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Table 3 Development of list of proposed interventions

From: Opportunities to improve postpartum care for mothers and infants: design of context-specific packages of postpartum interventions in rural districts in four sub-Saharan African countries

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 +++ ++   + ++ ++ +++   +++ + ++
  1. 1The codes range from ‘- - -’ to ‘+++’ to assess the feasibility/relevance of the mentioned criteria
  2. 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