Bottleneck analysis of maternal and newborn health services in hard-to-reach areas of Bangladesh using 'TANAHASHI' framework': An explanatory mixed-method study.

Autor: Chowdhury MAK; Asian University for Women, Chittagong, Bangladesh., Karim F; Maternal and Child Health Division, International Centre for Diarrhoeal Diseases Research, Bangladesh, Dhaka, Bangladesh., Hasan MM; Maternal and Child Health Division, International Centre for Diarrhoeal Diseases Research, Bangladesh, Dhaka, Bangladesh., Ali NB; Maternal and Child Health Division, International Centre for Diarrhoeal Diseases Research, Bangladesh, Dhaka, Bangladesh., Khan ANS; Maternal and Child Health Division, International Centre for Diarrhoeal Diseases Research, Bangladesh, Dhaka, Bangladesh., Siraj MS; Maternal and Child Health Division, International Centre for Diarrhoeal Diseases Research, Bangladesh, Dhaka, Bangladesh., Ahasan SMM; World Vision, Cox's Bazar, Bangladesh., Hoque DME; United Nations Population Fund, Dhaka, Bangladesh.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2022 May 12; Vol. 17 (5), pp. e0268029. Date of Electronic Publication: 2022 May 12 (Print Publication: 2022).
DOI: 10.1371/journal.pone.0268029
Abstrakt: Maternal and Newborn Health (MNH) is of paramount importance in the realm of attaining sustainable development goals that also focuses on universal health coverage (UHC). The study aimed at identifying and exploring the bottlenecks in MNH services in Hard-to-reach (HtR) areas of Bangladesh using the Tanahashi framework exploring the possible remedial approaches. The study was conducted in four different types of HtR areas (hilly, coastal, lowlands, and river islands) by utilizing a sequential explanatory mixed-method design. Overall, we collected information from 20 health facilities and 2,989 households by interviewing 2,768 recently delivered women (RDW) with a structured questionnaire and qualitative interviews (n = 55) of facility managers, local stakeholders, RDWs, and health care providers (HCP). The quantitative data were analyzed principally for descriptive statistics and the qualitative data was analyzed by utilizing the thematic approach. Antenatal care, under-5 care, and family planning services were available in almost all the facilities. However, Normal vaginal deliveries were performed in 55.6% of the union-level facilities. Only 40% of sub-district level facilities had provision for C-sections. Blood transfusion services were available in only 20.1% of facilities, whereas laboratory services were obtainable in 51.7% of facilities. Overall, the bottlenecks were identified in cases of availability of drugs, human resources, transportation, lack of knowledge regarding different essential services and health components, out of pocket expenditure etc. There have been several remedial approaches suggested from both the demand and supply side that included incentives for care providers for staying in these areas, a coordinated transport/referral system, and health education campaigns. More research works are warranted in HtR areas, especially to test the proposed interventions. Meanwhile, the government should take the necessary steps to overcome the bottlenecks identified.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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