口与健康调查中农村和城市受访者产科（即产前和分娩）服务使用情况的趋势。
我们发现，助产士服务计划使农村公共部门诊所的产前服务使用率提高了5个百分点，这与之前一项研究的结果一致。这一变化是由那些原本不会寻求护理的女性推动的。我们还发现，城市公共部门诊所的分娩服务使用率提高了4个百分点，同时城市家庭分娩率下降了4个百分点。这些变化很可能是由助产士的流失所解释的，并且体现了该计划影响的外溢。
尼日利亚助产士服务计划中的助产士流失与该计划对城市地区分娩服务使用的影响外溢有关。
