Table 3.
For each study site the development of a list of proposed interventions included the following process: | |||||||||||
• First, baseline assessment and stakeholders causal analysis workshop PPC findings were summarised in a SWOT analysis. The following characteristics and categories were assessed: | |||||||||||
o Characteristics of postpartum policies – category: postpartum policies | |||||||||||
o Characteristics of postpartum system – categories: health system organization, integration of PPC in other services (child clinic, HIV, FP, etc.), human resources, financial resources, PPC payment modalities for users/clients, and health information system | |||||||||||
o Characteristics of postpartum services – categories: facility-based PP services, community-based PP services, socio-cultural issues and access to PPC, geographic issues and access to PPC, financial issues and access to PPC, and access ‘in time’ to PPC | |||||||||||
o Characteristics of postpartum care – categories: technical effectiveness, patient centeredness, integration, continuity | |||||||||||
Example Kwale district, Kenya (Characteristics of postpartum services – facility-based PP services) | |||||||||||
Strengths | Weaknesses | Opportunities | Threats | ||||||||
Characteristics of postpartum services | |||||||||||
Facility-based PP services | • none | • PPC is neglected compared to antenatal and childbirth care | • Framework to upgrade facility-based PPC services is available | • Understaffing | |||||||
• Health workers are not aware of importance of PPC | • Lack of interest among health facility staff | ||||||||||
• Health workers do not know guidelines on PPC | |||||||||||
• BEmOC services are in part not available at first line health facilities | |||||||||||
• Using the SWOT analysis results and internationally recognised evidence, problems and possible interventions to tackle these problems were identified. Problems were listed for four categories: health system, health services, health care and others. | |||||||||||
Example Kwale district, Kenya (Care) | |||||||||||
Problem identified regarding postpartum care in Kwale district | Intervention proposed | ||||||||||
Care | |||||||||||
Attitude of health workers: lack of patient centred care, no respect for cultural beliefs and practices | • Train HWs on patient centred care and culturally appropriate behaviour and approaches | ||||||||||
Quality of care, poor skills of health workers | • Train HWs and establish regular supportive supervision of the HWs by district health management team. | ||||||||||
• Involvement of district QIT to improve quality of care and HW skills regarding PPC | |||||||||||
Postpartum care not felt as a priority among the health workers | • Sensitize HWs on the importance of PPC and train them on the contents of PPC | ||||||||||
Women discharged less than 24 h after delivery | • Upgrade logistical arrangements in the health HF to enable women to stay at least 24 h after they delivered. | ||||||||||
• Sensitize HWs and clients on the importance of staying at least 24 h at the HF before being discharged | |||||||||||
• Next the identified possible interventions were described in more detail by mentioning for each the challenges, opportunities and preconditions. Interventions were classified in four groups: (1) community-based interventions, (2) improvement of available PPC services, (3) integration of PPC for the mother in child clinics, and (4) interventions linking the community and health facility. | |||||||||||
Example Kwale district, Kenya (some interventions on improvement of available PPC services) | |||||||||||
Possible Intervention | Challenges | Opportunities | Preconditions | ||||||||
Improvement of available PPC services | |||||||||||
Improve BEmOC, PPC and other skills of health workers | • Availability of regular supportive supervision | • Availability of QIT to support improvement of quality of PPC | • none | ||||||||
Train health workers on patient-centred care and culturally adapted behaviour and approaches | • none | • none | • Trainers available | ||||||||
Sensitisation of health workers on importance of PPC for mother and newborn and PPC training | • Availability of regular supervision to support HWs to deliver PPC | • none | • Make arrangements to enable mother and newborn to stay at least 24 h after delivery | ||||||||
Dissemination of national guidelines and strategies regarding PPC among the health workers and training on PPC | • none | • Guidelines already available | • none | ||||||||
• Finally each of the above described interventions was assessed against a set of criteria. | |||||||||||
Example Kwale district, Kenya (some interventions on improvement of available PPC services) | |||||||||||
Possible interventions | Criteria 1 | ||||||||||
Inclusion in local MNCH policy | Acceptability | Evidence-base | Feasible/ realistic to implement: | Effectiveness | Sustainability (long-term) | ||||||
Financial | Human resources | Infrastructure, equipment & supplies | Health system | Referral structure | Supervision | ||||||
Improvement of available PPC services | |||||||||||
Improve BEmOC, PPC and other skills of health workers | +++ | +++ | ++ | + | + | ++ | ++ | ++ | ± | ++ | + |
Train health workers on patient-centred care and culturally adapted behaviour and approaches | + | + | + | + | + | + | + | + | + | ++ | |
Sensitizing of health workers on importance of PPC for mother and newborn and PPC training | +++ | - | ++ | ++ | ++ | +++ | + | ± | ± | ||
Dissemination of national guidelines and strategies regarding PPC among the health workers and training on PPC | +++ | ++ | + | ++ | ++ | +++ | +++ | + | ++ |
1The codes range from ‘- - -’ to ‘+++’ to assess the feasibility/relevance of the mentioned criteria
BEmOC, basic emergency obstetric care; FP, family planning; HF, health facility; HIV, human immunodeficiency virus; HW, health worker; PP, postpartum; PPC, postpartum care; QIT, quality improvement team; SWOT, strengths, weaknesses, opportunities and threats