Health Systems and Workforce | Strengthening Quality of Care | Focus: Gender | Focus: Small and Sick Newborns | Focus: Private Sector Room: Protea Pre-Formed Panel
May 09, 2023 13:15 - 14:15(Africa/Johannesburg)
20230509T1315 20230509T1415 Africa/Johannesburg Can We Address the Complexity of Childbirth and Newborn Care with Multi-component and Complex Interventions? Experience from the ALERT, Quali-Dec, and SCSL Projects from Sub-Saharan Africa, Latin America, and Asia

The complexity of childbirth care is characterized by three interfaces: First, the two continua of care from pre-pregnancy to postpartum care and community to referral hospital, meaning that the key health system characteristics and the functioning of the linkages between services points, including the referral systems, have a major impact. Second, childbirth care includes preventive and promotive, thus routine care as well as time-sensitive emergency care. Third, quality childbirth care is provided by a team of nurses, midwives, and obstetricians, as well as neonatologists and pediatric staff, thus a multi-professional team with different pre-service training and professional values and identities, creating frictions. 

Over- and under-provision of evidence-based interventions are seen in all settings, with the overuse of caesarean sections being a well-known example. Abuse and neglect have been raised and responsiveness during birth is high on the international agenda. Improving quality of care within these complex systems demands a careful combination of strategies to address the complexity and the different drivers of this complex system. But complex interventions may also overburden implementers and systems. Complex interventions demand sufficient resources, long-term investments, and sufficient patience to mentor and support implementing teams and institutions. 

Here, we summarize our learning from three complex interventions. We apply a scalability and adaptability lens to highlight critical issues.

Room: Protea International Maternal Newborn Health Conference 2023 information@imnhc.org
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The complexity of childbirth care is characterized by three interfaces: First, the two continua of care from pre-pregnancy to postpartum care and community to referral hospital, meaning that the key health system characteristics and the functioning of the linkages between services points, including the referral systems, have a major impact. Second, childbirth care includes preventive and promotive, thus routine care as well as time-sensitive emergency care. Third, quality childbirth care is provided by a team of nurses, midwives, and obstetricians, as well as neonatologists and pediatric staff, thus a multi-professional team with different pre-service training and professional values and identities, creating frictions. 

Over- and under-provision of evidence-based interventions are seen in all settings, with the overuse of caesarean sections being a well-known example. Abuse and neglect have been raised and responsiveness during birth is high on the international agenda. Improving quality of care within these complex systems demands a careful combination of strategies to address the complexity and the different drivers of this complex system. But complex interventions may also overburden implementers and systems. Complex interventions demand sufficient resources, long-term investments, and sufficient patience to mentor and support implementing teams and institutions. 

Here, we summarize our learning from three complex interventions. We apply a scalability and adaptability lens to highlight critical issues.

The Leveraging Evidence to Reduce Perinatal Mortality and Morbidity (ALERT) Study Targeting High-Caseload Hospitals of Benin, Malawi, Tanzania, and Uganda: Early Implementation Experience
Panel 01:15 PM - 02:15 PM (Africa/Johannesburg) 2023/05/09 11:15:00 UTC - 2023/05/09 12:15:00 UTC
Small and Sick Newborns (SSNB)
Strengthening Quality of Care
Health Systems and Workforce
Presenters Lenka Benova
Institute Of Tropical Medicine, Institute Of Tropical Medicine
Co-authors Jean-Paul Dossou
Director, CERRHUD
Peter Waiswa
Professor, Makerere University
KA
Kristi Annerstedt
Assistant Professor, Karolinska Institutet
HM
Helle Moelsted-Alvesson
Departmental Director Of Education, Karolinska Institutet
AP
Andrea Pembe
Professor, Muhimbili University Of Health And Allied Sciences
KH
Kidanto Hussein
Associate Dean, Aga Khan University, Dar Es Salaam, Aga Khan University Dar Es Salaam, East Africa
MG
Mechthild Gross
Professor, Midwifery Research And Education Unit, Hannover Medical School. Hannover, Germany
EC
Effie Chipeta
Director Of Scientific Operations, Kamuzu University Of Health Science
CH
Claudia Hanson
Senior Lecturer, Karolinska Institutet
Quali-Dec: Complex Intervention to Improve Decision-Making for Caesarean Section
Panel 01:15 PM - 02:15 PM (Africa/Johannesburg) 2023/05/09 11:15:00 UTC - 2023/05/09 12:15:00 UTC
Gender
Strengthening Quality of Care
Health Systems and Workforce
Presenters
CK
Charles Paulin Kaboré
Researchers, Institut De Recherche En Sciences De La Santé
Co-authors
CH
Claudia Hanson
Senior Lecturer, Karolinska Institutet
Lenka Benova
Institute Of Tropical Medicine, Institute Of Tropical Medicine
AD
Alexandre Dumont
Research Director, IRD-Université De Paris
MH
Mac Quo Nhu Hung
Obstetrician, Pham Ngoc Thach University
PL
Pisake Lumbiganon
Professor, Faculty Of Medicine, Khon Kaen University
GC
Guillermo Carroli
Director, Centro Rosarino De Estudios Périnatales Asociación
AB
Ana Pilar Betran
Medical Officer, World Health Organization
Effect of Collaborative Quality Improvement on Stillbirths, Neonatal Mortality, and Newborn Care Practices in Hospitals of Telangana and Andhra Pradesh, India: Evidence from a Quasi-experimental Mixed-Methods Study
Panel 01:15 PM - 02:15 PM (Africa/Johannesburg) 2023/05/09 11:15:00 UTC - 2023/05/09 12:15:00 UTC
Small and Sick Newborns (SSNB), Private Sector
Strengthening Quality of Care
Health Systems and Workforce
Presenters
KZ
Karen Zamboni
Researcher, Karolinska Institutet
Co-authors Lenka Benova
Institute Of Tropical Medicine, Institute Of Tropical Medicine
CH
Claudia Hanson
Senior Lecturer, Karolinska Institutet
ZH
Zelee Hill
Professor, Institute For Global Health, University College London, London, UK.
SS
Samiksha Singh
Professor, Institute Of Public Health, India
JS
Joanna Schellenberg
Professor, The London School Of Hygiene & Tropical Medicine (LSHTM)
Researcher
,
Karolinska Institutet
Institute of Tropical Medicine
,
Institute of Tropical Medicine
Researchers
,
Institut de Recherche en Sciences de la Santé
Senior lecturer
,
Karolinska Institutet
Senior lecturer
,
Karolinska Institutet
Dr. Jean-Paul Dossou
Director
,
CERRHUD
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The Leveraging Evidence to Reduce Perinatal Mor...
IMNHC_1684440987lenka_benova.pptx View Submitted by Lenka Benova 4
Quali-Dec: Complex Intervention to Improve Deci...
IMNHC_1683194122198_QualiDec_presentation_for_IMNH__1_.pptx View Submitted by Lenka Benova 5
Effect of Collaborative Quality Improvement on ...
IMNHC_1684441031claudia_hanson.pptx View Submitted by Lenka Benova 2
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