Midwife-Led Care in Low- and Middle-Income Countries with a Focus on Implementation in Bangladesh

University of Technology Sydney. Faculty of Health.: Rigorous research on midwife-led models of care in high-income countries show that they are effective and should be offered to most women, as they provide benefits for childbearing women and their newborns. There are few studies on midwife-led models of care in low- and middle-income countries (LMIC). A better understanding of midwife-led care (MLC) in LMICs is needed. : The overall aim was to explore how MLC is being implemented in LMICs. The three objectives were to systematically review the current evidence on midwife-led care in low- and middle-income countries, to assess the policies and health system efforts related to midwife-led care in a LMIC (Phase 1) and then to explore how midwife-led care was implemented in this country (Phase 2). : First, two reviews were conducted. In Phase 1, a policy and health systems analysis in Bangladesh, was undertaken. Finally, Phase 2 was a case study in Bangladesh using an explanatory mixed methods design. In this primary study, a multistage purposeful sampling technique was used and face to face interviews and focus groups were conducted. Data analysis used a framework approach. A synthesis of all phases identified the essential elements of MLC in these contexts. : The reviews showed that midwife-led care may be cost-effective, is likely to improve maternal mortality and morbidity, reduce interventions and improves quality of care, although more research is needed. MLC is provided in a variety of settings: urban and rural; in primary, secondary or tertiary facilities; in the private and public sector; in free-standing or alongside midwife-led units; and midwives work alone or in teams. Workforce shortages exist and negatively impact on the provision of MLC. Standards of education, regulation and training influence the quality of care and supportive environments are important. The policy and health systems analysis highlighted the need for leadership and resource mobilisation. The case study identified four themes in relation to the implementation of MLC in Bangladesh. These were addressing the heart and soul of MLC, empowering midwives to become leaders, structuring midwife-led care and providing care across the continuum. : Midwife-led care in low- and middle-income countries has potential to improve outcomes in maternal and newborn health and might be cost-effective. The implementation of midwife-led care varies and supportive systems and workforce planning are key to its success. The essential elements of MLC that were identified could be applied to similar contexts

Collective Intelligence for Knowledge Building and Research in Communities of Practice and Virtual Learning Environments: A Project Experience

There is little evidence about how collective intelligence, social networks, and communities of practice work in maternal health projects. In this paper, we discuss the approaches towards collective intelligence in a project by focusing on the virtual and web-based environments communities of practice and social network approach. This paper builds upon a research project IS0907 COST action and focuses on the communities of practice, social media within organization and team projects, and how through these networks and communities collective intelligence is building. Also, the current investigation stands as an example of COST IS0907 team and the relationship built between countries and communities of practice through working groups, manage knowledge transfer, and improve research collaboration and partnerships. This article aims to present the working environment developed to facilitate collective intelligence role in knowledge building and how communities of practice can enrich collaboration, in maternal health project settings, both educational and effective health research and knowledge building

Editorial : Women's health in low-resourced countries : epidemiology, governance, advocacy, capacity

No abstract available.http://frontiersin.org/Public_Healthpm2021School of Health Systems and Public Health (SHSPH

The provision of midwife-led care in low-and middle-income countries:An integrative review

BACKGROUND:The provision of midwife-led care, the model of care in which midwives are the lead professionals for women and newborn infants across the continuum, has been shown to be effective in improving outcomes for women and newborn infants, but predominantly based on research in high-income countries. OBJECTIVE:To explore how midwife-led care is provided in low- and middle-income countries. The specific question was to examine how, where and by whom has midwife-led care been provided in low-and-middle-income countries? DESIGN:An integrative literature review was undertaken and included studies using a range of methods. DATA SOURCES:A systematic search was conducted in Pubmed, EMBASE (Ovid), Web of Science, Scopus, Google Scholar, The Cochrane Library and hand-searching of relevant journals and website of International Organizations and relevant grey-literature. REVIEW METHODS:After applying inclusion criteria, systematic sifting and quality assessment processes, data were extracted from relevant studies. The software program NVivo was used to initially extract the findings and results of the studies. Coded data from primary data sources were iteratively compared, using patterns and themes as per the conceptual framework of the WHO on skilled health personnel providing care for childbearing women and newborn infants, including an analysis of the competent provider, standards of practice and the enabling environment. FINDINGS:Of a total of 3324 articles retrieved, 31 studies were included. There were 18 qualitative, nine quantitative and four mixed method studies with different levels of quality from five of six global regions published between 1997 and 2017. In these studies, midwife-led care was not found to be a standardised model in low- and middle-income countries (LMIC) and there was limited evidence on the effectiveness of midwife-led care in these countries. Care provided across the continuum was however described in most studies. Standards of practice in education, regulation and training varied widely as did the enabling environment in which midwife-led care took place. CONCLUSION AND IMPLICATION FOR PRACTICE AND RESEARCH:Midwife-led care is provided across low- and middle-income countries but lack of enabling factors limits the quality of care that midwives can provide. Further research about this model of care is needed to understand the ingredients of successful implementation, their effectiveness and sustainability