Health system bottlenecks hindering provision of supportive and dignified maternity care in public health facilities.
Health system bottlenecks hindering provision of supportive and dignified maternity care in public health facilities.
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DOI：
10.1371/journal.pgph.0000550
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Avan, Bilal Iqbal
中科院分区：
文献类型：
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作者：
Hameed, Waqas;Khan, Bushra;Siddiqi, Sameen;Asim, Muhammad;Avan, Bilal Iqbal
在许多低收入和中等收入国家，妇女在分娩期间受到虐待的现象十分普遍。缺乏证据表明，卫生系统干预措施的发展，以促进支持和尊重产妇护理设施为基础的设置。我们研究了阻碍巴基斯坦二级公共卫生系统提供支持性和尊重性孕产妇保健的卫生系统瓶颈。采用定性探索性设计，对巴基斯坦南部六个公共卫生机构的产科护理人员进行了四十次深入采访。访谈指南和数据分析的制定遵循世卫组织卫生系统的六个组成部分。数据分析采用了归纳和演绎相结合的方法。我们的研究确定了一系列阻碍提供RMC的瓶颈。在领导/治理方面，缺乏体制指导、监督和监测以及耐心反馈机制。没有系统的机制来筛选和记录病人的心理社会需求。卫生工作者缺乏关于RMC的培训机会，导致知识和技能有限;人们还担心领导层对优秀表现缺乏认可，临床和非临床工作人员之间的关系和协调不良。关于域的服务提供，我们发现，患者被认为是不合作的，非RMC表现是可以接受的，并在一定条件下正常化，和限制性政策的积极参与的同伴。最后，缺乏清洁，窗帘隐私，座位安排的同伴是确定的问题基础设施问题。需要一套提供服务的干预措施，有效利用卫生系统的所有六个组成部分：从对产科团队能力建设的投资到通过适当的治理和问责机制创造有利的设施环境。这种干预措施不仅应侧重于以尊重和有尊严的方式提供产妇护理，而且还应确保护理不加歧视地满足孕妇的心理需求。
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.