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GLOBVAC-Global helse- og vaksin.forskn

Validation of a Continuity of Midwifery Care Model in Palestine

Alternative title: Forsking på effekt av modell med sammenhengende jordmoromsorg i Palestina

Awarded: NOK 3.8 mill.

The World Health Organization (WHO) recommends implementing midwife-led continuity models of care to improve maternal health services, also to adapt such models to low- and middle-income countries with adequate Midwife education. Research has proven that Continuity of care from midwifes throughout pregnancy, birth and postnatal period have several advantages and more research in this area is requested. Palestine Ministry of Health launched a Midwifery-led continuity model in 2013 to serve women in rural areas in the occupied West Bank. The implementation was done in collaboration with Norwegian Aid Committee (NORWAC), funded by the Norwegian Ministry of Foreign Affairs. There are few qualified midwives employed in the governmental health services in Palestine, they worked in stressful conditions at the hospitals, and had little autonomy and possibilities to work with antenatal care. Women in rural areas had little access to quality care, and armed Israeli soldiers and settlers make it unsafe to move between places. An innovative organization of midwife resources made improvements possible. This PhD-research examined the effect of implementing a Midwife-led continuity model of care, where midwives from the public hospitals reached out to rural villages. The midwives provide pregnancy-care and postnatal home-visits to the same case-load of women and visits the same village weekly. The aim was to improve rural women?s access, and usage of god quality maternal services that improve health outcome and satisfaction with care. The three quantitative observational studies contribute to a comprehensive validation of implementing the model. The first; a cluster study showed that compared to standard care, women receiving the Midwifery-led Continuity model of care increased number of antenatal visits, and more pregnancy complications were identified increasing referrals to higher level of care, and improved postnatal care, by closer follow up of women and babies by home-visits. The second, a cohort study found that less women who received the Midwife-led model had unplanned caesarean section, induction of labour and anemia and blood transfusion postpartum, they also had less preterm births, babies transferred to neonatal intensive care, and babies with birth weight less than 1500 grams. The last study, wit case-control design found that women who receive the midwife-led continuity model were more satisfied with the care they received through the continuum of pregnancy, labour and postnatal period, and they also exclusively breastfed for a longer period The research revealed new knowledge regarding implementing a midwifery-led continuity model of care in a low-middle income country under military occupation. The research contributes to and support existing evidence from research in high income countries. The results confirms the recommendation from WHO to implement midwife-led continuity models of care adapted to low-and middle-income countries.

The Midwife-led continuity model of care was implemented to improve maternal health services for disadvantaged rural women in the occupied West Bank. The PhD research involved three quantitative observational studies that confirmed an association between the implementation and several different impacts and outcomes at both facility and individual level for women and babies.

The main objective is to validate a model of Continuity of Midwifery Care that is under implementation in the Palestinian governmental hospitals. The implementation of the model started in 2012 as a Norwegian funded project, aiming to improve reproductive health-services and equity for poor women in remote areas in the occupied Palestinian Territories (oPT) defined by OECD as a Low-middle income territory. The workforce of qualified midwives in Palestine is low, thus there is a need for innovative organisation of resources. This study will examine a model where midwives from the governmental hospitals are deployed to reach out weekly to remote villages, to give ante- and post-natal care. The study aims to monitor if this model will raise the women?s use of the health services by improving access to qualified care providers; midwives. The research topics focus on sustainable improvements of maternal health and health systems. The study will be carried out in collaboration with Norwegian research institutions. The investigation aims to provide new knowledge about organising continuity of care in a low-middle income, military occupied country. The study may contribute to universal knowledge also important for high-income countries striving to fill the gap between primary and secondary health systems. Attempts to overcome these challenges are made in many high-income countries, like the Norwegian "Interaction Reform" from 2012, to enhance the collaboration between primary and secondary health care. The fragmentation of health services constitutes a modern worldwide challenge that can threaten health. This study may provide new knowledge that contributes to overcome this challenge.

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GLOBVAC-Global helse- og vaksin.forskn