"If that helps encourage facilities to be more customer focused, that would be a positive, but not entirely necessary," Steranka said.
Instead, the official said that the restraint measurement is part of its Inpatient Psychiatric Facility Quality Reporting program, which is intended to encourage facilities to improve the quality of their inpatient care and disseminate information to the public so that they can be better informed when they choose their health care providers.
One way to encourage facilities to refer difficult cases may be to require receiving facilities to report back to referring facilities about the arrival and outcome of these cases.
They also promote use of clean delivery kits, encourage facility births and immediate newborn care.
Despite decades of efforts to encourage facility births, many women continue to deliver at home.
To encourage facility teams to continue pursuing problems, ZDF and Jhpiego arranged 3-day supportive supervision visits to each facility approximately twice a year.
- Woman, Ulanga District CHWs described listening to women recount neglect during delivery and how the experience of neglect undermines their ability to encourage facility-based deliveries.
Further, as the communities' fear of EVD deepens and their trust in health providers weakens, women are choosing to deliver away from the health system's reach, potentially reducing gains made in recent years to encourage facility delivery.
CHWs normally see infants from two months of age and trained TBAs are supposed to carry out home visits soon after a baby's delivery, encourage facility-based postnatal care, assess for danger signs in mother and baby, and make and follow up referrals when necessary.
Third, through meetings and other routine activities the sub-district managers are also trying to instil a new culture of reflection and questioning – trying to encourage facility managers to ask 'does it make sense, how must it be done, can it be done better?' As one manager argued, " We have to change the way we do things, and that means not accepting how things currently are".
Through the Maternal, Neonatal, and Child Health/Family Planning/Malaria Project (2006 2011), funded by USAID, IntraHealth International trained providers in family planning counseling and provision of contraceptives, encouraged facilities to integrate mother-and-child health services with other reproductive health services, and engaged and educated communities through public campaigns.
