Table 3 Interventions for increasing facility births in sub-Saharan Africa
Authors, year, Country | Community level intervention | Health system level intervention | Intervention effect | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
Target | Package | Mode | Actors | Time period | Target | package | Mode | Actors | Frequency | ||
Altaye et al., 2018, Ethiopia [37] | Pregnant women & family decision makers | Awareness-raising: ANCs, nutrition & birth preparedness | Conversation, distribution of booklets | CHWs | Twice during pregnancy | 63% (N = 688) in the intervention group versus 56% (N = 3502) in the comparison (p = 0.011) | |||||
August et al., 2016, Tanzania [27] | Pregnant women | Awareness raising: ANC, birth preparedness, postpartum danger signs | Individual home sessions using pictorial cards | CHWs | At least four times during pregnancy? | 75.6% (N = 603) to 90.2% (671) in the intervention group versus 76.1% (N = 591) to 79.6% (N = 588) in the comparison group [no p-value reported]. Difference in difference: 11.5% points increase (p = 0.123) | |||||
Turan et al., 2011, Eritrea [35] | Women and men | Awareness raising: ANC, birth preparedness, birth danger signs | Group sessions | Maternal health volunteers | Once a week | 3% (N = 7) to 47% (N = 58) in intervention group versus 4% (N = 9) to 15% (N = 31) in the comparison group; p = 0.003 | |||||
Mbonye et al., 2007, Uganda [25] | Pregnant women | Awareness raising: malaria, ANC, administration of malaria preventive treatment | Home visits | TBAs, drug vendors, CHWs, peer mobilizers | Twice | From 34.3% (N = 276) before the intervention to 41.5% (N = 434) after the intervention, p = 0.02 | |||||
Ommeh et al., 2019, Kenya [23] | Pregnant women | Ambulance voucher for delivery | Enrollment | Community health volunteers | Once | Pregnant women, ambulance drivers | Ambulance voucher for delivery | Enrollment during ANC & training | [Not reported] | Once | In Suguta area: 98% (N = 52) after the intervention versus 30% (N = 16) before the intervention In Barsaloi area: 100% (N = 33) after the intervention versus 30% (N = 10) before the intervention |
Massavon et al., 2017, Uganda [26] | Pregnant women | Awareness raising about the voucher program | Radio and stakeholders meetings | Community volunteers, health providers | [Not reported] | Pregnant women | Transport voucher for delivery | Distribution during ANC | [Not reported] | [Not reported] | 20% [N not reported] to 80% in the intervention group versus 44% [N not reported] to 61% [N not reported] in the comparison group that is a difference in difference of 43% higher in intervention group |
Masavon et al., 2017, Uganda [26] | Pregnant women | Awareness raising about the baby kit | Radio and stakeholders meetings | Community volunteers, health providers | [Not reported] | Pregnant women | Baby kits (plastic basin, soap, polythene bag, ½ kg of sugar, a piece of cotton cloth for wrapping the baby) | Distribution during ANC | [Not reported] | [Not reported] | 47% [N not reported] to 58% [N not reported] in the intervention group versus 90% [N not reported] to 71%[N not reported] in the comparison group that is a difference in difference of 30% higher in intervention group |
Wang et al., 2016, Zambia [30] | Pregnant women | Promotion about the baby kit | [Not reported] | Community volunteers | [Not reported] | Pregnant women | Baby kit (cloth, baby diaper, blanket) | Promotion during ANC; distribution after delivering in health facility | Health providers | [Not reported for promotion]; Once (for distribution) | 36.3% (N = 359) in the intervention group versus 26% (N = 304) in the comparison group (AOR: 1.63; P-value < 0.01, 95% CI: 1.29; 2.06) |
Mwaniki et al., 2015, Kenya [24] | Pregnant women | Tracing and accompanying women to health facility for delivery | Household visits | TBAs, CHWs | Routinely | Pregnant women | Pregnancy screening; ANC follow up; payment for services in installments; reduction of waiting time, iron & ARVs available, enhancement of patient privacy; dialogue with community | During routine activities | Health providers | Routinely | 52% (N = 259) after intervention versus 33% (N = 164) before the intervention, p = 0.012 |
Obare et al., 2013, Kenya [22] | Pregnant women | Voucher for maternal health expenses | Identification of women through a poverty grading tool | Distributors from a voucher management agency | Once | Pregnant women | Provision of standard quality services | Routine services | Health providers | Routinely | 63% (N = 453) in the intervention group versus 37% (N = 118) in the comparison group; OR:2.1 (95% CI: 1.5 – 3.1) |
Satti et al., 2012, Lesotho [31] | Pregnant women | Awareness raising on facility-based care; identification and accompaniment of women to the health center and back home after delivery | Community gatherings (awareness raising); household visits (identification) | NGO Partners in Health, maternal health workers | Once a month | Pregnant women | HIV testing & treatment, nutrition support to babies, baby kits for women delivering in health facility; maternal waiting house | Routine services | NGO Partners in Health, health providers, maternal health workers | Routinely | 16 women on average delivering each month in the 2nd year of the intervention, compare to 12 women in the 1st year of the intervention and 4 women in the year preceding the intervention |
Sangho et al., 2010, Mali [32] | TBAs, pregnant women | Training on delivery and resuscitation, equipment for TBAs (gloves, plastic sheets, bleach, soap, compresses) identification and awareness raising of pregnant women | Session (training), [Not reported for the others] | CHWs, women’s associations, [Not reported for the others] | Once for training and equipment, [Not reported for awareness raising] | Health providers, pregnant | Training on delivery and resuscitation, equipment, care provision | Session (training), routine services (care) | Health providers for care, [Not reported for training] | Once for training and equipment, routinely for care | Dialakoroba: 93% (N = 243) after the intervention versus 86% (N = 324) before the intervention (p = 0.005) Safébougoula: 90% (N = 271) after the intervention versus 80% (N = 304) before the intervention ( p = 0.0005) |
Wilunda et al., 2016, Ethiopia [34] | CHWs, village leaders, community | Strengthening sensitization capacity; promotion of free maternal services | Radio broadcasts for promotion, [Not reported for the others] | [Not reported] | [Not reported] | Local health system managers, hospital, health centers, pregnant women | Improving infrastructures, information system, meeting coordination, monitoring; removal of user fees, equipment of maternity wards, training and supervision of CHWs, free ambulance services, care provision | Standard checklists for supervision, routine services for care, [Not reported for the others] | Doctors with Africa, hospital staff (training), health providers (care) | Routinely for care, [Not reported for the others] | 60% [N not reported] during the intervention compared to 27% [N not reported] before the intervention; AOR: 5.04 (2.53–10.06) |