Analysis of maternal and infant health indicators in Kazakhstan: 2003–2018

BACKGROUND: The health status of women and children is the first and foremost priority for all countries in the world. In the first decade of Kazakhstan’s independence, the country’s population decreased by over 1 million, or 9.7%. Since 2003, the population of Kazakhstan has been growing steadily and is projected to be 18.9 million people in 2021. The focus on maternal and child health, an increase in the birth rate and a decrease in child and maternal mortality rates are the most important directions for state policy to improve the health and demographic situation in the country. AIM: The main purpose of the article is to analyze the main indicators of maternal and neonatal health in Kazakhstan before and after the implementation of the state health development programs “Densaulyk” and “Salamatty Kazakhstan.” METHODS: A retrospective study was carried out in two main databases of the Ministry of Health of Kazakhstan (Medinfo Database and www.stat gov kz). RESULTS: According to the official statistics in Medinfo database, almost all 12 maternal health and 11 infant health indicators had a positive tendency after implementing state programs (2011–2018). Notable exceptions among maternal and infant indicators included: Rate of C-section increased to 81.3%, provision of care by obstetrician-gynecologists decreased to 16% and the number of hospital beds for pregnant women, women in labor and parturient women dropped to 37.9%, service provision by pediatricians (including neonatologists) decreased to 27.8% with provision of children’s hospital beds dropping to 24.9%. CONCLUSIONS: Health indicators related to mother, pregnancy and children under 1 year old showed favorable results after implementing the state programs “Densaulyk” and “Salamatty Kazakhstan. However, high mortality rates among premature and low birth weight babies point to the need for changes in prevention and education systems in general

Investigating the criterion validity of contingent valuation-willingness to pay methods

This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University LondonWith theoretical foundations in welfare theory, the cost benefit analysis (CBA) technique is a powerful tool for assessing benefits particularly where markets do not exist or would fail (for example due to the existence of public goods) or have become potentially politically excluded (such as the health sector). Unlike other economic evaluation techniques, costs and benefits are measured in monetary terms allowing for comparisons within and between different sectors of the economy for resource allocation decisions. Using contingent valuation (CV) techniques, people’s preferences for goods are determined by finding out what they would be willing to pay (WTP) for specified benefits or improvements; or accept (WTA), as compensation for withdrawal or loss of benefit. While the use of WTP methods has grown in other sectors, the uptake in health has been limited. A long-standing criticism is that stated WTP estimates may be poor indicators of actual WTP, calling into question their validity and the use of such estimates for welfare valuation. The aim of this thesis is to investigate the criterion validity of CV-WTP studies. A four-pronged approach including critical appraisals of the available literature and evidence on criterion validity and empirical analyses was adopted. The thesis established the scarcity in criterion validity assessments, particularly in the health sector and that evidence on the criterion validity of CV-WTP is more varied than authors are presenting. The variety in the methods used to assess and report criterion validity assessments is demonstrated. Further, the impact of the analysis of hypothetical WTP on criterion validity assessments and conclusions thereof is demonstrated. The empirical analyses further demonstrate the differences in predictions and predictors of WTP analyses, discussing the effect of these on criterion validity assessments and conclusions. Finally, the thesis offers suggestions for the reporting of criterion validity assessments, in efforts to improve the method

Estimating treatment costs for uncomplicated diabetes at a hospital serving refugees in Kenya

Diabetes mellitus (DM) is increasing markedly in low- and middle-income countries where over three-quarters of global deaths occur due to non-communicable diseases. Unfortunately, these conditions are considered costly and often deprioritized in humanitarian settings with competing goals. Using a mixed methods approach, this study aimed to quantify the cost of outpatient treatment for uncomplicated type-1 (T1DM) and type-2 (T2DM) diabetes at a secondary care facility serving refugees in Kenya. A retrospective cost analysis combining micro- and gross-costings from a provider perspective was employed. The main outcomes included unit costs per health service activity to cover the total cost of labor, capital, medications and consumables, and overheads. A care pathway was mapped out for uncomplicated diabetes patients to identify direct and indirect medical costs. Interviews were conducted to determine inputs required for diabetes care and estimate staff time allocation. A total of 360 patients, predominantly Somali refugees, were treated for T2DM (92%, n = 331) and T1DM (8%, n = 29) in 2017. Of the 3,140 outpatient consultations identified in 2017; 48% (n = 1,522) were for males and 52% (n = 1,618) for females. A total of 56,144 tests were run in the setting, of which 9,512 (16.94%) were Random Blood Sugar (RBS) tests, and 90 (0.16%) HbA1c tests. Mean costs were estimated as: $2.58 per outpatient consultation,$1.37 per RBS test and $14.84 per HbA1c test. The annual pharmacotherapy regimens cost$91.93 for T1DM and $20.34 for T2DM. Investment in holistic and sustainable non-communicable disease management should be at the forefront of humanitarian response. It is expected to be beneficial with immediate implications on the COVID-19 response while also reducing the burden of care over time. Despite study limitations, essential services for the management of uncomplicated diabetes in a humanitarian setting can be modest and affordable. Therefore, integrating diabetes care into primary health care should be a fundamental pillar of long-term policy response by stakeholders

Task sharing and task shifting: optimizing the primary health care workforce for improved delivery of noncommunicable disease services in Kenya

Integration of noncommunicable disease (NCD) care into primary health care (PHC) is crucial in addressing the NCD burden: this could improve health promotion and access to early NCD diagnosis and facilitate continuous management of NCDs at the population level. Successful NCD integration requires both investment in the health system and refocusing of PHC from an infectious disease emphasis to a system approach inclusive of NCD care. Strengthening the health workforce (HWF) is key in reorganizing the PHC system: availability and adequate capacity and distribution of health workers are crucial. Task sharing and task shifting (TSS) is an effective intervention to address HWF challenges: sharing clinical tasks with non-physician health workers (NPHWs) such as nurses and community health workers (CHWs) or shifting some tasks to them could help strengthen HWF to accommodate NCD care at the PHC level. An enabling legal and regulatory framework and adequate training of NPHWs are required to support TSS: the key enablers for successful TSS are training and on-the-job support for NPHWs. The barriers include the lack of a legal and regulatory framework for the new roles NPHWs assume such as prescribing medicines and other health system responsibilities

The role of community health workers in COVID-19 home-based care: lessons learned from Rwanda

Investment in the health system is essential for effective pandemic response: Despite Rwanda’s rapid implementation of control measures to manage the COVID-19 pandemic, the country faced several challenges in the early stages, due to inadequate infrastructure and a shortage of trained staff. A home-based care approach alleviated the facility-based care burden during the pandemic: Implemented in September 2020, this key strategy engaged community health workers (CHWs) to provide health education and monitor patients with mild COVID-19 symptoms. The integration of medical doctors (MDs) into home-based care teams strengthened the COVID-19 response in Rwanda: Operation Save the Neighbour, launched in 2021, integrated MDs into home-based care teams. This improved the quality of care provided to COVID-19 patients, enhanced patient monitoring, and offered additional support to CHWs at household level. The provision of continuous support to CHWs contributed to overcoming challenges in implementing home-based care models: CHWs played a critical role in community mobilization and surveillance. However, they faced significant challenges, including fear, anxiety, and overwhelming workloads. To support these frontline workers, ongoing training and an adequate supply of resources, including personal protective equipment (PPE), are required

Can Reproductive Health Voucher Programs Improve Quality of Postnatal Care? A Quasi-Experimental Evaluation of Kenya’s Safe Motherhood Voucher Scheme

This study tests the group-level causal relationship between the expansion of Kenya’s Safe Motherhood voucher program and changes in quality of postnatal care (PNC) provided at voucher-contracted facilities. We compare facilities accredited since program inception in 2006 (phase I) and facilities accredited since 2010-2011 (phase II) relative to comparable non-voucher facilities. PNC quality is assessed using observed clinical content processes, as well as client-reported outcome measures. Two-tailed unpaired t-tests are used to identify differences in mean process quality scores and client-reported outcome measures, comparing changes between intervention and comparison groups at the 2010 and 2012 data collection periods. Difference-in-differences analysis is used to estimate the reproductive health (RH) voucher program’s causal effect on quality of care by exploiting group-level differences between voucher-accredited and non-accredited facilities in 2010 and 2012. Participation in the voucher scheme since 2006 significantly improves overall quality of postnatal care by 39% (p=0.02), where quality is defined as the observable processes or components of service provision that occur during a PNC consultation. Program participation since phase I is estimated to improve the quality of observed maternal postnatal care by 86% (p=0.02), with the largest quality improvements in counselling on family planning methods (IRR 5.0; p=0.01) and return to fertility (IRR 2.6; p=0.01). Despite improvements in maternal aspects of PNC, we find a high proportion of mothers who seek PNC are not being checked by any provider after delivery. Additional strategies will be necessary to standardize provision of packaged postnatal interventions to both mother and new-born. This study addresses an important gap in the existing RH literature by using a strong evaluation design to assess RH voucher program effectiveness on quality improvement

Promoting Respectful Maternity Care: A training guide for facility-based workshops—Participant\u27s guide

This guide was produced as part of the Respectful Maternity Care (RMC) Resource Package. The Resource Package was designed to support health facility managers, health care providers, and communities in confronting disrespect and abuse (D&A) during facility-based childbirth and to promote respectful maternity care. The Resource Package includes a facilitator’s guide (facility-based workshops), facilitator’s guide (community-based workshops), participant’s guide, community flipchart, tools, and program briefs. Workshop objectives outlined in the Participant’s Guide: Outline current status of maternal and neonatal health in relation to respectful care. Discuss key RMC concepts, terminology, legal and rights-based approaches related to respectful maternity care and the RMC Resource Package. Demonstrate knowledge and use of VCAT theory and practice. Discuss selected evidence-based strategies that reduce D&A. Discuss participants’ role in promoting RMC. Develop action plans to support the implementation of RMC interventions at various levels of health (e.g., policy, program, regional/county, subcounty, facility, and community)

Promoting Respectful Maternity Care: A training guide for community-based workshops—Community facilitator\u27s guide

This guide was produced as part of the Respectful Maternity Care (RMC) Resource Package. The Resource Package was designed to support health facility managers, health care providers, and communities in confronting disrespect and abuse (D&A) during facility-based childbirth and to promote respectful maternity care. The Resource Package includes a facilitator’s guide (facility-based workshops), facilitator’s guide (community-based workshops), participant’s guide, community flipchart, tools, and program briefs. The Community Facilitator’s Guide, designed to be used by facilitators to promote respectful maternity care at the community level, can be adapted to educate a variety of stakeholders in community settings (i.e., Community Health Extension Workers, Community Health Workers, society leaders, legal aid officers). The Guide highlights key practical points to enable participants to act as resource persons regarding the rights and obligations of childbearing women, and as advocates of respectful maternity care including how to conduct an Alternative Dispute Resolution mechanism

An assessment of opportunities and challenges for public sector involvement in the maternal health voucher program in Uganda

This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Continued inequities in coverage, low quality of care, and high out-of-pocket expenses for health services threaten attainment of Millennium Development Goals 4 and 5 in many sub-Saharan African countries. Existing health systems largely rely on input-based supply mechanisms that have a poor track record meeting the reproductive health needs of low-income and underserved segments of national populations. As a result, there is increased interest in and experimentation with results-based mechanisms like supply-side performance incentives to providers and demand-side vouchers that place purchasing power in the hands of low-income consumers to improve uptake of facility services and reduce the burden of out-of-pocket expenditures. This paper describes a reproductive health voucher program that contracts private facilities in Uganda and explores the policy and implementation issues associated with expansion of the program to include public sector facilities. Methods: Data presented here describes the results of interviews of six district health officers and four health facility managers purposefully selected from seven districts with the voucher program in southwestern Uganda. Interviews were transcribed and organized thematically, barriers to seeking RH care were identified, and how to address the barriers in a context where voucher coverage is incomplete as well as opportunities and challenges for expanding the program by involving public sector facilities were investigated. Results: The findings show that access to sexual and reproductive health services in southwestern Uganda is constrained by both facility and individual level factors which can be addressed by inclusion of the public facilities in the program. This will widen the geographical reach of facilities for potential clients, effectively addressing distance related barriers to access of health care services. Further, intensifying ongoing health education, continuous monitoring and evaluation, and integrating the voucher program with other services is likely to address some of the barriers. The public sector facilities were also seen as being well positioned to provide voucher services because of their countrywide reach, enhanced infrastructure, and referral networks. The voucher program also has the potential to address public sector constraints such as understaffing and supply shortages.Conclusions: Accrediting public facilities has the potential to increase voucher program coverage by reaching a wider pool of poor mothers, shortening distance to service, strengthening linkages between public and private sectors through public-private partnerships and referral systems as well as ensuring the awareness and buy-in of policy makers, which is crucial for mobilization of resources to support the sustainability of the programs. Specifically, identifying policy champions and consulting with key policy sectors is key to the successful inclusion of the public sector into the voucher program

Exploring the effectiveness of the output-based aid voucher program to increase uptake of gender-based violence recovery services in Kenya: a qualitative evaluation

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Few studies in Africa have explored in detail the ability of output-based aid (OBA) voucher programs to increase access to gender-based violence recovery (GBVR) services. Methods: A qualitative study was conducted in 2010 and involved: (i) in-depth interviews (IDIs) with health managers, service providers, voucher management agency (VMA) managers and (ii) focus group discussions (FGDs) with voucher users, voucher non-users, voucher distributors and opinion leaders drawn from five program sites in Kenya. Results: The findings showed promising prospects for the uptake of OBA GBVR services among target population. However, a number of factors affect the uptake of the services. These include lack of general awareness of the GBVR services vouchers, lack of understanding of the benefit package, immediate financial needs of survivors, as well as stigma and cultural beliefs that undermine reporting of cases or seeking essential medical services. Moreover, accreditation of only hospitals to offer GBVR services undermines access to the services in rural areas. Poor responsiveness from law enforcement agencies and fear of reprisal from perpetrators also undermine treatment options and access to medical services. Low provider knowledge on GBVR services and lack of supplies also affect effective provision and management of GBVR services. Conclusions: The above findings suggest that there is a need to build the capacity of health care providers and police officers, strengthen the community strategy component of the OBA program to promote the GBVR services voucher, and conduct widespread community education programs aimed at prevention, ensuring survivors know how and where to access services and addressing stigma and cultural barriers.The Bill and Melinda Gates Foundatio