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      Can a standards-based approach improve access to and quality of primary health care? Findings from an end-of-project evaluation in Ghana

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          Abstract

          Background

          Jhpiego implemented a 5-year project to strengthen the Community-Based Health Planning and Services (CHPS) model in six coastal districts of Ghana’s Western Region. The project utilized a quality improvement approach (Standards-Based Management and Recognition [SBM-R]) to strengthen implementation fidelity of the CHPS model. This article presents findings from an end-of-project evaluation comparing quality, access to care, and experience of care in intervention and comparison CHPS zones.

          Methods

          A non-equivalent, posttest–only, end-of-project evaluation compared 12 randomly selected intervention zones with 12 matched comparison zones. Data from standards-based assessments measured provision of care in three categories: community engagement, clinical services, and facility readiness and management. Access to and experience of care were assessed using a household survey of 426 randomly selected community members from the selected CHPS zones. Bivariate and multivariate analyses were conducted to compare performance on these measures between intervention and comparison CHPS zones.

          Results

          Overall, intervention zones outperformed comparison zones on achievement of standards (83.6% vs 58.8%) across all three assessment categories, with strongest results in community engagement (85.7% vs. 41.4%). Respondents in intervention zones were more than twice as likely to have received a home visit from a community health officer, three times as likely to have a home visit from a community health volunteer, and more likely to have attended a health talk (41.9% vs. 27.0%). Client experiences of care were reported as positive in both study arms.

          Conclusions

          The evaluation demonstrated improved access to quality care; however, there were very few differences in client experience of care between intervention and comparison zones. As Ghana and other countries are committed to scaling up universal health care, a pragmatic approach such as SBM-R could prove useful to engage both facility- and community-based service providers, as well as community members, to improve provision of care.

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          Most cited references 29

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          Quality of care for pregnant women and newborns-the WHO vision.

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            The Ghana community-based health planning and services initiative for scaling up service delivery innovation.

            Research projects demonstrating ways to improve health services often fail to have an impact on what national health programmes actually do. An approach to evidence-based policy development has been launched in Ghana which bridges the gap between research and programme implementation. After nearly two decades of national debate and investigation into appropriate strategies for service delivery at the periphery, the Community-based Health Planning and Services (CHPS) Initiative has employed strategies tested in the successful Navrongo experiment to guide national health reforms that mobilize volunteerism, resources and cultural institutions for supporting community-based primary health care. Over a 2-year period, 104 out of the 110 districts in Ghana started CHPS. This paper reviews the development of the CHPS initiative, describes the processes of implementation and relates the initiative to the principles of scaling up organizational change which it embraces. Evidence from the national monitoring and evaluation programme provides insights into CHPS' success and identifies constraints on future progress.
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              Determinants of women’s satisfaction with maternal health care: a review of literature from developing countries

              Background Developing countries account for 99 percent of maternal deaths annually. While increasing service availability and maintaining acceptable quality standards, it is important to assess maternal satisfaction with care in order to make it more responsive and culturally acceptable, ultimately leading to enhanced utilization and improved outcomes. At a time when global efforts to reduce maternal mortality have been stepped up, maternal satisfaction and its determinants also need to be addressed by developing country governments. This review seeks to identify determinants of women’s satisfaction with maternity care in developing countries. Methods The review followed the methodology of systematic reviews. Public health and social science databases were searched. English articles covering antenatal, intrapartum or postpartum care, for either home or institutional deliveries, reporting maternal satisfaction from developing countries (World Bank list) were included, with no year limit. Out of 154 shortlisted abstracts, 54 were included and 100 excluded. Studies were extracted onto structured formats and analyzed using the narrative synthesis approach. Results Determinants of maternal satisfaction covered all dimensions of care across structure, process and outcome. Structural elements included good physical environment, cleanliness, and availability of adequate human resources, medicines and supplies. Process determinants included interpersonal behavior, privacy, promptness, cognitive care, perceived provider competency and emotional support. Outcome related determinants were health status of the mother and newborn. Access, cost, socio-economic status and reproductive history also influenced perceived maternal satisfaction. Process of care dominated the determinants of maternal satisfaction in developing countries. Interpersonal behavior was the most widely reported determinant, with the largest body of evidence generated around provider behavior in terms of courtesy and non-abuse. Other aspects of interpersonal behavior included therapeutic communication, staff confidence and competence and encouragement to laboring women. Conclusions Quality improvement efforts in developing countries could focus on strengthening the process of care. Special attention is needed to improve interpersonal behavior, as evidence from the review points to the importance women attach to being treated respectfully, irrespective of socio-cultural or economic context. Further research on maternal satisfaction is required on home deliveries and relative strength of various determinants in influencing maternal satisfaction. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0525-0) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: Project administrationRole: SupervisionRole: Writing – original draft
                Role: Data curationRole: Formal analysisRole: InvestigationRole: SupervisionRole: VisualizationRole: Writing – original draft
                Role: Data curationRole: Formal analysisRole: InvestigationRole: SupervisionRole: VisualizationRole: Writing – original draft
                Role: ConceptualizationRole: InvestigationRole: Project administrationRole: SupervisionRole: Writing – original draft
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                10 May 2019
                2019
                : 14
                : 5
                Affiliations
                [1 ] Monitoring, Evaluation and Research, Jhpiego, Johns Hopkins University Affiliate, Baltimore, MD, United States of America
                [2 ] Department of Health Information Management, University of Cape Coast, Cape Coast, Ghana
                [3 ] Strategy & Analytics, Deloitte Consulting, LLP, Rossylyn, VA, United States of America
                [4 ] Strategic Information and Evaluation, Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America
                [5 ] Independent Development Consultant, Takoradi, Ghana
                [6 ] Technical Leadership and Innovations, Jhpiego, Johns Hopkins University Affiliate, Baltimore, MD, United States of America
                Public Health Foundation of India, INDIA
                Author notes

                Competing Interests: Please note this study was funded by Jubilee Partners as part of the overall project award; the funding agency did not have a role in the study design, data collection, analysis or the decision to submit for publication. The funding does not alter our adherence to PLOS ONE policies on sharing data and materials.

                Article
                PONE-D-17-30190
                10.1371/journal.pone.0216589
                6510430
                31075150
                © 2019 Maly et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 1, Tables: 5, Pages: 19
                Product
                Funding
                Funded by: Ghana Tullow LTD
                Award ID: TGHA-1053207
                Funded by: Jhpiego
                This project, evaluation and most of the writing activities were funded by Jubilee Partners through Ghana Tullow LTD agreement number TGHA-1053207 ( http://www.tullowoil.com/operations/west-africa/ghana) which was awarded to Jhpiego Corporation. Additional funding for development of this manuscript was provided by Jhpiego ( https://www.jhpiego.org/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Health Care
                Health Services Administration and Management
                People and Places
                Geographical Locations
                Africa
                Ghana
                Medicine and Health Sciences
                Health Care
                Health Care Policy
                Health Systems Strengthening
                Medicine and Health Sciences
                Health Care
                Quality of Care
                Medicine and Health Sciences
                Health Care
                Health Education and Awareness
                Research and Analysis Methods
                Mathematical and Statistical Techniques
                Statistical Methods
                Multivariate Analysis
                Physical Sciences
                Mathematics
                Statistics
                Statistical Methods
                Multivariate Analysis
                Research and Analysis Methods
                Research Design
                Survey Research
                Surveys
                Physical Sciences
                Mathematics
                Probability Theory
                Statistical Distributions
                Custom metadata
                All relevant data files are available from the Figshare database (DOI: 10.6084/m9.figshare.8061503).

                Uncategorized

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