Evaluating Value-Based Maternal Healthcare in Sub-Saharan Africa: A Systematic Review
Abstract
:1. Introduction
2. Results
2.1. The Importance of Value-Based Care (VBC) in Maternal Health
2.2. Cost–Utility and Value-Based Analysis in Resource-Limited Settings
2.3. Challenges and Solutions for Maternity Care Delivery
2.3.1. Shortages of Skilled Healthcare Workers
2.3.2. Poor Infrastructure
2.3.3. High Care Costs
2.4. Measuring Value and Patient-Centred Outcomes
2.4.1. Developing Context-Appropriate Measurement Sets
2.4.2. Holistic View of Health
2.4.3. Human-Centred Outcomes in Healthcare Delivery
2.4.4. The Role of Patient-Centred Outcomes
3. Discussion
4. Methods
4.1. Inclusion and Exclusion Criteria
4.2. Information Sources
4.3. Search Strategy
4.4. Search Terms
4.5. Study Selection
4.6. Data Extraction
4.7. Quality Assessment
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A. CASP Checklist
Study Title | Year Published | Was There a Clear Statement of the Aims of the Research? | Was the Methodology Appropriate? | Was the Research Appropriate to Address the Aims of the Research? | Was the Data Collected in a Way that Addressed the Research Issue? | Was the Data Analysis Sufficiently Rigorous? | Was There a Clear Statement of Findings? | How Valuable Was the Research? | Total Out of 7 |
Quality of basic maternal care functions in health facilities of five African countries: an analysis of national health system surveys. | 2016 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 |
Cost-utility of intermediate obstetric critical care in a resource-limited setting: a value-based analysis. | 2020 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 |
Implementing value-based healthcare using a digital health exchange platform to improve pregnancy and childbirth outcomes in urban and rural Kenya. | 2022 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 7 |
Quality of care in the free maternal healthcare era in sub-Saharan Africa: a scoping review of providers’ and managers’ perceptions. | 2021 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 6 |
Making a case for Value-Based Care (VBC). | 2023 | 0 | 1 | 1 | 0 | 0 | 1 | 1 | 4 |
References
- Souza, J.P.; Day, L.T.; Rezende-Gomes, A.C.; Zhang, J.; Mori, R.; Baguiya, A.; Jayaratne, K.; Osoti, A.; Vogel, J.P.; Campbell, O.; et al. A global analysis of the determinants of maternal health and transitions in maternal mortality. Lancet Glob. Health 2024, 12, e306–e316. [Google Scholar] [CrossRef] [PubMed]
- Musarandega, R.; Nyakura, M.; Machekano, R.; Pattinson, R.; Munjanja, S.P. Causes of maternal mortality in Sub-Saharan Africa: A systematic review of studies published from 2015 to 2020. J. Glob. Health 2021, 11, 04048. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization (WHO). Maternal Mortality. Available online: https://x.gd/J31vG (accessed on 15 January 2024).
- Vallely, L.M.; Calvert, B.; De Silva, M.; Panisi, L.; Babona, D.; Bolnga, J.; Duro-Aina, T.; Noovao-Hill, A.; Naidu, S.; Leisher, S.; et al. Improving maternal and newborn health and reducing stillbirths in the Western Pacific Region—Current situation and the way forward. Lancet Reg. Health West. Pac. 2023, 32, 100653. [Google Scholar] [CrossRef] [PubMed]
- United Nations (UN). Goal 3: Ensure Healthy Lives and Promote Well-Being for All at All Ages. Available online: https://tinyurl.com/29nvv5f5 (accessed on 20 January 2024).
- Graham, W.J.; Bell, J.S.; Bullough, C.H.W. Can skilled attendance at delivery reduce maternal mortality in developing countries? In Safe Motherhood Strategies: A Review of the Evidence 2001; Elsevier: Amsterdam, The Netherlands, 2001. [Google Scholar]
- Onambele, L.; Guillen-Aguinaga, S.; Guillen-Aguinaga, L.; Ortega-Leon, W.; Montejo, R.; Alas-Brun, R.; Aguinaga-Ontoso, E.; Aguinaga-Ontoso, I.; Guillen-Grima, F. Trends, Projections, and Regional Disparities of Maternal Mortality in Africa (1990–2030): An ARIMA Forecasting Approach. Epidemiologia 2023, 4, 322–351. [Google Scholar] [CrossRef] [PubMed]
- Dahab, R.; Sakellariou, D. Barriers to accessing maternal care in low income countries in Africa: A systematic review. Int. J. Environ. Res. Public Health 2020, 17, 4292. [Google Scholar] [CrossRef] [PubMed]
- Prata, N.; Passano, P.; Sreenivas, A.; Gerdts, C.E. Maternal Mortality in Developing Countries: Challenges in Scaling-Up Priority Interventions. Womens Health 2010, 6, 311–327. [Google Scholar] [CrossRef] [PubMed]
- Esther, A.Q.; Yahaya, H.; Esther, A.O.; Aboagye-Mensah, P.; Blessing, A.J.; Ikome, T.E. A Scoping Review on Influence of Socioeconomic Status on Antenatal Care Utilization and Pregnancy Outcomes in Sub-Saharan Africa. MedRxiv 2023, 28, 514–519. [Google Scholar] [CrossRef]
- Flake, S. Lack of Access to Maternal Healthcare in Sub-Saharan Africa. Ballard Brief 2022, 2022, 4. [Google Scholar]
- Ngonzi, J.; Tornes, Y.F.; Mukasa, P.K.; Salongo, W.; Kabakyenga, J.; Sezalio, M.; Wouters, K.; Jacqueym, Y.; Van Geertruyden, J.-P. Puerperal sepsis, the leading cause of maternal deaths at a Tertiary University Teaching Hospital in Uganda. BMC Pregnancy Childbirth 2016, 16, 207. [Google Scholar] [CrossRef]
- van Staalduinen, D.J.; van den Bekerom, P.; Groeneveld, S.; Kidanemariam, M.; Stiggelbout, A.M.; van den Akker-van Marle, M.E. The implementation of value-based healthcare: A scoping review. BMC Health Serv. Res. 2022, 22, 270. [Google Scholar] [CrossRef] [PubMed]
- Ansu-Mensah, M.; Danquah, F.I.; Bawontuo, V.; Ansu-Mensah, P.; Mohammed, T.; Udoh, R.H.; Kuupiel, D. Quality of care in the free maternal healthcare era in sub-Saharan Africa: A scoping review of providers’ and managers’ perceptions. BMC Pregnancy Childbirth 2021, 21, 220. [Google Scholar] [CrossRef] [PubMed]
- Doctor, H.V.; Nkhana-Salimu, S.; Abdulsalam-Anibilowo, M. Health facility delivery in sub-Saharan Africa: Successes, challenges, and implications for the 2030 development agenda. BMC Public Health 2018, 18, 765. [Google Scholar] [CrossRef] [PubMed]
- Dohmen, P.; De Sanctis, T.; Janssens, W.; Van Raaij, E.M. Implementing value-based healthcare using a digital health exchange platform to improve pregnancy and childbirth outcomes in urban and rural Kenya. Front. Public Health 2022, 10, 1040094. [Google Scholar] [CrossRef] [PubMed]
- Fernández-Salido, M.; Alhambra-Borrás, T.; Casanova, G.; Garcés-Ferrer, J. Value-Based Healthcare Delivery: A Scoping Review. Int. J. Environ. Res. Public Health 2024, 21, 134. [Google Scholar] [CrossRef] [PubMed]
- Key, N. Newborn Health Conference. In BMC Procedings; Springer: Berlin/Heidelberg, Germany, 2024; Volume 18, p. 6. [Google Scholar]
- Muriithi, F.G.; Banke-Thomas, A.; Forbes, G.; Gakuo, R.W.; Thomas, E.; Gallos, I.D.; Devall, A.; Coomarasamy, A.; Lorencatto, F. A systematic review of behaviour change interventions to improve maternal health outcomes in sub-Saharan Africa. PLOS Glob. Public Health 2024, 4, e0002950. [Google Scholar] [CrossRef] [PubMed]
- Wisbaum, W.; Mas, N. The Triple Aim for the Future of Healthcare; Funcas: Madrid, Spain, 2015. [Google Scholar]
- Porter, M.E. Value-based health care delivery. Ann. Surg. 2008, 248, 503–509. [Google Scholar] [CrossRef] [PubMed]
- Bodenheimer, T.; Sinsky, C. From triple to quadruple aim: Care of the patient requires care of the provider. Ann. Fam. Med. 2014, 12, 573–576. [Google Scholar] [CrossRef]
- O’Dell, M.L. What is a patient-centered medical home? Mo. Med. 2016, 113, 301. [Google Scholar] [PubMed]
- Clement, R.C.; Shah, K.; Campion, E.R. Orthopedics in the Age of Accountable Care Organizations and Population Health: From Profit-Center to Cost-Center. Am. J. Orthop. (Belle Mead NJ) 2018, 47, 9. [Google Scholar] [CrossRef] [PubMed]
- Varacallo, M.A.; Herzog, L.; Toossi, N.; Johanson, N.A. Ten-year trends and independent risk factors for unplanned readmission following elective total joint arthroplasty at a large urban academic hospital. J. Arthroplast. 2017, 32, 1739–1746. [Google Scholar] [CrossRef]
- Jacofsky, D.J.; Jawin, P.; Walton, G.; Fraser, L. Contracting strategies for arthroplasty—Bundles to population health. J. Knee Surg. 2017, 30, 19–27. [Google Scholar] [PubMed]
- Carron, T.; Domeisen Benedetti, F.; Fringer, A.; Fierz, K.; Peytremann-Bridevaux, I. Integrated care models in Swiss primary care: An embedded multiple case study. J. Eval. Clin. Pract. 2023, 29, 1025–1038. [Google Scholar] [CrossRef]
- Rosalia, R.A.; Wahba, K.; Milevska-Kostova, N. How Digital Transformation Can Help Achieve Value-Based Healthcare: Balkans as a Case in Point; The Lancet Regional Health—Europe: London, UK, 2021; p. 4. [Google Scholar]
- Moeti, T.; Mokhele, T.; Weir-Smith, G.; Dlamini, S.; Tesfamicheal, S. Factors affecting access to public healthcare facilities in the City of Tshwane, South Africa. Int. J. Environ. Res. Public Health 2023, 20, 3651. [Google Scholar] [CrossRef] [PubMed]
- Maphumulo, W.T.; Bhengu, B.R. Challenges of quality improvement in the healthcare of South Africa post-apartheid: A critical review. Curationis 2019, 42, a1901. [Google Scholar] [CrossRef] [PubMed]
- Percept. Leapfrog to Value. In Making a Case for Value-Based Care (VBC); Percept: Cape Town, South Africa, 2023. [Google Scholar]
- Marotta, C.; Di Gennaro, F.; Pisani, L.; Pisani, V.; Senesie, J.; Bah, S.; Koroma, M.M.; Caracciolo, C.; Putoto, G.; Amatucci, F.; et al. Cost-utility of intermediate obstetric critical care in a resource-limited setting: A value-based analysis. Ann. Glob. Health 2020, 86, 82. [Google Scholar] [CrossRef] [PubMed]
- Kruk, M.E.; Leslie, H.H.; Verguet, S.; Mbaruku, G.M.; Adanu, R.M.K.; Langer, A. Quality of basic maternal care functions in health facilities of five African countries: An analysis of national health system surveys. Lancet Glob. Health 2016, 4, e845–e855. [Google Scholar] [CrossRef] [PubMed]
- Tiruneh, G.T.; Demissie, M.; Worku, A.; Berhane, Y. Community’s experience and perceptions of maternal health services across the continuum of care in Ethiopia: A qualitative study. PLoS ONE 2021, 16, e0255404. [Google Scholar] [CrossRef] [PubMed]
- Galle, A.; Kavira, G.; Semaan, A.; Kaj, F.M.; Benova, L.; Ntambue, A. Utilisation of services along the continuum of maternal healthcare during the COVID-19 pandemic in Lubumbashi, DRC: Findings from a cross-sectional household survey of women. BMJ Open 2023, 13, e069409. [Google Scholar] [CrossRef] [PubMed]
- Kitila, S.B.; Feyissa, G.T.; Wordofa, M.A. Completion of the Maternal Health Care Continuum—Barriers and Facilitators Among Pregnant Women in Jimma Zone, Southwest Ethiopia: A Prospective Study. Health Serv. Insights 2023, 16, 11786329231214608. [Google Scholar] [CrossRef] [PubMed]
- Ramos, P.; Savage, C.; Thor, J.; Atun, R.; Carlsson, K.S.; Makdisse, M.; Neto, M.C.; Klajner, S.; Parini, P.; Mazzocato, P. It takes two to dance the VBHC tango: A multiple case study of the adoption of value-based strategies in Sweden and Brazil. Soc. Sci. Med. 2021, 282, 114145. [Google Scholar] [CrossRef] [PubMed]
- Nilsson, K.; Bååthe, F.; Andersson, A.E.; Wikström, E.; Sandoff, M. Experiences from implementing value-based healthcare at a Swedish University Hospital—A longitudinal interview study. BMC Health Serv. Res. 2017, 17, 169. [Google Scholar] [CrossRef] [PubMed]
- Cossio-Gil, Y.; Omara, M.; Watson, C.; Casey, J.; Chakhunashvili, A.; Miguel, M.G.-S.; Kahlem, P.; Keuchkerian, S.; Kirchberger, V.; Luce-Garnier, V.; et al. The roadmap for implementing value-based healthcare in European University Hospitals—Consensus report and recommendations. Value Health 2022, 25, 1148–1156. [Google Scholar] [CrossRef] [PubMed]
- Van Engen, V.; Bonfrer, I.; Ahaus, K.; Buljac-Samardzic, M. Value-based healthcare from the perspective of the healthcare professional: A systematic literature review. Front. Public Health 2022, 9, 800702. [Google Scholar] [CrossRef] [PubMed]
- Kidanemariam, M.; Pieterse, A.H.; van Staalduinen, D.J.; Bos, W.J.W.; Stiggelbout, A.M. Does value-based healthcare support patient-centred care? A scoping review of the evidence. BMJ Open 2023, 13, e070193. [Google Scholar] [CrossRef] [PubMed]
- Nambiar, D.; Mathew, B.; Dubey, S.; Moola, S. Interventions addressing maternal and child health among the urban poor and homeless: An overview of systematic reviews. BMC Public Health 2023, 23, 492. [Google Scholar] [CrossRef] [PubMed]
- Oleribe, O.O.; Momoh, J.; Uzochukwu, B.S.C.; Mbofana, F.; Adebiyi, A.; Barbera, T.; Williams, R.; Robinson, S.D.T. Identifying key challenges facing healthcare systems in Africa and potential solutions. Int. J. Gen. Med. 2019, 12, 395–403. [Google Scholar] [CrossRef] [PubMed]
- Nilsen, P.; Seing, I.; Ericsson, C.; Birken, S.A.; Schildmeijer, K. Characteristics of successful changes in health care organizations: An interview study with physicians, registered nurses and assistant nurses. BMC Health Serv. Res. 2020, 20, 147. [Google Scholar] [CrossRef] [PubMed]
- Kolaski, K.; Logan, L.R.; Ioannidis, J.P.A. Guidance to best tools and practices for systematic reviews. Br. J. Pharmacol. 2024, 181, 180–210. [Google Scholar] [CrossRef] [PubMed]
- Long, H.A.; French, D.P.; Brooks, J.M. Optimising the value of the critical appraisal skills programme (CASP) tool for quality appraisal in qualitative evidence synthesis. Res. Methods Med. Health Sci. 2020, 1, 31–42. [Google Scholar] [CrossRef]
Publication Details | Aim | Study Design | Country | VBHC Framework Utilised | Key Results/Themes |
---|---|---|---|---|---|
Ansu-Mensah M, Danquah FI, Bawontuo V, Ansu-Mensah P, Mohammed T, Udoh RH, et al. Quality of care in the free maternal healthcare era in sub-Saharan Africa: a scoping review of providers’ and managers’ perceptions. BMC Pregnancy Childbirth. 2021 [14]. | Explore providers’ and managers’ perceptions of free maternal healthcare and its impact on the quality of care in Sub-Saharan Africa [14]. | Scoping review | Multiple countries in Sub-Saharan Africa [14] | Not explicitly stated as VBHC, but the study focused on the effects of free maternal healthcare policies on quality of care from the perspectives of healthcare providers and managers [14] | The review found 15 studies across nine countries. The majority (14 out of 15) reported poor quality of maternal healthcare from the perspective of managers and providers. Contributing factors to the perception of poor maternal healthcare included the late reimbursement of funds, heavy workload on providers, the lack of essential drugs and stock-outs of medical supplies, the lack of clear policy definition, out-of-pocket payments, and the inequitable distribution of staff. Only one study reported satisfaction with the quality of maternal healthcare [14]. |
Dohmen P, De Sanctis T, Janssens W, Van Raaij EM. Implementing value-based healthcare using a digital health exchange platform to improve pregnancy and childbirth outcomes in urban and rural Kenya. Front Public Health. 2022 [16]. | Implement value-based healthcare (VBHC) using a digital health exchange platform to improve pregnancy and childbirth outcomes [16]. | Cohort-based implementation with a theory of change approach | Kenya |
| The MomCare program in Kenya aimed to transform maternal, neonatal, and child health (MNCH) services by using a digital health platform to shift from a supply-driven to a value-driven model. Employing a value-based healthcare (VBHC) framework, it successfully improved outcomes, including maternal and neonatal mortality rates. The program used an incremental, cohort-based approach, adapting and learning iteratively by widening inclusion criteria, adding service components, and enhancing patient engagement through SMS-based communications. MomCare demonstrated the feasibility of implementing VBHC in an LMIC setting to enhance MNCH services, aligning with SDG 3 targets in Kenya [16]. |
Percept, Leapfrog to Value. Making a case for Value-Based Care (VBC). 2023. Available from: www.percept.co.za [31]. | Introduce and explore the implementation of value-based care (VBC) in maternity care to improve maternal and infant care by aligning resources and incentives to patient priorities [31]. | Analysis and proposal | South Africa | VBC framework focusing on the care delivery model, payment and incentives, and measurement. Levers for value include investing more in antenatal care, collaborative care models, joint care planning, and an integrated episode of care (pre- and postnatal) [31]. | The VBC framework aims to transform maternity care in South Africa by adopting a human-centred approach that prioritises patient needs alongside provider and payer perspectives. Key levers for value are identified to address challenges in the current system, such as shortages of clinical skills, poor referral systems, and inequitable service delivery between public and private sectors. The proposal includes a partnership between Percept and Leapfrog to Value to design and implement a value-based solution for maternity care, emphasising the importance of measuring both clinical outcomes and outcomes that matter to patients for a comprehensive value assessment [31]. |
Marotta C, Di Gennaro F, Pisani L, Pisani V, Senesie J, Bah S, et al. Cost-utility of intermediate obstetric critical care in a resource-limited setting: a value-based analysis. Ann Glob Health. 2020 [32]. | Evaluate the cost utility of implementing and operating a high-dependency unit (HDU) for obstetric care in a resource-limited setting, focusing on value-based healthcare [32]. | Retrospective cost–utility analysis | Sierra Leone | Not specified; QALY (Quality-Adjusted Life Year) used to measure the health outcomes against the costs [32]. | 523 patients were admitted to the HDU with a total investment and operation costs of EUR 120,082, resulting in an extra cost of EUR 230 per admitted patient. The overall cost per QALY gained was EUR 10, significantly lower than the WHO threshold for high cost-effectiveness. The HDU was considered a highly cost-effective frugal innovation in a limited resource context [32]. |
Kruk ME, Leslie HH, Verguet S, Mbaruku GM, Adanu RMK, Langer A. Quality of basic maternal care functions in health facilities of five African countries: an analysis of national health system surveys. Lancet Glob Health. 2016 [33]. | Analyse the quality of basic maternal care functions and its association with volume of deliveries and surgical capacity in healthcare facilities [33]. | Combined nationally representative health system surveys (Service Provision Assessments by the Demographic and Health Survey Programme) with data for volume of deliveries and quality of delivery care [33]. | Kenya, Namibia, Rwanda, Tanzania, Uganda [33] | Not specified; used an index of 12 indicators of structure and processes of care, including infrastructure and use of evidence-based routine and emergency care interventions [33]. | Primary care facilities, which do not have caesarean section capacity, were found to have substantially lower quality of basic maternal care functions compared to secondary care facilities. Facilities with higher birth volumes had higher quality scores. More than 40% of facility deliveries in these five African countries occurred in primary care facilities, which scored poorly on basic measures of maternal care quality [33]. |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Lukwa, A.T.; Chiwire, P.; Aggrey, S.; Akinsolu, F.T.; Nyabunze, A.; Okova, D. Evaluating Value-Based Maternal Healthcare in Sub-Saharan Africa: A Systematic Review. Women 2024, 4, 226-240. https://doi.org/10.3390/women4030017
Lukwa AT, Chiwire P, Aggrey S, Akinsolu FT, Nyabunze A, Okova D. Evaluating Value-Based Maternal Healthcare in Sub-Saharan Africa: A Systematic Review. Women. 2024; 4(3):226-240. https://doi.org/10.3390/women4030017
Chicago/Turabian StyleLukwa, Akim Tafadzwa, Plaxcedes Chiwire, Siya Aggrey, Folahanmi Tomiwa Akinsolu, Admire Nyabunze, and Denis Okova. 2024. "Evaluating Value-Based Maternal Healthcare in Sub-Saharan Africa: A Systematic Review" Women 4, no. 3: 226-240. https://doi.org/10.3390/women4030017