Abstract
District level healthcare serves as a nexus between community and district level facilities. Inputs at the district level can be broadly divided into governance and accountability mechanisms; leadership and supervision; financial platforms; and information systems. This paper aims to evaluate the effectivness of district level inputs for imporving maternal and newborn health. We considered all available systematic reviews published before May 2013 on the pre-defined district level interventions and included 47 systematic reviews.Evidence suggests that supervision positively influenced provider’s practice, knowledge and client/provider satisfaction. Involving local opinion leaders to promote evidence-based practice improved compliance to the desired practice. Audit and feedback mechanisms and tele-medicine were found to be associated with improved immunization rates and mammogram uptake. User-directed financial schemes including maternal vouchers, user fee exemption and community based health insurance showed significant impact on maternal health service utilization with voucher schemes showing the most significant positive impact across all range of outcomes including antenatal care, skilled birth attendant, institutional delivery, complicated delivery and postnatal care. We found insufficient evidence to support or refute the use of electronic health record systems and telemedicine technology to improve maternal and newborn health specific outcomes.There is dearth of evidence on the effectiveness of district level inputs to improve maternal newborn health outcomes. Future studies should evaluate the impact of supervision and monitoring; electronic health record and tele-communication interventions in low-middle-income countries.
Highlights
District level healthcare is the cornerstone of primary health
An ideal district health system should offer primary care services and provide first level of outpatient care and referrals for more specialized care. They serve as a nexus between community and facility level care for health information; play a direct role in training health care workers; and provide necessary data to guide national health policy. This role is fundamental to effective health care delivery and failure to recognize the interrelationship between community and district-level facilities might result in inefficiency and fragmented delivery of meaningful public health interventions
We considered all available systematic reviews on the pre-defined district level interventions published before May 2013 as outlined in our conceptual framework [20]
Summary
An ideal district health system should offer primary care services and provide first level of outpatient care and referrals for more specialized care They serve as a nexus between community and facility level care for health information; play a direct role in training health care workers; and provide necessary data to guide national health policy. Outpatient clinics at district hospitals provide primary prevention services for MNH including universal maternal and childhood immunizations. These programs may vary in structure and functioning from country to country depending on the healthcare needs and infrastructure. For this review we have broadly categorized these interventions into four categories: governance and accountability mechanisms; leadership and supervision; financial incentives; and information systems
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