Notice bibliographique
Résumé
Summary Women’s access to skilled birth attendance (SBA) is of major interest and concern in Afghanistan to the public, health professionals and international partners of the vulnerable healthcare in the country. This thesis aims at understanding the situation of SBA through the research work of the author and the available evidence on the subject matter. The theoretical framework used is a modified Tanahashi model that distinguishes various layers of access to SBA including its availability, accessibility, acceptability, utilization and quality. Chapter 1 introduces the unique situation in Afghanistan surrounding SBA necessary for developing a holistic understanding of the Afghan context. Country specific issues such exclusivity of SBA to female midwives and obstetrician/gynecologist, extreme shortage of SBA providers just a couple of decades ago and a rapid increase in the number of midwives in the period, a split healthcare provision system led by Ministry of Public Health, funded by international donors and implemented by non-governmental organizations are highlighted. Finally, the interlinking concepts of health system components, human resources for health and quality of care are described and incorporated in the final research theoretical framework of a modified Tanahashi model. Chapter 2 describes the availability and utilization of Emergency Obstetric and Newborn Care (EmONC) in terms of the defining healthcare package of the seven Basic EmONC (BEmONC) and additional two Comprehensive EmONC (CEmONC) signal functions. The study shows how various signal functions are missing from facilities designated to provide the healthcare. Chapter 3 explores availability and distribution of human resources for provision of CEmONC. Availability of SBA providers is explored at different facility levels and during different days, shifts, and times. The study emphasizes the need for innovative approaches for deployment, skills development, and retention of SBA providers, especially in underserved areas. Chapter 4 is based on the study of midwifery education programs in Afghanistan established to fill the vast gap of availability of SBA in Afghanistan. The study examines two distinctive midwifery education programs established and operating in the country and summarizes lessons learned for future improvement of the systems. Chapter 5 explores the level of trainings received by SBA providers and their level of confidence in providing the healthcare. The study documents and recommends the need for continued in-service training and hands-on practice for all SBA providers in order to ensure its effectiveness. The study specifically demonstrate that midwifes rather than medical doctors are key to reliable SBA in Afghanistan. Chapter 6 presents the findings of a study of the quality of the educational programs in 29 public and private midwifery education programs as a prerequisite for the quality of care of their graduate SBA providers. The study documents the quality of midwifery education with respect to the necessary infrastructure and management, teachers and preceptors, clinical practice sites, curriculum, and support of students. Chapter 7 is based on a qualitative study of women’s experience of care during facility based childbirth healthcare. The study looks at respectful maternity care from the women’s, healthcare providers’ and health managers’ perspectives and highlights key areas of improvement. Chapter 8 synthetizes all of the findings of the research work along with the available local and international evidence into the hierarchical frame of Tanahashi model and from the perspectives of the recipient of the care, the healthcare providers and the health system. The chapter provides a list of recommendations based on the evidence compiled as the outcome of the thesis.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».