Perspectives of Healthcare Providers in Maternal and Child Health Services in Bokeo Province, Lao People’s Democratic Republic: A Qualitative Study
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Abstract
In Bokeo province, Lao People’s Democratic Republic, the high rates of poverty and poor health outcomes are striking. According to data collected from the Lao government, the area has a high mortality rate among mothers and children under five years old. Consequently, there is an urgent need for significant enhancements in maternal and child health (MCH) services. This study aims to investigate the perspectives of healthcare providers on the MCH situation, difficulties, challenges, and potential solutions for the growth and implementation of MCH services. We conducted in-depth interviews with 45 healthcare providers from varying healthcare system levels using qualitative methods. The key findings are as follows: Healthcare providers demonstrate a strong understanding of MCH policies, acknowledgment of national objectives, and dedication to personal growth. However, significant obstacles exist, including access barriers for ethnic minorities, transportation complications, inadequate healthcare personnel, and insufficient equipment and infrastructure. Healthcare providers have also indicated a need for more training and opportunities for professional development to improve MCH outcomes. To enhance MCH outcomes in Bokeo province, addressing these challenges and supporting healthcare providers in their quest for self-improvement is essential. The findings of our study can aid in creating targeted interventions and policies to improve MCH outcomes in Bokeo province and similar regions. By focusing on critical areas such as antenatal care, skilled birth attendance, postnatal care, immunizations, nutrition, family planning, health education, and access to healthcare, we can strive towards improved health outcomes and reduced mortality rates.
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References
• Adhikari, B., Phommasone, K., Pongvongsa, T., Koummarasy, P., Soundala, X., Henriques, G., Sirithiranont, P., Parker, D. M., von Seidlein, L., & White, N. J. (2019). Treatment-seeking behaviour for febrile illnesses and its implications for malaria control and elimination in Savannakhet Province, Lao PDR (Laos): A mixed method study. BMC Health Services Research, 19(1), Article 252. https://doi.org/10.1186/s12913-019-4070-9
• Ba, D. M., Zhang, Y., Pasha-Razzak, O., Khunsriraksakul, C., Maiga, M., Chinchilli, V. M., & Ssentongo, P. (2023). Factors associated with pregnancy termination in women of childbearing age in 36 low-and middle-income countries. PLOS Global Public Health, 3(2), Article e0001509. https://doi.org/10.1371/journal.pgph.0001509
• Bell, V., & Alttahir, Y. (2016). Impact assessment in practice: Case studies from Save the Children programs in Lao PDR and Afghanistan. In V. Jakupec & M. Kelly (Eds.), Assessing the impact of foreign aid: Value for money and aid for trade (pp. 199–213). Elsevier.
• Bodhisane, S., & Pongpanich, S. (2022). The influence of the National Health Insurance scheme of the Lao People’s Democratic Republic on healthcare access, catastrophic health expenditures for patients with chronic renal disease, and the possibility of integrating organ transplantation into the health financing system. Health Research Policy and Systems, 20(1), Article 71. https://doi.org/10.1186/s12961-022-00869-4
• Boulom, S., Essink, D. R., Kang, M.-H., Kounnavong, S., & Broerse, J. E. (2020). Factors associated with child malnutrition in mountainous ethnic minority communities in Lao PDR. Global Health Action, 13(sup2), Article 1785736. https://doi.org/10.1080/16549716.2020.1785736
• Chankham, T., Yamamoto, E., Reyer, J. A., Arafat, R., Khonemany, I., Panome, S., Hongkham, D., Bounfeng, P., Anonh, X., & Hamajima, N. (2017). Knowledge of free delivery policy among women who delivered at health facilities in Oudomxay Province, Lao PDR. Nagoya Journal of Medical Science, 79(2), 135–145. https://doi.org/10.18999/nagjms.79.2.135
• Chen, W.-T., Shiu, C., Lee, F. R., Moolphate, S., & Aung, M. N. (2023). Infrastructure collapsed, health care access disrupted, Myanmar people with chronic diseases are in danger. Journal of Global Health, 13, Article 03002. https://doi.org/10.7189/jogh.13.03002
• Choummanivong, M., Karimi, S., Durham, J., Sychareun, V., Flenady, V., Horey, D., & Boyle, F. (2020). Stillbirth in Lao PDR: A healthcare provider perspective. Global Health Action, 13(sup2), Article 1786975. https://doi.org/10.1080/16549716.2020.1786975
• Gera, T., Shah, D., Garner, P., Richardson, M., & Sachdev, H. S. (2016). Integrated management of childhood illness (IMCI) strategy for children under five. Cochrane Database of Systematic Reviews, 6, Article CD010123. https://doi.org/10.1002/14651858.CD010123.pub2
• Global Data Lab. (2022). GDL Area Profile Report: Bokeo (Lao). Area database (V4.2.1). https://globaldatalab.org/profiles/region/LAOr105/
• Herwansyah, H., Czabanowska, K., Kalaitzi, S., & Schröder-Bäck, P. (2022). The utilization of maternal health services at primary healthcare setting in Southeast Asian Countries: A systematic review of the literature. Sexual & Reproductive Healthcare, 32, Article 100726. https://doi.org/10.1016/j.srhc.2022.100726
• Kawaguchi, Y., Sayed, A. M., Shafi, A., Kounnavong, S., Pongvongsa, T., Lasaphonh, A., Xaylovong, K., Sato, M., Matsui, M., Imoto, A., Huy, N. T., & Moji, K. (2021). Factors affecting the choice of delivery place in a rural area in Laos: A qualitative analysis. PLOS ONE, 16(8), Article e0255193. https://doi.org/10.1371/journal.pone.0255193
• Khamphilavong, K., Zhang, L., Soukkhavong, M., Awais, M., & Kang, Y. (2023). Ethnobotanical study on the utilized of medicinal plants by the Phouthai ethnic group in Khammouan province, Lao PDR. International Journal of Probiotics and Dietetics, 3(1), 32–45. https://doi.org/10.33140/IJPD.03.01.05
• Khatri, R. B., Mengistu, T. S., & Assefa, Y. (2022). Input, process, and output factors contributing to quality of antenatal care services: A scoping review of evidence. BMC Pregnancy and Childbirth, 22(1), Article 455. https://doi.org/10.1186/s12884-022-05331-5
• Kilpatrick, A. L., Bouphavanh, K., Sengchanh, S., Namvongsa, V., & Gray, A. Z. (2019). Medical education in Lao People’s Democratic Republic: The challenges students face in accessing learning resources. The Asia Pacific Scholar, 4(2), 39–47. https://doi.org/10.29060/taps.2019-4-2/oa2034
• Kruk, M. E., Lewis, T. P., Arsenault, C., Bhutta, Z. A., Irimu, G., Jeong, J., Lassi, Z. S., Sawyer, S. M., Vaivada, T., Waiswa, P., & Yousafzai, A. K. (2022). Improving health and social systems for all children in LMICs: Structural innovations to deliver high-quality services. The Lancet, 399(10337), 1830–1844. https://doi.org/10.1016/s0140-6736(21)02532-0
• Meemon, N., Paek, S. C., Pradubmook Sherer, P., Keetawattananon, W., & Marohabutr, T. (2021). Transnational mobility and utilization of health services in northern Thailand: Implications and challenges for border public health facilities. Journal of Primary Care & Community Health, 12. https://doi.org/10.1177/21501327211053740
• Millogo, T., Chomi, E., Kouanda, S., & Ali, M. (2023). Getting up to date with what works: A systematic review on the effectiveness and safety of task sharing of modern methods in family planning services. BioMed Research International, 2023, Article 8735563. https://doi.org/10.1155/2023/8735563
• Nagpal, S., Masaki, E., Pambudi, E. S., & Jacobs, B. (2019). Financial protection and equity of access to health services with the free maternal and child health initiative in Lao PDR. Health Policy and Planning, 34(Suppl_1), i14–i25. https://doi.org/10.1093/heapol/czz077
• Nonaka, D., Inthavong, N., Takahashi, K., Chanthakoumane, K., Toyama, Y., Luangphaxay, C., Pongvongsa, T., & Kounnavong, S. (2022). Primary health care situations in remote rural villages of the Savannakhet province, Lao People’s Democratic Republic. Tropical Medicine and Health, 50(1), Article 90. https://doi.org/10.1186/s41182-022-00482-9
• Numair, T., Harrell, D. T., Huy, N. T., Nishimoto, F., Muthiani, Y., Nzou, S. M., Lasaphonh, A., Palama, K., Pongvongsa, T., & Moji, K. (2021). Barriers to the digitization of health information: A qualitative and quantitative study in Kenya and Lao PDR using a cloud-based maternal and child registration system. International Journal of Environmental Research and Public Health, 18(12), Article 6196. https://doi.org/10.3390/ijerph18126196
• Phommachanh, S., Essink, D. R., Jansen, M., Broerse, J. E., Wright, P., & Mayxay, M. (2019). Improvement of quality of antenatal care (ANC) service provision at the public health facilities in Lao PDR: Perspective and experiences of supply and demand sides. BMC Pregnancy and Childbirth, 19(1), Article 255. https://doi.org/10.1186/s12884-019-2345-0
• Ramadan, M., Gutierrez, J. C., Feil, C., Bolongaita, S., Bernal, O., & Uribe, M. V. (2023). Capacity and quality of maternal and child health services delivery at the subnational primary healthcare level in relation to intermediate health outputs: A cross-sectional study of 12 low-income and middle-income countries. BMJ Open, 13(1), Article e065223. https://doi.org/10.1136/bmjopen-2022-065223
• Safe, M., Wittick, P., Philaketh, K., Manivong, A., & Gray, A. (2022). Mixed‐methods evaluation of a continuing education approach to improving district hospital care for children in Lao PDR. Tropical Medicine & International Health, 27(3), 262–270. https://doi.org/10.1111/tmi.13726
• Sakuma, S., Yasuoka, J., Phongluxa, K., & Jimba, M. (2019). Determinants of continuum of care for maternal, newborn, and child health services in rural Khammouane, Lao PDR. PLOS ONE, 14(4), Article e0215635. https://doi.org/10.1371/journal.pone.0215635
• Sato, C., Phongluxa, K., Toyama, N., Gregorio, E. R., Miyoshi, C., Nishimoto, F., Takayama, T., Pongvongsa, T., Takahashi, K., & Kounnavong, S. (2019). Factors influencing the choice of facility-based delivery in the ethnic minority villages of Lao PDR: A qualitative case study. Tropical Medicine and Health, 47, Article 50. https://doi.org/10.1186/s41182-019-0177-2
• Smith, T. J., Tan, X., Arnold, C. D., Sitthideth, D., Kounnavong, S., & Hess, S. Y. (2022). Traditional prenatal and postpartum food restrictions among women in northern Lao PDR. Maternal & Child Nutrition, 18(1), Article e13273. https://doi.org/10.1111/mcn.13273
• Sonoda, M., Syhavong, B., Vongsamphanh, C., Phoutsavath, P., Inthapanith, P., Rotem, A., & Fujita, N. (2017). The evolution of the national licensing system of health care professionals: A qualitative descriptive case study in Lao People’s Democratic Republic. Human Resources for Health, 15(1), Article 51. https://doi.org/10.1186/s12960-017-0215-2
• Sychareun, V., Somphet, V., Chaleunvong, K., Hansana, V., Phengsavanh, A., Xayavong, S., & Popenoe, R. (2016). Perceptions and understandings of pregnancy, antenatal care and postpartum care among rural Lao women and their families. BMC Pregnancy and Childbirth, 16(1), Article 245. https://doi.org/10.1186/s12884-016-1031-8
• Sydavong, T., Goto, D., Kawata, K., Kaneko, S., & Ichihashi, M. (2019). Potential demand for voluntary community-based health insurance improvement in rural Lao People’s Democratic Republic: A randomized conjoint experiment. PLOS ONE, 14(1), Article e0210355. https://doi.org/10.1371/journal.pone.0210355
• The World Bank. (2020a). Lao PDR poverty profile and poverty assessment 2020. World Bank. https://www.worldbank.org/en/country/lao/publication/lao-pdr-poverty-profile-and-poverty-assessment-2020
• The World Bank. (2020b). Maternal mortality ratio (per 100,000 live births). Gender Data Portal. https://genderdata.worldbank.org/indicators/sh-sta-mmrt/
• Thongmixay, S., Essink, D. R., de Greeuw, T., Vongxay, V., Sychareun, V., & Broerse, J. E. (2019). Perceived barriers in accessing sexual and reproductive health services for youth in Lao People’s Democratic Republic. PLOS ONE, 14(10), Article e0218296. https://doi.org/10.1371/journal.pone.0218296
• Turkmani, S., Smith, R. M., Tan, A., Kamkong, C. B., Anderson, R., Sakulku, S., Jat, T. R., Biswas, A., & Homer, C. S. (2023). An evaluation of the introduction of telehealth for remote antenatal and postnatal contacts in Bangladesh and Lao People's Democratic Republic during the COVID-19 pandemic. PLOS Global Public Health, 3(5), Article e0000786. https://doi.org/10.1371/journal.pgph.0000786
• United Nations. (2023). Goal 3: Ensure healthy lives and promote well-being for all at all ages. Sustainable Development Goals. https://www.un.org/sustainabledevelopment/health/
• Withers, M., Kharazmi, N., & Lim, E. (2018). Traditional beliefs and practices in pregnancy, childbirth and postpartum: A review of the evidence from Asian countries. Midwifery, 56, 158–170. https://doi.org/10.1016/j.midw.2017.10.019
• Wittick, T. A., Bouphavanh, K., Namvongsa, V., Khounthep, A., & Gray, A. (2019). Medical education in Laos. Medical Teacher, 41(8), 877–882. https://doi.org/10.1080/0142159X.2018.1552780
• World Health Organization. (2018, February 1). Maternal health care: Policies, technical standards and services accessibility in eight countries in the Western Pacific Region. WHO Regional Office for the Western Pacific.
• World Health Organization. (2023, February 22). Maternal mortality. https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
• Wungrath, J. (2023). Antenatal care services for migrant workers in Northern Thailand: Challenges, initiatives, and recommendations for improvement. Journal of Child Science, 13(01), e118–e126. https://doi.org/10.1055/s-0043-1772844
• Yoon, H. B., Shin, J.-S., Bouphavanh, K., & Kang, Y. M. (2016). Evaluation of a continuing professional development training program for physicians and physician assistants in hospitals in Laos based on the Kirkpatrick model. Journal of Educational Evaluation for Health Professions, 13, Article 21. https://doi.org/10.3352/jeehp.2016.13.21