RESUMO
In Nigeria, two maternal and neonatal health Networks of Care (NOC) focus on extending the reach and quality of routine and emergency maternal and neonatal health services tailored to the different contexts. This paper uses the four domains of the NOC framework-Agreements and Enabling Environment, Operational Standards, Quality, Efficiency and Responsibility, and Learning and Adaptation-to describe the NOC, highlighting how each developed to address specific local needs. In Northern Nigeria, the NOC were established in collaboration among Clinton Health Access Initiative and the government to reduce maternal and neonatal morbidity and mortality. Health centers and communities in the network were supported to be better prepared to provide maternal and neonatal care, while birth attendants at all levels were empowered and equipped to stabilize and treat complications. The approach brought services closer to the community and facilitated rapid referrals. The NOC in Lagos State extended the reach of routine and emergency maternal and neonatal health services through organically developed linkages among registered traditional birth attendant clinics, private and public sector facilities, the Primary Healthcare Board, and the Traditional Medicine Board. Traditional birth attendants are registered, trained, and monitored by Apex Community Health Officers, whose responsibilities include collection and review of data and ensuring linkages to postpartum services, such as family planning and immunizations. While differing in their approaches, both NOC provide locally appropriate, pragmatic approaches to supporting women birthing in the community and encouraging institutional delivery to ensure that women and their babies have access to timely, appropriate, and safe services.
Assuntos
Redes Comunitárias/tendências , Serviços de Saúde Materno-Infantil/tendências , Assistência Centrada no Paciente/métodos , Humanos , Nigéria , Assistência Centrada no Paciente/tendênciasRESUMO
Background: The objective of this study is to describe delivery care utilizations and to identify socioeconomic barriers to practicing facility-based deliveries, in urban poor communities of Lagos, Nigeria. Methods: The study was a prospective cohort study conducted in Lagos Mainland, a local government area of Lagos State, Nigeria. A total of 723 randomly selected pregnant women participated in this study. The socio-economic barriers were sought from three different perspectives, i.e., household wealth as a financial barrier, linguistic capacity as a social barrier, and residential area as a physical barrier. The data were analyzed with descriptive and multivariate statistical methods using the imputed datasets. Results: While 41.9% of the participants delivered at governmental health facilities, 28.3% and 29.8% of them gave births at private health facilities and other places, respectively. As the results of the analyses, household wealth was positively associated with childbirth at a governmental health facility. Egun-speaking women were more likely to give births at private facilities than Yoruba-speaking women, while Igbo-speaking and Hausa-speaking women were more likely to choose other places for their childbirths. Conclusion: This study identified the financial and linguistic barriers to facility-based deliveries among women in urban poor communities.