Barriers to and incentives for achieving partograph use in obstetric practice in low- and middle-income countries: a systematic review.

The partograph is a graphic display of the progress of labour, recommended by the World Health Organization, but often underused in practice in low- and middle-income countries. We were interested in going beyond demonstration of potential efficacy - on which the existing literature concentrates - through a systematic review to identify barriers to and incentives for achieving partograph use

Feasibility and effectiveness of electronic vs. paper partograph on improving birth outcomes:A prospective crossover study design

BACKGROUND: The partograph has been endorsed by World Health Organization (WHO) since 1994 which presents an algorithm for assessing maternal and foetal conditions and labor progression. Monitoring labour with a partograph can reduce adverse pregnancy outcomes such as prolonged labor, emergency C-sections, birth asphyxia and stillbirths. However, partograph use is still very low, particularly in low and middle income countries (LMICs). In Bangladesh the reported partograph user rate varies from 1.4% to 33.0%. Recently, an electronic version of the partograph, with the provision of online data entry and user aid for emergency clinical support, has been tested successfully in different settings. With this proven evidence, we conducted and operations research to test the feasibility and effectiveness of implementing an e-partograph, for the first time, in 2 public hospitals in Bangladesh. METHODS: We followed a prospective crossover design. Two secondary level referral hospitals, Jessore and Kushtia District Hospital (DH) were the study sites. All pregnant women who delivered in the study hospitals were the study participants. All nurse-midwives working in the labor ward of study hospitals were trained on appropriate use of both types of partograph along with standard labour management guidelines. Collected quantitative data was analyzed using SPSS 23 statistical software. Discrete variables were expressed as percentages and presented as frequency distribution and cross tabulations. Chi square tests were employed to test the association between exposure and outcome variables. Potential confounding factors were adjusted using multivariate binary logistic regression methods. Ethical approval was obtained from the institutional review board of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b). FINDINGS: In total 2918 deliveries were conducted at Jessore DH and 2312 at Kushtia DH during one-year study period. Of them, 1012 (506 in each facility) deliveries were monitored using partograph (paper or electronic). The trends of facility based C-section rates was downwards in both the hospitals; 43% to 37% in Jessore and from 36% to 25% in Kushtia Hospital. There was a significant reduction of prolonged labour with e-partograph use. In Kushtia DH, the prolonged labour rate was 42% during phase 1 with the paper version which came down to 29% during phase-2 with the e-partograph use. The similar result was observed in Jessore DH where the prolonged labour rate reduced to 7% with paper partograph from the reported 30% prolonged labour with e-partograph. The e-partograph user rate was higher than the paper partograph during both phases (phase 1: 3.31, CI: 2.04-5.38, p < .001 and in phase 2: 15.20 CI: 6.36-36.33, p < .001) after adjusting for maternal age, parity, gestational age, religion, mother's education, husband's education, and fetal sex. CONCLUSION: The partograph user rate has significantly improved with the e- partograph and was associated with an overall reduction in cesarean births. Use of the e-partograph was also associated with reduced rates of prolonged labour. This study has added to the growing body of evidence on the positive impact of e-partograph use. We recommend implementing e-partograph intervention at scale in both public and private hospitals in Bangladesh. TRIAL REGISTRATION: ClinicalTrials.gov NCT03509103

Emerging Opportunities: Monitoring and Evaluation in a Tech-Enabled World

Various trends are impacting on the field of monitoring and evaluation in the area of international development. Resources have become ever more scarce while expectations for what development assistance should achieve are growing. The search for more efficient systems to measure impact is on. Country governments are also working to improve their own capacities for evaluation, and demand is rising from national and community-based organizations for meaningful participation in the evaluation process as well as for greater voice and more accountability from both aid and development agencies and government.These factors, in addition to greater competition for limited resources in the area of international development, are pushing donors, program participants and evaluators themselves to seek more rigorous – and at the same time flexible – systems to monitor and evaluate development and humanitarian interventions.However, many current approaches to M&E are unable to address the changing structure of development assistance and the increasingly complex environment in which it operates. Operational challenges (for example, limited time, insufficient resources and poor data quality) as well as methodological challenges that impact on the quality and timeliness of evaluation exercises have yet to be fully overcome

Developing effective hospital management information systems: A technology ecosystem perspective

This thesis presents the results of the program of research performed in the completion of a Doctor of Philosophy (Business) entitled: Developing Effective Hospital Management Information Systems: A Technology Ecosystem Perspective. The central contention of this thesis is that the current ecosystem models in the information technology (IT) and information systems (IS) literature can be extended and improved. In turn they can be better applied to the field of IS and the development and implementation of information systems. This research seeks to highlight an example of how these models can be extended, through an analysis of the specific context of the hospital management information system environment, using the technology ecosystems model (TEM) of Adomavicius et al (Adomavicius et al., 2005). The environment in which hospital managers operate is characterised by high demand pressures, strong public service expectations, and an ever diminishing income stream (in relative terms) with which to provide services. Even in private hospital care, many of these pressures still apply, as well as a pressure to maintain profit margins. The agenda context here is a complex one, particularly when one considers the role of hospitals in this context. Hospitals have multiple competing priorities when viewed from a management perspective. This is despite the fact that the core mission of the hospital is to provide timely, safe care within available human and financial resources, to patients who present for care. This care can be across multiple care settings inside the hospital including the inpatient space, the operating theatres, the intensive care unit, and the emergency department; and in outreach settings. Hospitals however, have been described as a series of cottage industries each loosely coupled with a common objective of supplying care to patients. All of these factors combine to mean that managing a hospital with the above-mentioned aim in mind, is a very difficult task. Nakagawa et al (Nakagawa et al., 2011) talk specifically to this difficulty. In this research I undertake this examination through 2 core exercises. Firstly I examine the literature – both the information related and health care literature, for insights into the questions at hand. Secondly I examine the lessons learned from five Case Studies (CSs). The first four of these are based in physical hospital facilities across three Australian states. The final one is a “virtual CS” in which the views of multiple parties, not centred on any given physical institution, are sought and examined in relation to these questions. Based on the data collected in both the literature review and the CS’, and through a process of triangulation and research model validation, I conclude that a hospital management technology ecosystem (a HOME) can be described. Its existence thus validates the core TEM, and in fact the findings support some meaningful extensions to the TEM. The HOME is predominantly characterised by the presence of strong drivers of change that arise from outside the immediate hospital environment. Examples include changes in the labour market, and the skill sets of workers; changes in the broader development and availability of technology (for example – think of the effects of the rise of smart phones), and changes in government policies and funding arrangements. In the majority of cases these broader influencing forces (Environment Shaping Forces – ESF’s) can be seen to act on the local management environment and the role of technology in that environment, through describable intermediaries. A very obvious example of this is the effect of a global financial downturn - eventually this wide reaching force could be expected to affect hospitals (be they private or public) through struggling performance of a parent company, or state government funding cutbacks. In turn this could easily lead to reduced spending on IT in a given hospital. These findings, along with those around services provided by the ecosystem, and the measurement of ecosystem success or failure, add substantially to the IS knowledge base in this area. This research thus acts as a sound basis for further research in this new direction, but also provides a usable conceptual and practical framework within which stakeholders – managers, clinicians, beauracrats and the software development community - can view the management of hospitals and the technologies in support of that management