Drivers of improved service-delivery for safe motherhood

By Angela Kisakye

In order to understand how safe motherhood is effectively promoted it appears critical to explore the entire chain, from policy-making to implementation. This blog outlines the drivers of improved service-delivery for safe motherhood at level of health facilities and District Health Management Teams (DHMTs). Some of the drivers discussed include the impact of capacity-building workshops, supportive supervision and performance-based management.

Capacity-building and information dissemination

Many of the Medical Doctors assigned with managerial and administrative responsibilities have limited or no training in management. Accordingly, many health ministries propose that 'strengthening the management and leadership skills of managers to ensure adequate supervision of HCWs [Health Care Workers] will facilitate efficient and effective utilization of resources. For many capacity building initiatives, trainings vary in style; some are more valued than others. Horizontal learning (from peers in similar situations), as well as practicals and participatory discussions are often appreciated by those eager to improve their indicators. However, it seems difficult to foster self-critique amongst managers. Even if encouraged to consider 'management weaknesses', managers tend to attribute poor performance to factors 'beyond their control, like cultural beliefs and erratic supply of commodities. Managers often have a tendency to blame the community for low demand, rather than recognizing their own role in improving service delivery. The managers’ attitude often overlooks dissatisfaction with health care services and treatment – widely voiced by mothers, from across the socio-economic spectrum. Carefully working with health managers to reflect on the bottlenecks to service delivery is critical.

Knowledge gained may not be implemented in practice

In many contexts, selected individuals are invited to trainings on the assumption that they will share information with colleagues and then implement best practices collectively. However, this technocratic conception of knowledge dissemination overlooks group dynamics. Managers and health workers alike often face difficulties persuading their colleagues about lessons learnt at a workshop.

Supportive supervision for maternal health service delivery

In many rural facilities, the majority of health providers do not receive routine supportive supervision from the center. Extended periods of absence from line-managers, who do not check on whether agreed strategies have been implemented, often leads frontline healthcare workers to feel that their efforts are not valued and that no one cares about what they are doing. Efforts should be in place to supervise and guide frontline health workers in order to improve health service delivery.

Increasing attention to maternal health indicators at the center

Increased pressure from central governments to improve maternal health indicators: antenatal coverage, average antenatal visits, institutional deliveries and post-natal coverage has in many instances led to more supportive supervision from the center. Since there has been increased attention to maternal health indicators, more rural facilities have received supportive supervision to under-performing districts.

Image courtesy of google images

Advocacy for maternal health

To amplify support for maternal health care, there have been a number of sensitization workshops and conferences worldwide, on the presumption that some people are unaware of the numerical occurrence of maternal deaths. This kind of information dissemination has created safe motherhood champions worldwide.

This blog suggests that service-delivery in the health sector improves with performance-based management, that is top-down pressure to improve indicators, or financial incentives. Commitment also seems to be enhanced when workers feel valued and appreciated, such as through supportive-supervision. Awareness-raising and disseminating information via trainings is critical in improving service delivery for maternal health services.  

Resources

1. African Union (2010) 'Africa Cares: No Woman Should Die While Giving Life', AU Message.

http://www.africa-union.org/root/UA/Newsletter/SA/2010/African%20Union-1.pdf.

2. Rowe, Alexander K.; de Savigny, Don; Lanata, Claudio F. and Victora, Cesar G. (2006) 'How Can We Achieve and Maintain High-Quality Performance of Health Workers in Low-Resource Settings?', Lancet 366: 1026-35.

I would like to Acknowledgements Alice Evans for some of the content in this blog.