Making interventions effective
Relatively low cost effective interventions are available which have been proved to improve maternal and newborn child health. These include a core set of interventions which span the Continuum of Care “pre-pregnancy to delivery, the postnatal period, and childhood; and are provided by families and communities, and through outpatient services, clinics and other health facilities.”
Skilled attendance at birth and particularly emergency obstetric care is crucial for reducing deaths and serious disability amongst mothers and newborns. Ante-natal and post-natal care; safe abortion services where legal; improved family planning services; and community based services are the other priority interventions. When delivered throughout the Continuum as packages based on delivery strategies and common target populations, these interventions have helped to prevent maternal and newborn deaths.
Interventions can be ‘efficacious’ but many depend on presence of a well-functioning health system, a country’s policies, economy, local practices and culture, to be ‘effective’. The essential interventions recommended by The Partnership on Maternal, Newborn and Child Health, when delivered as integrated ‘packages’ have been seen to be effective in various contexts. For example, a systematic review ‘Community-Based Intervention Packages for Preventing Maternal Morbidity and Mortality and Improving Neonatal Outcomes’ found that community-level service delivery packages can reduce newborn deaths significantly.
Low-resource countries face serious barriers to achieving these desirable outcomes. Despite some overall progress globally in delivering MNCH services over the years, the coverage and access of several crucial services is still affected and inequitable across and within countries.The Countdown to 2015 Decade Report (2000 – 2010) showed that poorer and less educated women had a poorer coverage of all the key interventions across the Continuum of Care. The widest disparities in coverage of services between the rich and poor were in Africa and South Asia, which also share a significant burden of maternal and newborn mortality and ill-health.
Human resources and essential commodities are crucial building blocks of the health care system – the scaling-up of which can not only help improve coverage but also contribute to effective services. Equally important for interventions to be effective is the quality of care at various service points where health care is accessed. Good quality care is defined as a “clinically effective, safe and a good experience for the patient.” Performance of skilled health care workers, good management and co-ordination of services across the various levels, amongst other factors influence women’s experience and perceptions and thereby encourage (or discourage) use of the health care services.