000			05434nam a22003857a 4500
003			OSt
005			20240412001035.0
007			ta
008			161212t2016 spcbd||f msb| 00| 0 eng d
040			_aOSt _bcat
041			_aeng
100	1		_914405 _aSpeciale, Anna Maria
245	1	0	_aMidwifery in low resources environments. Challenges and opportunities in maternal and reproductive health service provision / _cAnna Maria Speciale ; Montserrat Solsona (dir.)
260			_a[Bellaterra] : _bUniversitat Autònoma de Barcelona. Departament de Geografia ; Centre d'Estudis Demogràfics, _c2016
300			_a176 p. : _btaules, gràf., mapes ; _c30 cm
500			_aTesi doctoral - Universitat Autònoma de Barcelona. Departament de Geografia ; Centre d'Estudis Demogràfics, 2016.
504			_aInclou bibliografia.
504			_aInclou un llistat d'abreviatures, un llistat de figures, llistat de mapes i taules.
505			_a1. The current context of maternal health in low resource environments. -- 2.- Conceptual framework and metholodogy for three case studies in low resource environments. -- 3.- Afghanistan: understanding barriers and gaps in midwifery service provision. -- Tanzania: challenges in the formation of a quality midwifery workforce. -- 5.- Ghana: potential solutions for the improvement of the midwifery workforce and an increase in service availability. -- 6.- Conclusions.
520			_aThis thesis sought to answer the question: “Are midwives in low resource countries providing the quality maternal and reproductive health services that are needed? What gaps exist?” What training improvements will better prepare midwives to provide quality maternal and reproductive health services?” This thesis is a compilation of case studies: two investigative studies for problem identification and gaps in quality in midwifery service provision and midwifery education and one project evaluation providing information about outcomes and improvements in the quality and availability of midwifery care. The first case study takes place in Afghanistan and is a presentation of the Tanahashi framework and its use to identify barriers and bottlenecks in midwifery service provision. Final results were quite disturbing, as after discounting for availability, acceptability, accessibility, contact the effective coverage remaining was 12% for urban populations and 26% for the rural population. The Tanzanian case study offers a very complete picture of the level of quality of service that can be found particularly in low-resource settings. The research provided in this thesis demonstrated that quality of services being offered by recent graduates is very low, with less than 25% passing skills testing of crucial life-saving skills. Additionally it showed that the current curriculum and training system do not meet international standards. The final case study took place in Ghana. This case study was based on a project evaluation for a training intervention. This case study presents qualitative findings that demonstrate that the teachers, the preceptors and the students all felt that the program had a positive impact. Quantitative caseload reviews revealed that the preceptors offered more long term family planning and comprehensive abortion care services in the community after this project. In the post-2015 agenda midwives have been identified as the leading providers for maternal and reproductive health services. Globally, there is an important shortage in midwives and even countries with sufficient numbers, there are grave concerns about the distribution of the midwifery workforce in low resource countries with a tendency toward a concentration in urban environments while the greatest need is in the rural areas. However an increase in the number of midwives without an increase in quality will likely be fruitless. Midwifery is diverse in every country and great differences in maternal and reproductive health exist within countries. Prior to designing interventions, assessments such as those viewed in this thesis should be completed. This is an exciting time for midwifery globally, and particularly in low resource countries. It is hoped that this thesis contributes to the growing literature regarding midwifery and that it provides some clear examples of the study of and improvement (particularly with regard to quality and availability) of midwifery services in low resource countries. While the current challenges are great, so are the opportunities.
650		7	_2lemac _914406 _aLlevadores _xEstudi de casos _zPaïsos en vies de desenvolupament
650		7	_2lemac
650		7	_2lemac _9630 _aTesis i dissertacions acadèmiques _xEstudi de casos _zPaïsos en vies de desenvolupament
655		7	_2popin _91124 _aATENCIÓN MÉDICA _fMEDICAL CARE _iATENCIÓ MÈDICA
655		7	_2popin _91533 _aMADRE _fMOTHER _iMARE
655		7	_2popin _9113 _aPAÍSES EN DESARROLLO _fDEVELOPING COUNTRIES _iPAÏSOS EN DESENVOLUPAMENT
655		0	_aTESIS DOCTORAL _fDOCTORAL THESIS _iTESI _93593
655		7	_913712 _aESTUDIOS DE CASOS _fCASE STUDIES _iESTUDIS DE CASOS
710	2		_913692 _aCentre d'Estudis Demogràfics _eed.
700	1		_aSOLSONA PAIRÓ, Montserrat _4dir. _92567
710	2		_913683 _aUniversitat Autònoma de Barcelona. _bDepartament de Geografia _eed.
856	4	1	_uhttp://www.tdx.cat/handle/10803/392672 _yTambé disponible en línia
901			_aRevisat
942			_2udc _cTD
999			_c8018 _d8018