Abstract
Most of the maternal and newborn deaths occur at birth or within 24 hours of birth. Therefore, essential lifesaving interventions need to be delivered at basic or comprehensive emergency obstetric care facilities. Facilities provide complex interventions including advice on referrals, post discharge care, long-term management of chronic conditions along with staff training, managerial and administrative support to other facilities. This paper reviews the effectiveness of facility level inputs for improving maternal and newborn health outcomes. We considered all available systematic reviews published before May 2013 on the pre-defined facility level interventions and included 32 systematic reviews.Findings suggest that additional social support during pregnancy and labour significantly decreased the risk of antenatal hospital admission, intrapartum analgesia, dissatisfaction, labour duration, cesarean delivery and instrumental vaginal birth. However, it did not have any impact on pregnancy outcomes. Continued midwifery care from early pregnancy to postpartum period was associated with reduced medical procedures during labour and shorter length of stay. Facility based stress training and management interventions to maintain well performing and motivated workforce, significantly reduced job stress and improved job satisfaction while the interventions tailored to address identified barriers to change improved the desired practice. We found limited and inconclusive evidence for the impacts of physical environment, exit interviews and organizational culture modifications.At the facility level, specialized midwifery teams and social support during pregnancy and labour have demonstrated conclusive benefits in improving maternal newborn health outcomes. However, the generalizability of these findings is limited to high income countries. Future programs in resource limited settings should utilize these findings to implement relevant interventions tailored to their needs.
Highlights
Most of the maternal and newborn deaths occur at birth or within 24 hours of birth; essential lifesaving interventions need to be delivered at basic or comprehensive emergency obstetric and newborn care (BEmONC /Comprehensive Emergency Obstetric and Newborn Care (CEmONC)) facilities [1,2,3,4]
We considered all available systematic reviews on the predefined facility level interventions published before May 2013 as outlined in our conceptual framework [32]
For the preidentified interventions, which did not report maternal and newborn health (MNH) outcomes, we have reported the impacts on other health outcomes as reported by the review authors
Summary
Most of the maternal and newborn deaths occur at birth or within 24 hours of birth; essential lifesaving interventions need to be delivered at basic or comprehensive emergency obstetric and newborn care (BEmONC /CEmONC) facilities [1,2,3,4]. Facilities should be equipped with commodities and skilled personnel to provide minimum required standard care for women and newborns in need of obstetric and special care. They should be able to Alongside emergency obstetric care; facilities provide complex clinical care interventions including referrals, post discharge care, long-term management of chronic conditions and managerial and administrative support to Basic services. A basic emergency obstetric care facility is one in which all functions 1–7 are performed. A comprehensive emergency obstetric care facility is one in which all functions 1–9 are performed. For this review we have broadly categorized these interventions into four categories: interventions for well performing and motivated work force; interpersonal care and social support; safety culture; and staffing models
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