Browsing by Person "De Brouwere, Vincent"
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Item Access to maternal and perinatal health services: lessons from successful and less successful examples of improving access to safe delivery and care of the newborn.(Wiley-Blackwell, 2010-08) Witter, Sophie; Richard, Fabienne; De Brouwere, VincentSummary The huge majority of the annual 6.3 million perinatal deaths and half a million maternal deaths take place in developing countries and are avoidable. However, most of the interventions aiming at reducing perinatal and maternal deaths need a health care system offering appropriate antenatal care and quality delivery care, including basic and comprehensive emergency obstetric care facilities. To promote the uptake of quality care, there are two possible approaches: influencing the demand and/or the supply of care. Five lessons emerged from experiences. First, it is difficult to obtain robust evidence of the effects of a particular intervention in a context, where they are always associated with other interventions. Second, the interventions tend to have relatively modest short-term impacts, when they address only part of the health system. Third, the long-term effects of an intervention on the whole health system are uncertain. Fourth, because newborn health is intimately linked with maternal health, it is of paramount importance to organise the continuum of care between mother and newborn. Finally, the transfer of experiences is delicate, and an intervention package that has proved to have a positive effect in one setting may have very different effects in other settings. L'accs aux services de sant maternelle et prinatale: leons tires d'exemples russies et moins russies de l'amlioration de l'accs un accouchement et des soins srs pour le nouveau-n L'immense majorit des 6,3 millions de dcs prinataux et du demi-million de dcs maternels surviennent dans les pays en dveloppement et sont vitables. Cependant, la plupart des interventions visant rduire la mortalit prinatale et maternelle ont besoin d'un systme de soins de sant offrant des prestations de soins prnataux appropris et de qualit, y compris des services complets de soins obsttriques d'urgence de base. Afin de promouvoir l'adoption de soins de qualit, il y a deux approches possibles: influencer la demande et/ou l'offre de soins. Cinq leons ont t dgages de certaines expriences. D'abord, il est difficile d'obtenir des preuves solides des effets d'une intervention particulire dans un contexte o_ ils sont toujours associs d'autres interventions. Deuximement, les interventions ont tendance avoir des impactes relativement modestes court terme quand elles ne visent qu'une partie du systme de sant. Troisimement, les effets long terme d'une intervention sur l'ensemble du systme de sant sont incertains. Quatrimement, comme la sant du nouveau-n est intimement lie celle de la mre, il est d'une importance primordiale d'organiser la continuit des soins entre la mre et le nouveau-n. Enfin, le transfert d'expriences est dlicat et une trousse d'intervention qui s'est avre positive dans un contexte peut avoir des effets trs diffrents dans d'autres contextes. Punto de vista Acceso a servicios maternos y perinatales: lecciones de ejemplos exitosos y menos exitosos en la mejora del acceso a un parto seguro y cuidados neonatales La gran mayor_a de las 6.3 millones de muertes perinatales y el medio mill_n de muertes maternas suceden en pa_ses en v_as de desarrollo y son inevitables. Sin embargo, la mayor_a de las intervenciones que buscan reducir las muertes maternas y perinatales requieren de un sistema sanitario que ofrezca unos cuidados prenatales apropiados y unos cuidados de calidad durante el parto, incluyendo el acceso a instalaciones obsttricas bsicas y de emergencia. A la hora de promover la mejora del servicio hay dos posibilidades: influenciar la demanda y/o la oferta de cuidados. Se obtuvieron cinco lecciones como resultado de las diferentes experiencias. Primero, es dif_cil obtener una evidencia robusta de los efectos que tiene una intervenci_n en particular dentro de un contexto en el cual siempre hay otras intervenciones asociadas. Segundo, las intervenciones tienden a tener impactos con ventanas de tiempo relativamente cortas cuando solo han sido dirigidas hacia una parte del sistema sanitario. Tercero, los efectos a largo plazo de una intervenci_n, sobre todo en el sistema de salud, son inciertos. Cuarto, puesto que la salud neonatal est_ntimamente ligada a la salud materna, es muy importante ligar los cuidados continuos de la madre y del neonato. Finalmente, la transferencia de experiencias es delicada y un tipo de intervenci_n que ha tenido un efecto positivo en un lugar puede tener efectos muy diferentes en otro.Item Learning lessons and moving forward: how to reduce financial barriers to obstetric care in low-income contexts(Antwerp: ITG Press., 2008) Witter, Sophie; Richard, Fabienne; De Brouwere, Vincent; De Brouwere, V.; Richard, F.; Witter, SophieItem 'Rowing against the current': The policy process and effects of removing user fees for caesarean sections in Benin(BMJ, 2018-02-02) Dossou, Jean-Paul; Cresswell, Jenny A.; Makoutode, Patrick; De Brouwere, Vincent; Witter, Sophie; Filippi, Veronique; Kanhonou, Lydie G.; Goufodji, Sourou B.; Lange, Isabelle; Lawin, Lionel; Affo, Fabien; Marchal, BrunoBackground In 2009, the Benin government introduced a user fee exemption policy for caesarean sections. We analyse this policy with regard to how the existing ideas and institutions related to user fees influenced key steps of the policy cycle and draw lessons that could inform the policy dialogue for universal health coverage in the West African region. Methods Following the policy stages model, we analyse the agenda setting, policy formulation and legitimation phase, and assess the implementation fidelity and policy results. We adopted an embedded case study design, using quantitative and qualitative data collected with 13 tools at the national level and in seven hospitals implementing the policy. Results We found that the initial political goal of the policy was not to reduce maternal mortality but to eliminate the detention in hospitals of mothers and newborns who cannot pay the user fees by exempting a comprehensive package of maternal health services. We found that the policy development process suffered from inadequate uptake of evidence and that the policy content and process were not completely in harmony with political and public health goals. The initial policy intention clashed with the neoliberal orientation of the political system, the fee recovery principles institutionalised since the Bamako Initiative and the prevailing ideas in favour of user fees. The policymakers did not take these entrenched factors into account. The resulting tension contributed to a benefit package covering only caesarean sections and to the variable implementation and effectiveness of the policy. Conclusion The influence of organisational culture in the decision-making processes in the health sector is often ignored but must be considered in the design and implementation of any policy aimed at achieving universal health coverage in West African countries.Item Studying complex interventions: reflections from the FEMHealth project on evaluating fee exemption policies in West Africa and Morocco(BioMed Central, 2013-11-08) Marchal, Bruno; Van Belle, Sara; De Brouwere, Vincent; Witter, SophieBackground The importance of complexity in health care policy-making and interventions, as well as research and evaluation is now widely acknowledged, but conceptual confusion reigns and few applications of complexity concepts in research design have been published. Taking user fee exemption policies as an entry point, we explore the methodological consequences of 'complexity' for health policy research and evaluation. We first discuss the difference between simple, complicated and complex and introduce key concepts of complex adaptive systems theory. We then apply these to fee exemption policies. Design We describe how the FEMHealth research project attempts to address the challenges of complexity in its evaluation of fee exemption policies for maternal care. We present how the development of a programme theory for fee exemption policies was used to structure the overall design. This allowed for structured discussions on the hypotheses held by theresearchers and helped to structure, integrate and monitor the sub-studies. We then show how the choice of data collection methods and tools for each sub-study was informed by the overall design. Discussion Applying key concepts from complexity theory proved useful in broadening our view on fee exemption policies and in developing the overall research design. However, we encountered a number of challenges, including maintaining adaptiveness of the design during the evaluation, and ensuring cohesion in the disciplinary diversity of the research teams. Whether the programme theory can fulfil its claimed potential to help making sense of the findings is yet to be tested. Experience from other studies allows for some moderate optimism. However, the biggest challenge complexity throws at health system researchers may be to deal with the unknown unknowns and the consequence that complex issues can only be understood in retrospect. From a complexity theory point of view, only plausible explanations can be developed, not predictive theories. Yet here, theory-driven approaches may help.