How a Continuity of Midwifery Care Model affect the usage and quality of maternal services in rural Palestine

For the Lancet Palestinian Health Alliance (LPHA) conference 2017: How a Continuity of Midwifery Care Model affect the usage and quality of maternal services in rural Palestine Authors: Berit Mortensen MSc (beritmor@me.com) and Erik Fosse MD, Phd Medical Faculty, University of Oslo, and the Intervention Center Oslo University Hospital, Oslo, Norway Abstract 465 words: Background: The Palestinian Ministry of Health provided care for 45,6% of the pregnant women in the occupied West Bank in 2013. No report described the difference between urban and rural areas; nevertheless, private service providers are more available to women in urban areas. Women living in remote areas are vulnerable because Israeli armed soldier and settlers make it dangerous to move. Abdul Rahim et al. described governmental maternal services with poor quality and antenatal-visits lacking content, short consultation time and dissatisfaction with care. In 2013 the Ministry of Health started a stepwise implementation of a Continuity of Midwifery Care Model in rural areas on the West Bank in cooperation with Norwegian aid Committee (NORWAC). The model entailed deploying midwives from the local governmental hospital to ante-and postnatal care in rural clinics. This study explored if the model increased the usage and the quality of health services after two years’ experience in Nablus and Jericho regions. Methods: The study was based on registry data at cluster level. Data from 14 clinics offering the new model was compared with data from 25 clinics offering standard care. Primary outcome was: mean number of antenatal visits per woman, number of pregnant referred to higher level of care, number of women receiving postnatal home visits. We compared the change in outcomes two years before with two years after the implementation. Multilevel Poisson regression was used to examine difference between the intervention and standard care groups and testing the change. Findings: A statistical significant difference was found between the intervention and control group (p-value