PMNCH Knowledge Summary 23: Human Rights & Accountability

Panel presentation for the Global Maternal Health Conference, held in Tanzania in January 2013, organised by Kate Sabot Presentation Outline (1) Overview of PMNCH (2) Overview of Knowledge Summary Process (3) KS 23 Highlight

Data Informed Platform for Health Feasibility Study Report, Amhara and Oromia Regions, Ethiopia

IDEAS has published a report on the feasibility of implementing the Data Informed Platform for Health in Amhara and Oromia Regions, Ethiopia. The Data Informed Platform for Health is a framework to guide coordination, bringing together key data from public and private health sectors on inputs and processes that could influence maternal and newborn health. The key data will be synthesised to create a measure of programme implementation strength for each local area, which in turn can be used in the evaluation of the effects of large-scale programmes on health outcomes

Knowledge Summary 23: Human Rights & Accountability

Progress has been made in reducing maternal and child mortality, yet millions continue to die from preventable causes. These deaths represent an accountability challenge and a major concern shared by both the health and human rights communities. The Millennium Development Goals (MDGs) commit to reducing these deaths. Powerful complementarities exist between MDGs and human rights.1 The MDGs generate attention, mobilise resources and contribute technical health monitoring approaches. Human rights offer a fundamental emphasis on accountability, systematic and sustained attention to inequities and a legal grounding of commitments. This knowledge summary explores human rights accountability systems at community, country, regional and international levels and the potential synergies for achieving both human rights and public health goals including, and beyond, the MDGs

Engaging the public & private sectors in data sharing to improve maternal and newborn health in Uttar Pradesh, India

Background The private for-profit health sector in India delivers around 80% of outpatient treatment and 60% of hospitalisations, and includes more than three quarters of human resources for health. The sector includes solo doctor clinics, small hospitals and big corporate hospital chains, as well as many informal providers. The formal private health sector has grown rapidly without regulatory frameworks and quality assurance. Quality of care is variable and there is lack of adherence to standard treatments, protocols or pricing. Limited information is shared with public health information systems. Aim To develop an engagement strategy with the private for-profit health sector in Uttar Pradesh, India. The broader underlying goal is to develop and pilot a district level Data Informed Platform for Health (DIPH) for improved local health decision-making in maternal and child health including both the public and private health sectors. Methods We reviewed literature, and examined national plans and programme documents to identify lessons from successful public-private engagements for maternal and child health and collate key policies related to the private health sector in India. We sought inputs from 27 national, state and district level stakeholders for developing a strategy to engage with the private sector for a DIPH. Findings In India, public-private partnerships for service delivery and financing represent a key area of engagement with the private sector, especially for maternal and child health. Examples include the Merrygold network, a clinical social franchise, and the Sambhav voucher scheme, in which poor households can exchange vouchers for health services in selected city hospitals in Uttar Pradesh. Engagements related to data recording and reporting from the private health sector have been less successful. There are gaps in reporting even notifiable diseases like Tuberculosis. There is limited data available on the private sector at the national level. Legal provisions can facilitate data exchange and synthesis: a binding legal framework may be available when the Clinical Establishments Act, passed by the Indian Parliament in 2010, is implemented. Proposed engagement strategies Stakeholder consultations suggested that before the Clinical Establishments Act is implemented, the private sector might best be engaged by: 1.Relationship building among key private and public sector stakeholders. 2.Sensitisation of private and public sector groups and individuals with the concept of a DIPH. 3.Inclusion of selected private sector players in the DIPH 4.User-friendly data collection and management. 5.Provision of both financial and non-financial incentives to encourag

Where there’s ‘willingness’ there’s a way: barriers and facilitators to maternal, newborn and child health data sharing by the private health sector in Uttar Pradesh, India

In India and Uttar Pradesh (UP), the private health sector plays an important role in health care services, including institutional deliveries, but there is limited information on the availability of maternal, newborn and child health (MNCH) data that private facilities maintain and share with the public health information system. Sharing data could help the public sector plan their resources more efficiently. Aim of the study: To explore current practices of MNCH data availability and sharing/reporting by private health facilities and the barriers and facilitators to data sharing

Implementation pathway report: Community Resource Person An intervention by the Technical Support Unit Uttar Pradesh, India, February 2015

A report describing the methodology behind an implementation pathway for the Community Resource Person innovation being implemented by the Technical Support Unit (a large-scale collaboration between the Bill & Melinda Gates Foundation and the Uttar Pradesh government) in Uttar Pradesh, India

Linkages between public and non-government sectors in healthcare: a case study from Uttar Pradesh, India.

: Effective utilisation of collaborative non-governmental organisation (NGO)-public health system linkages in pluralistic health systems of developing countries can substantially improve equity and quality of services. This study explores level and types of linkages between public health sector and NGOs in Uttar Pradesh (UP), an underprivileged state of India, using a social science model for the first time. It also identifies gaps and challenges for effective linkage. Two NGOs were selected as case studies. Data collection included semi-structured in-depth interviews with senior staff and review of records and reporting formats. Formal linkages of NGOs with the public health system related to registration, participation in district level meetings, workforce linkages and sharing information on government-supported programmes. Challenges included limited data sharing, participation in planning and limited monitoring of regulatory compliances. Linkage between public health system and NGOs in UP was moderate, marked by frequent interaction and some reciprocity in information and resource flows, but weak participation in policy and planning. The type of linkage could be described as 'complementarity', entailing information and resource sharing but not joint action. Stronger linkage is required for sustained and systematic collaboration, with joint planning, implementation and evaluation.<br/

A content analysis of district level health data in Uttar Pradesh, India

The study aimed to conduct a content analysis of the different types of public health data maintained by the Health Department, the Department of Women and Child Development, and the private for profit and not for profit health sectors and the links that exist between them in terms of data sharing. Method: In two districts, Sitapur and Unnao, an IDEAS/PHFI study team visited district, sub-district and village level health facilities (public and private) as well as NRHM programme management units, and Women and Child Development offices. The team collected all available forms and interviewed facility staff and programme managers to understand the types of data collected, their flow and data sharing. Case studies of three not-for-profit non-governmental organisations were developed to understand how they maintain and share data with the public health system. Findings: The public health system collects a large volume of health data; Data exist for all of WHO’s health system building blocks, but it is unevenly distributed. There are fewer data on contextual information, e.g. village infrastructure and demographic profile, compared to service delivery; There is little formal or institutional routine data sharing between the public and private health sectors, and between the health department and other related departments such as Women and Child Development

A matched case-control study of risk factors for neonatal tetanus in Karachi, Pakistan

Background: Previous studies have identified various risk factors for neonatal tetanus (NNT) in rural areas of Pakistan. The present matched case control study was conducted to further evaluate these risk factors in an urban setting. Aim: The study was carried out to identify risk factors for NNT in Karachi. Materials and Methods: Patients of NNT (n = 125) diagnosed from January 1998 to February 2001 were recruited through a surveillance system of Expanded Programme on Immunization (EPI). Two neighbourhood controls (n = 250) were matched for each case for gender and date of birth of the case. Statistical Analysis: Conditional logistic regression was performed to assess the independent effect of factors associated with NNT. Results: The final multivariable model identified subsequent application of substances on the umbilical cord (adjusted matched odds ratio [adj. mOR] = 5.1 [2.7-9.7]), home delivery (adj. mOR = 1.8; 95% CI: 1.1- 3.1) and illiterate mother (adj. mOR = 1.6; 95% CI: 1.0- 2.0) as risk factors for NNT after adjusting for other variables in the model. Population attributable risk per cent (PAR %) for subsequent cord application was 69% and PAR % for home delivery was 31%. Conclusion: Health planners, while formulating control strategies through immunization programmes should also take into account the impact of post-delivery practices, such as 'subsequent cord application' along with pre-delivery practices. Health awareness regarding appropriate post-delivery practices should be promoted and counselling of pregnant women for giving preference to health care setting for delivery is also crucial

Effectiveness of a family-centered method for the early identification of social-emotional and behavioral problems in children: a quasi experimental study

Background: Social-emotional and behavioral problems are common in childhood. Early identification of these is important as it can lead to interventions which may improve the child's prognosis. In Dutch Preventive Child Healthcare (PCH), a new family-centered method has been implemented to identify these problems in early childhood. Its main features are consideration of the child's developmental context and empowerment of parents to enhance the developmental context. Methods/design: In a quasi-experimental study, embedded in routine PCH in the Netherlands, regions in which the family-centered method has been implemented (intervention condition) will be compared to "care as usual" regions (control condition). These regions are comparable in regard to socio-demographic characteristics. From more than 3,500 newborn babies, 18-month follow-up data on social-emotional and behavioral development will be obtained. PCH professionals will assess development during each routine well-child visit; participating parents will fill in standardized questionnaires. Primary outcomes in the study are the proportion of social-emotional and behavioral problems identified by PCH professionals in children aged 2-14 and 18 months in both conditions, and the proportion of agreement between the assessment of PCH professionals and parents. In addition, the added value of the family-centered approach will be assessed by comparing PCH findings with standardized questionnaires. The secondary outcomes are the degree to which the needs of parents are met and the degree to which they are willing to disclose concerns. Discussion: The family-centered method seems promising for early identification of social-emotional and behavioral problems. The results of this study will contribute to evidence-based public health. Trial registration: NTR2681