Оцінка ефективності перинатальної допомоги в Україні

Abstract

In the context of political changes, increasing social heterogeneity of society, high income differentiation, Russia’s aggressive war against Ukraine, and the COVID-19 pandemic, women during pregnancy and childbirth and newborns are becoming the most vulnerable groups in the population. Effective maternal and newborn health can only be promoted and maintained through effective healthcare systems. Purpose - to analyze and evaluate the integrated effectiveness of perinatal care in Ukraine at the national and regional levels. Materials and methods. A comprehensive analysis of regional peculiarities and an assessment of the main indicators of perinatal care in Ukraine in 2017, 2021 according to the data of the State Institution «Centre for Medical Statistics of the Ministry of Health of Ukraine», perinatal audit according to the World Health Organization «MATRIX - BABIES» methodology were carried out. A modified outcome model was used to assess the integrated effectiveness of perinatal care. Methods of systematic approach, comparative analysis, bibliographic, statistical data processing were used. Results. The population-based comprehensive study of the integrated performance of perinatal care at the national and regional levels showed a sufficient, above-average level of achievement of results (comprehensive assessment ratio (CAR) - 0.77 in 2017 and 0.73 in 2021) with a high level of coefficient of achievement of normative values of resource components (0.82 and 0.86) and activities (0.76 and 0.77, respectively), which is likely due to the reorientation of perinatal care facilities and institutions to evidence-based medical and organizational technologies. The negative trend in the perinatal care CAR for 2017-2021 (5.19% decline rate) is due to a decrease in the ratio of achievement of the normative value of the performance component from 0.79 to 0.64 due to the rapid increase in maternal mortality from 12.5 to 42.5 per 100 thousand live births and an increase in bleeding in the sequential and postpartum periods from 7.1 to 8.9 per 1000 births, respectively, which may be due to the COVID-19 pandemic. Changes in the CAR of the integrated effectiveness of regional perinatal care systems in Ukraine in 2021 compared to 2017 were downward in the vast majority (15) of territories (the highest rate of decrease in the CAR (19.05-15.0%) was in Zhytomyr, Dnipro, Zaporizhzhia, and Poltava regions), and upward in 9 territories (the highest rate of increase in the CAR (9.37-7.58%) was in Zakarpattia, Chernivtsi, and Volyn regions), with stabilization of this indicator in Rivne region. The leaders of the integrated perinatal care efficiency (the Group 1) with a high level of results achievement ratio (CAR≥0.80), which indicates that the perinatal service in the regions is quite effective, are Kyiv, Ternopil, Ivano-Frankivsk, Lviv, and Chernivtsi regions. An another group of regions (the Group 2) with above average CAR (0.7-0.79), which requires strengthening of certain components of perinatal service facilities and institutions, includes 13 regions. The outsiders of the integral effectiveness of perinatal care (the Group 3 of regions with an average CAR of 0.6-0.69), requiring management decisions on more efficient operation of perinatal service facilities and institutions, are 7 regions (Dnipro, Donetsk, Zhytomyr, Zaporizhzhia, Kyiv, Poltava and Kherson regions). Conclusions. The integrated assessment of the effectiveness of perinatal care makes it possible to evaluate the effectiveness of management actions in ensuring the availability and quality of perinatal care, and to respond in a timely manner to changes in the macro- and microenvironment. Given that the model of integrated assessment of perinatal care effectiveness has dynamic properties, it is planned to revise them in the future as the healthcare sector transforms and the normative values of individual indicators of the integrated assessment are achieved. No conflict of interests was declared by the authors.