Health system barriers influencing perinatal survival in mountain villages of Nepal: implications for future policies and practices

Mohan Paudel,Lareen Newman,Sara Javanparast,Gouranga Dasvarma

doi:10.1186/s41043-018-0148-y

Abstract

BackgroundThis paper aims to examine the health care contexts shaping perinatal survival in remote mountain villages of Nepal. Health care is provided through health services to a primary health care level—comprising district hospital, village health facilities and community-based health services. The paper discusses the implications for future policies and practice to improve health access and outcomes related to perinatal health. The study was conducted in two remote mountain villages in one of the most remote and disadvantaged mountain districts of Nepal. The district is reported to rank as the country’s lowest on the Human Development Index and to have the worst child survival rates. The two villages provided a diversity of socio-cultural and health service contexts within a highly disadvantaged region.MethodsThe study findings are based on a qualitative study of 42 interviews with women and their families who had experienced perinatal deaths. These interviews were supplemented with 20 interviews with health service providers, female health volunteers, local stakeholders, traditional healers and other support staff. The data were analysed by employing an inductive thematic analysis technique.ResultsThree key themes emerged from the study related to health care delivery contexts: (1) Primary health care approach: low focus on engagement and empowerment; (2) Quality of care: poor acceptance, feeling unsafe and uncomfortable in health facilities; and (3) Health governance: failures in delivering health services during pregnancy and childbirth.ConclusionsThe continuing high perinatal mortality rates in the mountains of Nepal are not being addressed due to declining standards in the primary health care approach, health providers’ professional misbehaviour, local health governance failures, and the lack of cultural acceptance of formalised care by the local communities. In order to further accelerate perinatal survival in the region, policy makers and programme implementers need to immediately address these contextual factors at local health service delivery points.

Highlights

This paper aims to examine the health care contexts shaping perinatal survival in remote mountain villages of Nepal
Three key themes emerged from this study which are related to the local health service delivery approach, the quality of care as experienced by women and local health governance
The interviews in this study revealed that health care is limited within health facility premises and that care is limited to the provision of basic medicines in the form of pills

Summary

Introduction

This paper aims to examine the health care contexts shaping perinatal survival in remote mountain villages of Nepal. The district is reported to rank as the country’s lowest on the Human Development Index and to have the worst child survival rates. The two villages provided a diversity of socio-cultural and health service contexts within a highly disadvantaged region. According to the World Health Organisation, perinatal mortality comprises stillbirths, i.e. the death of a foetus commencing at 22 completed weeks (154 days) of gestation, and the death of a newborn child within seven completed days after birth [2]. The burden of perinatal deaths has inequitably affected developing countries. Almost all (98%) of the total number of perinatal deaths worldwide currently occur in developing countries [5, 6]. Sub Saharan African and South Asian nations have the world’s highest perinatal mortality rates [7]

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Conclusion