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What Works? Strategies to Increase Reproductive, Maternal and Child Health in Difficult to Access Mountainous Locations: A Systematic Literature Review

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  • Abbey Byrne
  • Andrew Hodge
  • Eliana Jimenez-Soto
  • Alison Morgan

Abstract

Background: Geography poses serious challenges to delivery of health services and is a well documented marker of inequity. Maternal, newborn and child health (MNCH) outcomes are poorer in mountainous regions of low and lower-middle income countries due to geographical inaccessibility combined with other barriers: poorer quality services, persistent cultural and traditional practices and lower socioeconomic and educational status. Reaching universal coverage goals will require attention for remote mountain settings. This study aims to identify strategies to address barriers to reproductive MNCH (RMNCH) service utilisation in difficult-to-reach mountainous regions in low and lower-middle income settings worldwide. Methods: A systematic literature review drawing from MEDLINE, Web of Science, Scopus, Google Scholar, and Eldis. Inclusion was based on; testing an intervention for utilisation of RMNCH services; remote mountain settings of low- and lower-middle income countries; selected study designs. Studies were assessed for quality and analysed to present a narrative review of the key themes. Findings: From 4,130 articles 34 studies were included, from Afghanistan, Bolivia, Ethiopia, Guatemala, Indonesia, Kenya, Kyrgyzstan, Nepal, Pakistan, Papua New Guinea and Tajikistan. Strategies fall into four broad categories: improving service delivery through selected, trained and supported community health workers (CHWs) to act alongside formal health workers and the distribution of critical medicines to the home; improving the desirability of existing services by addressing the quality of care, innovative training and supervision of health workers; generating demand by engaging communities; and improving health knowledge for timely care-seeking. Task shifting, strengthened roles of CHWs and volunteers, mobile teams, and inclusive structured planning forums have proved effective. Conclusions: The review highlights where known evidence-based strategies have increased the utilisation of RMNCH services in low income mountainous areas. While these are known strategies in public health, in such disadvantaged settings additional supports are required to address both supply and demand barriers.

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  • Abbey Byrne & Andrew Hodge & Eliana Jimenez-Soto & Alison Morgan, 2014. "What Works? Strategies to Increase Reproductive, Maternal and Child Health in Difficult to Access Mountainous Locations: A Systematic Literature Review," PLOS ONE, Public Library of Science, vol. 9(2), pages 1-7, February.
    • Handle: RePEc:plo:pone00:0087683
    DOI: 10.1371/journal.pone.0087683
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    References listed on IDEAS

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    1. Wang, Limin, 2003. "Determinants of child mortality in LDCs: Empirical findings from demographic and health surveys," Health Policy, Elsevier, vol. 65(3), pages 277-299, September.
    2. Oswald, I. H., 1983. "Are traditional healers the solution to the failures of primary health care in rural Nepal?," Social Science & Medicine, Elsevier, vol. 17(5), pages 255-257, January.
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    1. Joyce Twahafifwa Shatilwe & Desmond Kuupiel & Tivani P Mashamba-Thompson, 2021. "Evidence on access to healthcare information by women of reproductive age in low- and middle-income countries: Scoping review," PLOS ONE, Public Library of Science, vol. 16(6), pages 1-21, June.
    2. Ashrita Saran & Howard White & Kerry Albright & Jill Adona, 2020. "Mega‐map of systematic reviews and evidence and gap maps on the interventions to improve child well‐being in low‐ and middle‐income countries," Campbell Systematic Reviews, John Wiley & Sons, vol. 16(4), December.
    3. Yemisrach B. Okwaraji & Zelee Hill & Atkure Defar & Della Berhanu & Desta Wolassa & Lars Åke Persson & Geremew Gonfa & Joanna A. Schellenberg, 2020. "Implementation of the ‘Optimising the Health Extension Program’ Intervention in Ethiopia: A Process Evaluation Using Mixed Methods," IJERPH, MDPI, vol. 17(16), pages 1-20, August.
    4. Frederika Rambu Ngana & A A I N Eka Karyawati, 2021. "Scenario modelling as planning evidence to improve access to emergency obstetric care in eastern Indonesia," PLOS ONE, Public Library of Science, vol. 16(6), pages 1-22, June.

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