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HEWs brought improvement in utilization of family planning, ANC and HIV testing but not in assisting births.
On the other hand their deployment and work have not showed any improvement in utilization of health facilities for delivery, postnatal check up and use of iodized salt.
In 10 districts in East and Central Java, Indonesia, there was little improvement in utilization of maternal and child health services, one of the key indicators of health system performance.
A recent study by Fort et al. suggested that expanded implementation of an inclusive model for primary health care designed for the rural Guatemalan context can contribute to strengthening performance, based on findings of improvement in utilization, quality and coverage over a 5-year period in two pilot sites (19).
[ 14] Furthermore, emerging evidence from epidemiological studies in the country suggests that despite significant improvement in utilization of health facilities among women with life-threatening pregnancy-related complication in recent years [ 3], maternal deaths have not decreased proportionately [ 1, 2, 4]; suggesting sub-optimal quality of care.
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In this setting, the use of case-fatality rate estimates in prediction models may grossly under-estimate the survival benefit of further improvements in utilization.
In the explanatory analysis, we quantified improvements in utilization and adherence with drug treatments separately for baseline nonusers and users (Table 3).
The increased number of CSBAs, in addition to the integrated approach of the intervention, showed improvements in utilization of skilled provider care by mothers.
In fact, maternal education may lead to improvements in utilization of primary health care services such as vaccination programmes and other child survival programmes [ 15- 21].
Despite the success of LKT as a treatment strategy for ESRD, improvements in utilization have been largely stagnant in recent years, and ethnic/racial disparities in utilization of LKT persist [ 2, 27].
Given the temporal proximity of such improvements in utilization with adaptation implementation, it may be postulated that such adaptations may have had, across sites, a significant impact on service utilization.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com