Increasing facility delivery through maternity waiting homes for women living far from a health facility in rural Zambia: a quasi-experimental study.

OBJECTIVE: To report on the effectiveness of a standardised core Maternity Waiting Home (MWH) model to increase facility deliveries among women living >10 km from a health facility. DESIGN: Quasi-experimental design with partial randomisation at the cluster level. SETTING: Seven rural districts in Zambia. POPULATION: Women delivering at 40 health facilities between June 2016 and August 2018. METHODS: Twenty intervention and 20 comparison sites were used to test whether MWHs increased facility delivery for women living in rural Zambia. Difference-in-differences (DID) methodology was used to examine the effectiveness of the core MWH model on our identified outcomes. MAIN OUTCOME MEASURES: Differences in the change from baseline to study period in the percentage of women living >10 km from a health facility who: (1) delivered at the health facility, (2) attended a postnatal care (PNC) visit and (3) were referred to a higher-level health facility between intervention and comparison group. RESULTS: We detected a significant difference in the percentage of deliveries at intervention facilities with the core MWH model for all women living >10 km away (DID 4.2%, 95% CI 0.6-7.6, P = 0.03), adolescent women (<18 years) living >10 km away (DID 18.1%, 95% CI 6.3-29.8, P = 0.002) and primigravida women living >10 km away (DID 9.3%, 95% CI 2.4-16.4, P = 0.01) and for women attending the first PNC visit (DID 17.8%, 95% CI 7.7-28, P < 0.001). CONCLUSION: The core MWH model was successful in increasing rates of facility delivery for women living >10 km from a healthcare facility, including adolescent women and primigravidas and attendance at the first PNC visit. TWEETABLE ABSTRACT: A core MWH model increased facility delivery for women living >10 km from a health facility including adolescents and primigravidas in Zambia.

Pharmaceutical industry-led partnerships focused on addressing the global burden of non-communicable diseases: a review of Access Accelerated.

OBJECTIVE: In spite of the increasing number of global health partnerships led by biopharmaceutical companies, there is a paucity of information on the number, type, and role of partners. This paper aims to analyze partnerships carrying out company programs included in Access Accelerated, a new industry initiative, focused on addressing the global non-communicable disease burden. STUDY DESIGN: Document review and content analysis. METHODS: We extracted data on the number, type, and role of partners from 63 company programs reported into the Access Observatory, a public platform for reporting on access-to-medicines programs, in 2017. We did a descriptive analysis of the proportion of partners by sector, institution, and location. We used the Fischer's exact test to analyze the relationship between the program strategies, disease focus, and countries with the type of program partners. Based on our empirical findings, we developed a typology of program partnerships, according to which we categorized each of the 63 programs. RESULTS: Programs worked with three partners on average, the majority of which were local governmental or non-governmental organizations (70%). Most programs focused on health service strengthening (83%), community awareness and linkage to care (81%), and health service delivery (60%). Twenty-six of the 63 programs (41%) worked with the local Ministries of Health while 25 (40%) partnered with disease-specific organizations, 21 (33%) with hospitals, and 16 (25%) with academic institutions. Partnering with the Ministries of Health was significantly associated with the use of a health service strengthening program strategy (P = 0.02). Partnering with a hospital (P = 0.004) or private sector partner (P = 0.0009) was significantly associated with a program disease focus on cancer. Seventy-nine percent of the programs were solely funded by pharmaceutical companies. According to our program typology, 40 (63%) programs partnered directly or indirectly with multiple implementing organizations, which delivered the program directly to beneficiaries. CONCLUSION: Pharmaceutical companies play a leading role in funding Access Accelerated programs with local governmental or non-governmental organizations mainly involved in program implementation. A detailed and transparent reporting of the role of local stakeholders in agenda setting, planning, and coordination of programs is needed to ensure public trust and accountability of programs led by pharmaceutical companies. More research is needed to identify the partnerships that are particularly suitable to promote efficient implementation, evaluation, and reporting depending on the nature of the program and context.

Access to asthma medicines at the household level in eight counties of Kenya.

BACKGROUND: It is estimated that about 4 million Kenyans, i.e., 10% of the country's population, have asthma. We aimed to evaluate access to asthma medicines at the household level in eight counties of Kenya, including factors associated with location of purchase. METHODS: Individuals with a diagnosis and prescription of asthma medicines were asked about the location of diagnosis, purchase of medicines, availability of medicines at home and costs of medicines per month. A logistic regression model explored the relationship between patient characteristics and the probability that the patient purchased asthma medicines at a public facility. RESULTS: Of 128 (15.2%) individuals with a diagnosis of asthma who were receiving treatment, only 57.0% had asthma medicines at home. The most frequently purchased asthma medicine was salbutamol, with one third of individuals taking it orally instead of by inhalation. The majority (55.4%) purchased asthma medicines at private pharmacies. Female patients and lower socio-economic status were predictors of purchasing asthma medicines at public facilities. CONCLUSIONS: The availability and affordability of asthma medicines remain significant barriers to access to care. Improving the availability and affordability of all asthma medicines in the public sector, including inhaled corticosteroids, offers the opportunity to reach vulnerable populations.

Household decision-making about delivery in health facilities: evidence from Tanzania.

This study investigated how partners' perceptions of the healthcare system influence decisions about delivery-location in low-resource settings. A multistage population-representative sample was used in Kasulu district, Tanzania, to identify women who had given birth in the last five years and their partners. Of 826 couples in analysis, 506 (61.3%) of the women delivered in the home. In multivariate analysis, factors associated with delivery in a health facility were agreement of partners on the importance of delivering in a health facility and agreement that skills of doctors are better than those of traditional birth attendants. When partners disagreed, the opinion of the woman was more influential in determining delivery-location. Agreement of partners regarding perceptions about the healthcare system appeared to be an important driver of decisions about delivery-location. These findings suggest that both partners should be included in the decision-making process regarding delivery to raise rates of delivery at facility.