PDF(Pubmed)
Abstract：
Guinea-Bissau has among the world\'s highest maternal and perinatal mortality rates. To improve access to quality maternal and child health (MCH) services and thereby reduce mortality, a national health system strengthening initiative has been implemented. However, despite improved coverage of MCH services, perinatal mortality remained high. Using a systems-thinking lens, we conducted a situation analysis to explore factors shaping timeliness and quality of facility-based care during labour, childbirth, and the immediate postpartum period in rural Guinea-Bissau. We implemented in-depth interviews with eight peripartum care providers and participant observations at two health facilities (192 h) in 2021-22, and analysed interview transcripts and field notes using thematic network analysis. While providers considered health facilities as the only reasonable place of birth and promoted facility birth uptake, timeliness and quality of care were severely compromised by geographical, material and human-resource constraints. Providers especially experienced a lack of human resources and materials (e.g., essential medicines, consumables, appropriate equipment), and explained material constraints by discontinued donor supplies. In response, providers applied several adaptation strategies including prescribing materials for private purchase, omitting tests, and delegating tasks to birth companions. Consequences included financial barriers to care, compromised patient and occupational safety, delays, and diffusion of health worker responsibilities. Further, providers explained that in response to persisting access barriers, women conditioned care seeking on their perceived risk of developing birthing complications. Our findings highlight the need for continuous monitoring of factors constraining timeliness and quality of essential MCH services during the implementation of health system strengthening initiatives.
摘要：
几内亚比绍是世界上孕产妇和围产期死亡率最高的国家之一。改善获得优质妇幼保健（MCH）服务的机会，从而降低死亡率，实施了一项加强国家卫生系统的倡议。然而,尽管妇幼保健服务的覆盖面有所提高，围产期死亡率仍然很高。使用系统思维的镜头，我们进行了一项情况分析，以探讨影响分娩期间设施护理及时性和质量的因素，分娩,以及几内亚比绍农村的产后时期。在2021-22年，我们对8名围产期护理提供者进行了深入访谈，并在两个医疗机构（192小时）对参与者进行了观察，并使用主题网络分析分析了访谈记录和现场笔记。虽然服务提供者认为保健设施是唯一合理的出生地，并促进了设施分娩的吸收，护理的及时性和质量受到地域的严重影响，物质和人力资源的限制。供应商尤其缺乏人力资源和材料(例如，基本药物,耗材,适当的设备)，并解释了捐助者供应中断造成的物质限制。作为回应,提供商应用了几种适应策略，包括为私人购买开处方材料，省略测试，并将任务委托给生伴。后果包括护理的财务障碍，损害患者和职业安全，延迟,和卫生工作者责任的扩散。Further,提供商解释说，为了应对持续存在的访问障碍，女性条件护理寻求他们认为的发生分娩并发症的风险。我们的调查结果强调，在实施卫生系统加强举措期间，需要持续监测制约基本妇幼保健服务及时性和质量的因素。
