Assessing perinatal depression identifying abilities among maternal and child health workers in rural China using smartphone-based virtual patients: a multi-center cross-sectional study.

Preparing future public health professionals to address real-world maternal and child health (MCH) challenges requires educational approaches that extend beyond classroom instruction. In this context, integrating community-based education (CBE) into the curriculum serves as a pivotal strategy. This study assesses the implementation and effectiveness of a CBE module in MCH, designed for strengthening the knowledge and competencies of undergraduate public health students. A mixed-method pre- and post-intervention design was used to assess changes in students’ knowledge, skills, and practical competencies following one year of supervised community engagement in a semi-urban setting in Lahore, Pakistan. Quantitative assessments included survey questionnaires, quizzes, MCQs, and OSCE, while qualitative data were collected through focus group discussions, and self-reflection logs. Descriptive statistics, a paired-samples t-test, and a marginal homogeneity test were used to assess students’ learning and research outcomes. For qualitative data, thematic analysis was conducted using a deductive-inductive approach. Pre- and post- analysis revealed significant improvements (p < 0.001) in students’ knowledge across all MCH domains, along with enhanced skills of leadership, project/time management, communication, problem-solving, teamwork, handling unexpected situations, and designing community-tailored interventions (p < 0.001) following CBE implementation. Ongoing assessments indicated consistent learning with a mean quiz score of 80.2% (SD = 7.2), and a mean MCQ exam score of 81.5% (SD = 7.6). Qualitative data further revealed increased empathy, cultural sensitivity, and professional confidence. The study concludes that the CBE program provides students with valuable insights into the specific needs and challenges of communities related to MCH, thereby enhancing their knowledge and competency development. This experience supports the continuation of CBE programs for future students.

Maternal and child healthcare services constitute a vital component of the healthcare system and play a crucial role in safeguarding population health. However, in China, challenges such as the irrational allocation of MCH resources and suboptimal operational efficiency remain prevalent. This study aims to investigate the impact of resource allocation on the efficiency of the maternal and child healthcare system in China. Data for 31 provinces and municipalities in China were obtained from the China Health Statistical Yearbook and the China Statistical Yearbook covering the period 2017 to 2021. The comprehensive Maternal and Child Health resource density index was developed by applying the entropy weight method to analyze the allocation of MCH resources across provinces. Furthermore, a three-stage Data Envelopment Analysis (DEA) model was employed to calculate the efficiency of the provincial MCH systems. Finally, a spatial Durbin model was applied to examine the effect of the comprehensive MCH resource density on system efficiency. Between 2017 and 2021, the comprehensive Maternal and Child Health (MCH) resource density index in most regions of China increased from 0.108 to 0.138. In contrast, the average technical efficiency declined from 0.943 to 0.920, with substantial disparities observed across regions. The Moran's I index for MCH resource efficiency ranged from - 0.349 to - 0.245, indicating significant spatial autocorrelation. Key factors influencing the technical efficiency of MCH resources included the comprehensive CHRDI in maternal and child health, urbanization rate, and total health expenditure per capita (P < 0.05). While the allocation of maternal and child health resources in China improved between 2017 and 2021, significant regional disparities persist. The study further reveals that the level of MCH resource allocation exerts spatial spillover effects on efficiency. Based on the current data trend, optimizing resource allocation may require a combination of policy guidance, financial input, performance evaluation, regional collaboration, and other coordination strategies.

ABSTRACT Nigeria introduced Maternal and Child Health (MCH) programs to improve access to skilled care in response to persistently poor health outcomes among women and children. While existing assessments often emphasize the role of healthcare workers, the contributions of social workers and Community Health Extension Workers (CHEWs) remain largely overlooked. This study explores the roles played by social workers and CHEWs in enhancing access to MCH services through an intervention project in Anambra State, Nigeria. An exploratory qualitative design was employed, involving interviews with five social workers, ten healthcare workers, and three CHEWs. Thematic analysis revealed that both groups were instrumental in mobilizing pregnant women and other community members to utilize antenatal and postnatal services, facility-based deliveries, and basic noncommunicable disease care. Social workers, in particular, reported feeling undervalued despite their contributions to community health work. The findings underscore the importance of integrating social workers and CHEWs into strategies aimed at increasing demand for MCH services. This has significant implications for evidence-based policy development and health program planning in Nigeria. The study recommends the formal inclusion of social workers and CHEWs in MCH initiatives to strengthen community engagement and improve health outcomes.

Bypassing primary healthcare (PHC) facilities for maternal and child health (MCH) services is an increasingly common phenomenon in low- and middle-income countries (LMICs). This behaviour can undermine health system efficiency by overburdening referral hospitals and leaving PHC centres underutilised in LMICs. However, no comprehensive review has examined this behaviour. This scoping review synthesises evidence on how bypassing is defined, its prevalence, determinants, and how the concept has been framed in LMIC settings. Following PRISMA-ScR guidelines, we systematically searched PubMed, Embase, and Web of Science for peer-reviewed studies published between January 2010 and September 2024. Eligible studies reported empirical qualitative, quantitative, or mixed-methods findings on bypassing behaviour in PHC settings for MCH services in LMICs. We used a thematic synthesis approach to map definitions, estimate prevalence, and identify determinants and conceptualisations of bypassing behaviour. 20 studies from 11 LMICs met the inclusion criteria. Definitions of bypassing varied considerably, particularly regarding service type, treatment of referral or complication cases, and facility level. Because of this heterogeneity, reported prevalence of bypassing ranged widely from 1.8% to 88%, and these values were not directly comparable across studies. Determinants of bypassing behaviour fell into three broad categories: (1) individual factors such as higher socioeconomic status and previous obstetric complications; (2) perceptions of service quality, including inadequate equipment and negative prior experiences; and (3) sociocultural influences shaped by community perceptions. Conceptually, bypassing was interpreted both as a reactive response to perceived weaknesses in PHC and as a proactive strategy to seek safer and higher-quality care. Several studies also framed bypassing as a systemic issue, highlighting the limited obstetric capacity and readiness of PHC facilities and the need to reconsider the role of PHC in maternal care delivery. Evidence from this review shows that bypassing PHC facilities for MCH services is common in LMICs, especially for childbirth care. The behaviour reflects concerns about PHC quality rather than physical proximity to facilities. The substantial variability in how bypassing is defined highlights the need for conceptual clarity, including a clear distinction between voluntary bypassing and clinically indicated referrals. Strengthening both the technical and experiential quality of PHC, and clarifying its role within maternal care pathways, is essential. Clearer integration with higher-level facilities would also support more coordinated referral systems and help reposition PHC within maternal health service delivery.

A Maternal and Child Health (MCH) workforce skilled in program evaluation is vital for program assessment and data-driven decision making. Collaborative evaluation capacity-building opportunities for state, tribal, local, and territorial (STLT) public health staff, partner organizations, and students are key strategies in building a skilled workforce, promoting program improvement, effectiveness, and sustainability to improve long-term MCH outcomes. We evaluated the Centers for Disease Control and Prevention and Harvard T.H. Chan School of Public Health Program Evaluation Practicum to determine if it contributed to STLT participants' ability to implement evaluation plans responsive to their MCH programs and gather recommendations for Practicum improvement. Qualitative one-on-one interviews; data collected July-August 2023. Eighteen STLT public health staff, including Centers for Disease Control and Prevention Maternal and Child Health Epidemiology Program (MCHEP) field assignees, who participated in the Practicum between 2018 and 2022. Experiences of STLT MCH program staff and Centers for Disease Control and Prevention MCHEP field assignees. Six facilitator themes and 6 barrier themes for evaluating MCH programs were identified. Facilitators: an appreciation for evaluation from program partners and recipients; data availability; resources to support evaluation tasks; funding; internal program evaluation capacity; and organizational support. Barriers: data or systems access issues; staff turnover; shifting priorities; lack of evaluation readiness; limited evaluation capacity; and data collection issues. Four lessons-learned themes were identified: need for improved data collection tools; identification of future training needs; facilitation of programmatic decisions; and facilitation of evaluation buy-in. Five themes for recommendations on improving the Practicum were identified: collaborative learning and real-world examples; more evaluation support; modifying the Practicum structure; establishing appropriate Practicum teams; and helping programs determine evaluation readiness. Collaborative evaluation training like the Practicum can strengthen evaluation capacity within MCH programs and support program improvement. However, the Practicum may benefit from updated guidance, content, and structure to better assess participants' evaluation readiness and meet participants' needs.

Development and evaluation of an evidence-based training and supervision program to enhance clinical competence management in perinatal depression management among rural maternal and child health workers: A pre-post study.

The Health Resources and Services Administration's (HRSA) Maternal and Child Health Bureau (MCHB) provides funding to support Centers of Excellence (CoE) to prepare the next generation of Maternal and Child Health (MCH) leaders through specialized training and mentorship. This study describes the impact of Tulane University's workforce development program in MCH. We utilized a holistic evaluation approach to examine the impact of Tulane University's CoE, from the program's inception in 2000 through 2024, in building the MCH workforce. Utilizing a retrospective evaluation design, routinely collected quantitative and qualitative enrollment and follow-up survey data from program alumni were analyzed. Data reveal the following: (1) the program has trained a broad group of MCH professionals from a wide range of backgrounds, strengthening a workforce prepared to respond to needs of varied communities, (2) alumni overwhelmingly continue to work in MCH after graduation, frequently serving populations with significant unmet health needs and in collaboration with Title V (MCH) agencies, and (3) the majority of trainees go on to serve in leadership positions in policy, practice, academia, or clinical settings. A well-trained MCH workforce is contingent upon high-quality education and preparation for leadership roles. Through funding from HRSA's MCH Workforce Development Division, Tulane University's CoE has trained people from varied backgrounds, including from populations not well represented in health sciences and communities disproportionately affected by adverse health outcomes, to assume leadership roles and contribute substantively to the field. These results can inform MCH training programs to further strengthen their impact on developing the MCH workforce.

This study assessed influenza vaccination uptake, knowledge, beliefs, and willingness among healthcare workers (HCWs) in maternal and child health (MCH) institutions in Chengdu in the post-COVID-19 era and identified factors associated with vaccination behavior. A cross-sectional online survey was conducted in 10 Chengdu MCH institutions from May 12 to June 30, 2025, using a validated questionnaire. Analyses included descriptive statistics, univariate tests (chi-square; independent-samples t-tests/one-way ANOVA), and hierarchical multivariable logistic regression. Among 1,880 HCWs, 35.21% (662) reported receiving influenza vaccination since June 2024, and 10.43% reported clinician-diagnosed influenza. Before the 2025 influenza season, 57.61% reported willingness to be vaccinated. Objective knowledge was suboptimal: 45.05% correctly identified the time to develop protective antibodies (2-4 weeks), and 43.72% correctly identified the duration of protection (at least 6 months). Belief scores increased with higher education and professional title (p < 0.05) and were lowest among outsourced staff. Hierarchical regression (Nagelkerke R 2 = 0.377) identified independent correlates of vaccination uptake, including older age [odds ratio (OR) = 1.029 per year], master's degree or above (OR = 2.067), working in secondary-level MCH hospitals (OR = 5.377) or outpatient/preventive-care departments (OR = 1.682), being a nurse (OR = 1.804) or administrative staff member (OR = 3.262) versus physician, higher belief score (OR = 1.062 per point), and, most strongly, willingness to vaccinate (uncertain vs. unwilling: OR = 3.431; willing vs. unwilling: OR = 23.296). Influenza vaccination coverage among HCWs in Chengdu MCH institutions remained suboptimal in the post-pandemic period, with a clear intention-behavior gap. Uptake was associated with more favorable beliefs, higher willingness, older age, higher education, and institutional/departmental and occupational factors. Targeted strategies to strengthen confidence, improve access and convenience, and tailor interventions to specific departments and job categories are needed to increase coverage.

In Cambodia, village health support groups (VHSGs) are central to maternal and child health (MCH) service delivery, yet maternal mortality remains high with regional disparities. Although digital health solutions show promise, their real-world use is underexplored. This study therefore aims to evaluate the i-MoMCARE app in supporting VHSGs and health centre staff for delivering MCH services. A mixed-methods approach guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework was used. Reach was assessed using programme records (number of users trained and MCH cases managed). Effectiveness and adoption were evaluated using the mHealth App Usability Questionnaire (MAUQ) and qualitative data on user experience and intention to use. Implementation was examined through system usage monitoring and feedback on workflow integration. Maintenance was explored using qualitative insights on long-term use, barriers and recommendations. 44 VHSGs and 10 health centre staff were trained, and 96 MCH cases were managed with the app. Usefulness was rated highly (MAUQ 5.58, SD 1.04), with users appreciating the user-centric design that improved usability and integration into daily workflows. Effectiveness was similarly high (MAUQ 5.50, SD 0.95); the clinical decision support system and point-of-care alerts were valued as reliable decision-support tools, and the electronic medical record (EMR) was seen as a secure data repository. However, adoption was hindered by hardware and software limitations (MAUQ 5.79, SD 0.75), including device availability and low digital literacy. Our findings highlight the value of the i-MoMCARE app in supporting VHSGs, particularly those with limited training, by enhancing their decision-making. The study also lays the groundwork for a unified EMR in primary care. However, concerns around hardware and software limitations hinder adoption and sustained use. To enable scale-up, we recommend reducing access barriers and supporting sustained use through diversifying the platform's design and implementing phased incentivisation strategies.

Perinatal depression policies in China: A three-dimensional analysis with implications for low- and middle-income countries health systems.

Background: The quality of maternal health services at primary healthcare facilities remains a critical determinant of pregnant women’s service experiences and continued utilization of antenatal care (ANC). Inadequate service quality, particularly in terms of infrastructure, service processes, and interpersonal communication, may limit patient satisfaction and weaken the effectiveness of maternal health programs. Midwives play a central role in shaping service quality at Maternal and Child Health (MCH) clinics. This study aimed to examine the association between healthcare service quality and pregnant women’s satisfaction through midwife performance at the Batalaiworu Community Health Center, Southeast Sulawesi, Indonesia.Methods: A quantitative cross-sectional design was applied involving 51 pregnant women in Sidodadi Village, selected using saturated sampling. Data were collected using a structured questionnaire measuring healthcare service quality (structure and process dimensions) and patient satisfaction. Primary and secondary data were analyzed using the chi-square test to assess the association between variables.Results: Most respondents perceived healthcare service quality as good (72.5%), and 68.6% reported being satisfied with the services received. Bivariate analysis showed a statistically significant association between healthcare service quality and pregnant women’s satisfaction (ρ &lt; 0.001). Pregnant women who perceived better service quality tended to report higher satisfaction levels, although some dissatisfaction persisted despite favorable service conditions.Conclusion: The findings indicate a significant association between healthcare service quality and pregnant women’s satisfaction at the primary healthcare level. These results highlight the importance of strengthening midwife performance, particularly in communication, responsiveness, and patient-centered care practices, alongside maintaining adequate service infrastructure. Continuous supervision and capacity-building initiatives for midwives are recommended to enhance maternal health service quality and patient satisfaction.

Abstract Objectives This study investigates the association between the deployment of a community-based female health workforce program (Marwo Caafimaad) and the integration of District Health Information Software 2 (DHIS2)-enabled digital accountability mechanisms with maternal and child health (MCH) service utilization, governance responsiveness, and perceived service-level legitimacy within Somalia’s fragile health system. Methods An explanatory sequential mixed-methods case study was conducted across multiple Federal Member States of Somalia. Quantitative analyses utilized routine DHIS2 data (2018–2024) on antenatal care (ANC1), skilled birth attendance (SBA), and third-dose pentavalent vaccination (DPT3), applying difference-in-differences (DiD) models where phased roll-out permitted. Exposure was defined by the documented implementation of the Marwo Caafimaad program and functional district-level DHIS2 community feedback channels. Data quality was assessed through reporting completeness, cleaning protocols, and sensitivity analyses. Qualitative data (2024) were collected via key informant interviews and focus groups, analyzed using a realist evaluation lens to derive mechanism–context–outcome configurations. Findings were triangulated through joint display. Results Districts implementing both interventions demonstrated statistically significant improvements in ANC1, SBA, and DPT3 coverage relative to comparison districts. Qualitative analysis identified three reinforcing mechanisms: (1) culturally aligned female CHWs enhanced trust and acceptability; (2) digital feedback loops facilitated timely responsiveness and problem resolution; and (3) pragmatic legitimacy was strengthened through visible fairness and accountability. These mechanisms contributed to increased service uptake amidst insecurity and variable facility readiness. Conclusions In fragile and conflict-affected settings, the alignment of community health workforce strategies with actionable digital accountability mechanisms is associated with enhanced service performance and service-level legitimacy. Somalia’s experience underscores the amplifying effect of governance “software” (trust, responsiveness, fairness) on technical reforms.

Background: Anemia in pregnant women is a serious health problem because it increases the risk of maternal morbidity and mortality, preterm delivery, and low birth weight infants, especially during the third trimester when iron requirements significantly increase. Dietary patterns play an important role in the incidence of anemia, as inadequate intake of iron-rich foods and supporting nutrients can lead to decreased hemoglobin levels. Therefore, dietary patterns are an important factor associated with anemia among third-trimester pregnant women. Purpose: To determine the relationship between dietary patterns and the incidence of anemia among third-trimester pregnant women. Method: This study employed a quantitative research method with a cross-sectional design. The sampling technique used was purposive random sampling, involving a population of 80 pregnant women and a sample of 48 respondents. Data collection consisted of primary data for the dietary pattern variable, which were obtained using a dietary pattern questionnaire, and secondary data for the anemia variable, which were collected from the Maternal and Child Health (MCH) handbook records. Data were analyzed using the Kendall’s tau statistical test. Results: The results of the statistical analysis using Kendall’s tau test showed a p-value of 0.000, which was less than α = 0.05, indicating a statistically significant relationship between dietary patterns and the incidence of anemia. The correlation coefficient obtained was 0.859, indicating a strong category of relationship. Conclusion: It can be concluded that there is a significant relationship between dietary patterns and the incidence of anemia among third-trimester pregnant women.

Maternal and child health (MCH) continues to be a major public health concern in Uttar Pradesh, particularly in the eastern districts that face persistent gaps in access, quality, and continuity of care. To address these challenges, the Government of Uttar Pradesh initiated a Public-Private Partnership (PPP) model between 2020 and 2022 for operational management of Maternal and Child Health (MCH) wings. This assessment aimed to evaluate the functionality, quality, and effectiveness of these PPP-managed facilities to inform future policy directions. A mixed-methods approach was adopted, combining structured facility assessments, service data review, and qualitative interviews with staff and beneficiaries. Findings indicate that the MCH wings achieved high institutional delivery loads, with over 80% bed occupancy, reflecting strong community utilization. However, alarmingly high caesarean section rates (70–90%), weak antenatal and postnatal continuity, limited diagnostic capacity, and lack of quality certifications (NQAS/LaQshya) highlight systemic deficiencies. Human resources were available as per norms but constrained by long shifts and inadequate supervision. Infrastructure was largely adequate, though gaps in patient amenities and safety features persisted. Moreover, overlap with existing public facilities in some districts led to inefficiencies and duplication. Overall, while the PPP model has enhanced service availability, its long-term sustainability depends on stronger clinical governance, quality assurance mechanisms, and clearer contractual accountability to ensure equitable, efficient, and evidence-based maternal and newborn care. Keywords: Maternal and Child Health (MCH); Public-Private Partnership (PPP); Institutional Delivery; Quality of Care; Health Systems; Service Utilization; Facility Assessment

Universal access to family planning (FP) services is essential for safeguarding sexual and reproductive health and rights. Integration of FP and routine maternal and child health (MCH) services has been associated with increased uptake of long-acting reversible contraceptives and contributes to reduced unintended pregnancies, unsafe abortions and complications associated with short interpregnancy intervals. In the DRC, FP use remains limited despite national efforts to expand services, and rapidly growing cities such as Lubumbashi face additional challenges due to health system fragmentation and reliance on private-sector care. This study examined spatial distribution, MCH-integration and determinants of FP service provision in Lubumbashi. We analysed data from a 2023 census of 1,267 health facilities in Lubumbashi. Descriptive analyses summarized the availability of FP services in facilities by health zone, sector, type, routine-data integration, MCH services, -integration, monthly birth volume, medicine stock and mean cost of vaginal birth. Multilevel logistic regression models with random intercepts at the health zone level identified facility-level determinants of FP service provision. Geospatial analyses mapped service availability with 1 km coverage buffers, population-adjusted facility density, and FP-MCH integration levels by health zone. Overall, 731 facilities reported offering FP services (57.7% of total), with significant variation across health zones (31.0–70.5%). FP provision was strongly associated with high monthly birth volumes (aOR = 8.14, 95% CI 2.81–23.58), public ownership (aOR 4.09, 95% CI 1.62–9.99), and integration with all types of MCH services. Geospatial mapping showed that 94.3% of women live within a 1 km radius of a facility offering FP, but FP services and FP-MCH integration were less dense in peripheral health zones. Despite near universal geographic access to FP in Lubumbashi, service integration with MCH-services remains suboptimal, and coverage gaps persist in peripheral areas. The city should prioritise under-served health zones for both health facility based and outreach FP interventions to guarantee universal FP access, and efforts should be made to expand subsidized or free services in areas dominated by private for-profit facilities. Additional barriers such as stockouts, costs, fear of side effects, misinformation or partner-related constraints warrant further investigation. Family planning (FP) services are an essential part of reproductive health, helping women and couples decide if and when to have children. Yet despite their importance, little is known about where these services are offered and how they are integrated with other maternal and child health care (MCH) services in Lubumbashi, the second largest city of the DRC. We collected information from all 1,267 health facilities in the city in 2023. We wanted to know three things: where FP services are located, whether they are offered together with maternal and child health services, and what factors make a facility more or less likely to provide FP. We found that just over half of all facilities offered FP services, and most provided this alongside MCH care, meaning women could access multiple services at the same place. Mapping the facilities showed that FP services are clustered in the centre of the city, but nearly all women still live within one kilometre of a FP-providing facility. But access is not equal. Larger, public and private non-profit facilities, and those charging higher fees were more likely to provide FP. Smaller and less well-resources facilities were less likely to do so. This means that even if FP services are close, some women may still face barriers. While FP services in Lubumbashi are broadly available, health system and financial factors still limit equitable access. Policies to strengthen facilities and reduce cost barriers could help ensure that every woman can access FP services when she needs them.

Uganda hosts the largest refugee population in Africa, which exerts much pressure on the district health systems. While refugee-hosting districts (RH) receive targeted investments, the extent to which these influence maternal and child health (MCH) service coverage remains unclear. Using routine facility data, we examined differences in MCH coverage and trends between RH and non-refugee-hosting (non-RH) districts and also explored the effects of government health financing and health system performance on MCH coverage. We conducted a retrospective analysis utilizing routine health facility MCH data from the Uganda District Health Information System and district-level government Primary Healthcare (PHC) expenditure data from 2020 to 2023. MCH indicators were ANC1st trimester, ANC4, Institutional deliveries, mothers' Post-natal care (PNC), Measles1 and DPT3 vaccination. We computed a composite coverage index (CCI), health systems performance z-score and compared trends across RH and non-RH districts. Mixed Effects Models assessed the association between government expenditure, RH-status, health system performance over the years. RH districts consistently had modestly higher coverage of ANC1st trimester, ANC4, Institutional deliveries, PNC, Measles vaccination and CCI trends. Government expenditure was significantly higher in RH districts and refugee-dominant (RD) districts (p < 0.001 vs. p = 0.007). Refugee-dominant districts had higher but non-significant MCH coverage. Unadjusted models of MCH indicators and CCI were positively influenced by government financing and health systems performance z-score except for DPT3 and Measles, respectively. Adjusted models revealed that ANC4 coverage was 7.4% points higher in RH districts (7.42; 95% CI:0.753, 14.090; p = 0.029) and increased by 3.6% points for every unit increase in z-score (3.60; 95% CI: 0.729, 6.462; p = 0.014). CCI increased by 1.6% points and 2.3% points for every unit increased in the government expenditure and z-score respectively (1.55; 95% CI: 0.310, 2.788; p = 0.014) vs. (2.31; 95% CI: 0.642, 3.975; p = 0.007). Novel approach - leveraging routine facility data, revealed MCH coverage was modestly consistently higher in RH districts over the years and RH status influenced ANC4 coverage. Overall district-CCI depended on Government investment and health systems performance implying increase in PHC financing could be a key driver to universal district-level improvement.

Despite high coverage of facility-based maternal and child health (MCH) services in Mozambique, preventable maternal and neonatal deaths remain among the highest globally. To address this, the Integrated District Evidence-to-Action (IDEAs) program was implemented from 2016 to 2020 in central Mozambique as a facility-level Audit and Feedback (A&F) strategy. IDEAs adapted traditional A&F into three components: 1) biannual facility readiness assessments, 2) A&F meetings to develop action plans, and 3) supportive supervision with funding for implementation. This study estimates total and component-specific implementation costs of IDEAs and compares them to average district health budgets. Costs were estimated from a payer perspective following CHEERS guidelines, using both Gross and Microcosting methods. Costs were annualized over five years (2016-2020) with a 3% discount rate and are reported in 2020 USD. Staff time estimates were based on program staff consultations and national salary data. Outcomes include average cost per district and total annual cost by intervention component. We conducted a deterministic sensitivity analysis to identify cost drivers with the most significant impact on the overall cost. The IDEAs programs total (2016-2020) incurred total costs were $2,224,341 (2020 USD), with $1,702,648 (76.5%) for recurrent expenses and $495,323 (22.3%) for Capital expenses. Average annual district-level costs were $41,967, including A&F meetings ($10,893; 26.0%), Capital expenditures ($8255; 19.7%), targeted support ($9323; 22.2%) which includes $5700 (13.6%) for district-level cash transfers and $3623 (8.6%) for facility supervision, and readiness assessments ($6351; 15.1%).Per diems accounted for 52.0% of A&F meeting costs. IDEAs represented approximately 6.6% of the average district health budget. Implementation involved 33 participants with 2560 h yearly per district. Capital expenses were highly sensitive to when applying a standard 25% increase or decrease compared to other cost categories. Our findings offer practical guidance for district-level planners to adapt and scale IDEAs. Policymakers and donors should integrate recurring costs into budgets and explore cost-saving strategies like virtual tools or streamlined meetings to improve sustainability. Future research must assess long-term integration into government programs and test alternative approaches across diverse low-resource settings to guide scaling.

Continuum of care in maternal and child health (MCH) services is a key strategy for improving MCH outcomes. This study examines the effect of conditional cash incentives and community health worker support on the uptake of the continuum of MCH care, defined as the sequential utilization of antenatal, skilled delivery, and postnatal services. Using nationally representative cross-sectional datasets and a difference-in-difference framework, we find that both interventions significantly improved the continuum of MCH care. The intent-to-treat estimates showed a 5-percentage-point increase in the proportion of women completing the full continuum of care. Heterogeneity analysis revealed more substantial effects among educated women, those in urban areas, and those in higher wealth quintiles. Insights from qualitative interviews with mothers and community health workers suggested that awareness of antenatal care and institutional delivery increased; however, postnatal care was typically sought only in response to complications, and the uptake of all recommended MCH services as a full continuum was often hindered by intersecting demand- and supply-side barriers. Notably, participants emphasized that sustained community health worker engagement had a more significant impact on ensuring care continuity than cash incentives alone. These findings highlight the need for policy strategies that enhance community health worker-led support mechanisms, combined with financial incentives, to promote the comprehensive and sustained use of maternal health services among disadvantaged population groups.

Improving the health of mothers, newborns, and children through various maternal and child health (MCH) initiatives is an essential priority. One important strategy to enhance the quality of MCH services is improving the quality of recording and reporting data through the Local Area Monitoring of Maternal and Child Health. Midwives’ performance plays a crucial role in ensuring the accuracy and completeness of these recording and reporting activities. This study aimed to analyze factors associated with midwives’ performance in recording and reporting PWS KIA data in the working area of Panarung Primary Health Center. This study employed a cross-sectional design. The sample consisted of 20 midwives working in the Panarung Primary Health Center area, selected using a total sampling technique. Data were collected using a structured questionnaire. The relationships between variables were analyzed using the Fisher’s exact test. The analysis showed that supervision (p = 0.03) and facility availability (p = 0.02) were significantly associated with midwives’ performance. In contrast, age (p = 1.00), education level (p = 0.45), length of service (p = 1.00), perception (p = 0.65), motivation (p = 1.00), and workload (p = 1.00) were not significantly associated with midwives’ performance. In, conclusion, midwives’ performance in recording and reporting data of the Local Area Monitoring of Maternal and Child Health is significantly associated with supervision and the availability of facilities. Keywords: supervision; facilities; midwives’ performance; maternal and child health