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Type: Journal article
Title: Evidence from district level inputs to improve quality of care for maternal and newborn health: interventions and findings
Author: Salam, R.
Lassi, Z.
Das, J.
Bhutta, Z.
Citation: Reproductive Health, 2014; 11(Suppl. 2):S3-1-S3-19
Publisher: BioMed Central
Issue Date: 2014
ISSN: 1742-4755
Statement of
Rehana A Salam, Zohra S Lassi, Jai K Das, Zulfiqar A Bhutta
Abstract: District level healthcare serves as a nexus between community and district level facilities. Inputs at the district level can be broadly divided into governance and accountability mechanisms; leadership and supervision; financial platforms; and information systems. This paper aims to evaluate the effectivness of district level inputs for imporving maternal and newborn health. We considered all available systematic reviews published before May 2013 on the pre-defined district level interventions and included 47 systematic reviews. Evidence suggests that supervision positively influenced provider's practice, knowledge and client/provider satisfaction. Involving local opinion leaders to promote evidence-based practice improved compliance to the desired practice. Audit and feedback mechanisms and tele-medicine were found to be associated with improved immunization rates and mammogram uptake. User-directed financial schemes including maternal vouchers, user fee exemption and community based health insurance showed significant impact on maternal health service utilization with voucher schemes showing the most significant positive impact across all range of outcomes including antenatal care, skilled birth attendant, institutional delivery, complicated delivery and postnatal care. We found insufficient evidence to support or refute the use of electronic health record systems and telemedicine technology to improve maternal and newborn health specific outcomes. There is dearth of evidence on the effectiveness of district level inputs to improve maternal newborn health outcomes. Future studies should evaluate the impact of supervision and monitoring; electronic health record and tele-communication interventions in low-middle-income countries.
Keywords: Humans; Perinatal Care; Motivation; Evidence-Based Medicine; Pregnancy; Information Systems; Infant, Newborn; Maternal Health Services; Health Expenditures; Primary Health Care; Delivery of Health Care; Quality Assurance, Health Care; Female; Quality Improvement
Rights: © 2014 Salam et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
RMID: 0030038040
DOI: 10.1186/1742-4755-11-S2-S3
Appears in Collections:Medicine publications

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