Does outreaching Continuity of Midwifery-care improve usage and quality of services in Palestine?

Does outreaching Continuity of Midwifery-care improve usage and quality of services in Palestine? Abstract: Background: The Palestinian Ministry of Health (PMoH) provides care for 54% of the pregnant women in the occupied West Bank. Women living in remote areas are vulnerable because the distance and Israeli military presence hinders them to reach central health-facilities. In 2013 PMoH implemented an outreaching Continuity of Midwifery Care Model, deploying midwives from the hospitals, to give ante- and postnatal care to women in selected remote villages in Palestine. Objective: Our study aims to assess the acceptability and quality of care of this model. Design: A pragmatic cluster-non-randomised controlled trial, comparing register-data from 14 intervention-clinics with 28 control-clinics (with various professionals and no continuity), in Nablus and Jericho district. We will measure the change before (baseline) and after the implementation, and compare the change in the intervention cluster with the control cluster. We hypothesize an increase in the number of pregnant women registering and increase in number of visits per woman at the intervention-clinics. We hypothesize increased identification of pregnancy complications requiring higher level of care, and an increase in postnatal home visits at the intervention-clinics Discussion: Continuity of care allows for the building of a relationship. A relationship where women experience respect and thus gain trust in the health care provided. We believe that this relationship, as well as the care being provided in the near vicinity of the home of the women, increases women’s usage of care. Meta-studies support continuum of care and more research regarding developing midwifery-led models in low-income countries are requested : We believe this study is an important contribution as such.