Table 1 Scenarios modelled to determine the effect of current and improved antenatal, intrapartum, and postnatal healthcare services on maternal and perinatal health in Malawi
Scenario full name (Short name) | Scenario description | Changes to service delivery during intervention period (2023–2030) | |
|---|---|---|---|
Comparator scenario: | Status Quo (SQ) | The coverage and quality of maternity services remain unchanged from assumed levels in Malawi during the intervention period. Population level coverage of four or more antennal care (ANC) visits is ~51%, facility delivery is ~91%, maternal postnatal care (PNC) is 42% and newborn PNC is 60% (see S1 File, §2, §4). This scenario acts as the comparator for all other scenarios within this table. | N/A |
Scenarios relating to antenatal services: | Increased routine ANC coverage (AN coverage) | The population level coverage of routine ANC (four or more visits) is increased during the intervention period with no changes to service quality. | Changes in service utilisation/coverage: • 90% of women who deliver per year receive four or more ANC contacts Changes in service quality: • None Otherwise same as the Status Quo. |
Increased coverage and quality of antenatal services (AN coverage and qual.) | The population level coverage of routine ANC (four or more visits) is increased during the intervention period in addition to maximum quality in service delivery (e.g. all required interventions are delivered). In addition, the quality of inpatient antenatal services is set at maximum. There are no modelled changes to care delivered following termination of pregnancy (e.g. post abortion care/ectopic pregnancy case management). | Changes in service utilisation/coverage: • 90% of women who deliver per year receive four or more ANC contacts Changes in service quality: • All parameters representing the probability an intervention (e.g. initiation of iron and folic acid) may occur during ANC are set to 1.0 (as a proxy for quality). • All requested consumables (i.e. medicines) for ANC are available within a given health system interaction‖ (HSI). • All parameters representing the probability an intervention may occur during inpatient antenatal care as a proxy for quality set to 1.0. • All requested consumables for inpatient antenatal care are available within a given HSI. • The effect of delay threea is disabled during inpatient antenatal care meaning perfect availability of health care worker (HCW) time is assumed leading to no effect of the ‘squeezed’ health system on treatment effectiveness during care. Otherwise same as the Status Quo. | |
Maximum availability of antenatal services (AN max.) | The delivery of antenatal services within the pregnant population is maximised during the intervention period. This means that alongside all women receiving the maximum number of routine ANC contacts possible during their pregnancy, all care seeking for antenatal emergencies occurs and all required antenatal interventions are delivered. There are no modelled changes to care delivered following termination of pregnancy (e.g. post abortion care/ectopic pregnancy case management). | Changes in service utilisation/coverage: • All newly pregnant women during the intervention period initiate ANC within the first trimester. • Probability of attending any subsequent ANC visit set to 1.0 leading to maximum number of visits for a given pregnancy (dependent on pregnancy loss, preterm labour, or antenatal death). • Probability of maternal care seeking for antenatal emergencies (excluding those related to pregnancy loss) is set to 1.0. Changes in service quality: • All parameters representing the probability an intervention may occur during ANC as a proxy for quality set to 1.0. • All requested consumables for ANC are available within a given interaction. • All parameters representing the probability an intervention may occur during inpatient antenatal care as a proxy for quality set to 1.0. • All requested consumables for inpatient antenatal care are available within a given HSI. • The effect of delay three is disabled during inpatient antenatal care meaning perfect availability of health care worker (HCW) time is assumed leading to no effect of the ‘squeezed’ health system on treatment effectiveness during care. Otherwise same as the Status Quo. | |
No antenatal services (AN min.) | Antenatal services are not delivered to the population during the intervention period. This allows for estimation of the effect of current delivery of antenatal services on the population in the SQ scenario. | Changes in service utilisation/coverage: • No routine ANC occurs for any newly pregnant woman during the intervention period. • Probability of maternal care seeking for antenatal emergencies (excluding those related to pregnancy loss) is set to 0 meaning no antenatal emergency inpatient care is delivered. Otherwise same as the Status Quo. | |
Scenarios relating to intrapartum services: | Increased availability of intrapartum Basic Emergency Obstetric and Newborn Care (BEmONC) interventions (IP BEmONC) | The availability of prophylactic and BEmONC interventionsb delivered to women in labour is increased. | Changes in service quality: • Probability of prophylactic interventionc delivery during labour set at 90% • Probability of BEmONC intervention delivery during labour set at 90% • In addition, effect of delay three is disabled meaning perfect availability of health care worker (HCW) time is assumed leading to no effect of the ‘squeezed’ health system on treatment effectiveness during care. Otherwise same as the Status Quo. |
Increased availability of intrapartum Comprehensive Emergency Obstetric and Newborn Care (CEmONC) interventions (IP CEmONC) | The availability of prophylactic and CEmONC interventionsd delivered to women in labour is increased. | Changes in service quality: • Probability of prophylactic intervention delivery during labour set at 90% • Probability of BEmONC intervention delivery during labour set at 90% • Probability of CEmONC intervention delivery during labour set at 90% • In addition, effect of delay three is disabled meaning perfect availability of health care worker (HCW) time is assumed leading to no effect of the ‘squeezed’ health system on treatment effectiveness during care. Otherwise same as the Status Quo. | |
Maximum availability of intrapartum services (IP max). | The delivery of intrapartum services within the pregnant population is maximised during the intervention period. This means that alongside all women giving birth in a health facility, all required interventions are delivered. | Changes in service utilisation/coverage: • All women will deliver in either a health centre or a hospital during the intervention period. Changes in service quality: • Probability of prophylactic intervention delivery during labour set at 100% • Probability of BEmONC intervention delivery during labour set at 100% • Probability of CEmONC intervention delivery during labour set at 100% • In addition, effect of delay three is disabled meaning perfect availability of health care worker (HCW) time is assumed leading to no effect of the ‘squeezed’ health system on treatment effectiveness during care. Otherwise same as the Status Quo | |
No intrapartum services (IP min.) | Intrapartum services are not delivered to the population during the intervention period. This allows for estimation of the effect of current delivery of intrapartum services on the population in the SQ scenario. | Changes in service quality: • Probability of prophylactic intervention delivery during labour set at 0. • Probability of BEmONC intervention delivery during labour set at 0. • Probability of CEmONC intervention delivery during labour set at 0. Otherwise same as the Status Quo | |
Scenarios relating to postnatal services: | Increased postnatal care (PNC) coverage (PN coverage) | The population level coverage of routine PNC is increased during the intervention period with no changes to service quality. | Changes in service utilisation/coverage: • 90% of women and neonates who deliver per year receive one or more postnatal care visits. The first visit occurs within 48 h of delivery. • Otherwise same as the Status Quo |
Increased coverage and quality of postnatal services (PN coverage and qual.) | The population level coverage of routine PNC is increased during the intervention period in addition to maximum quality in service delivery (e.g. all required interventions are delivered). In addition, the quality of inpatient postnatal services is also maximised. | Changes in service utilisation/coverage: • 90% of women and neonates who deliver per year receive one or more postnatal care visits. The first visit occurs within 48 h of delivery. Changes in service quality: • All parameters representing the probability an intervention may occur during routine PNC as a proxy for quality set to 1.0. • All consumables for PNC are available within a given HSI. • All parameters representing the probability an intervention may occur during inpatient postnatal care as a proxy for quality set to 1.0 • All consumables for inpatient postnatal care available within a given interaction. • The effect of delay three is disabled during inpatient postnatal care meaning perfect availability of health care worker (HCW) time is assumed leading to no effect of the ‘squeezed’ health system on treatment effectiveness during care. Otherwise same as the Status Quo | |
Maximum availability of postnatal services (PN max). | The delivery of postnatal services within the pregnant population is maximised during the intervention period. This means that alongside all women and newborns receiving early PNC, all required interventions are delivered. Additionally, all women and newborns with complications later in the postnatal period will seek and receive care. | Changes in service utilisation/coverage: • 100% of women and neonates who deliver per year receive their first PNC visit within 48 h of delivery. Additionally, any future PNC visits required (due to complications) are 100% likely to occur Changes in service quality: • All parameters representing the probability an intervention may occur during routine PNC as a proxy for quality set to 1.0. • All consumables for PNC are available within a given HSI. • Probability of maternal or neonatal care seeking for postnatal emergencies is set to 1.0. • All parameters representing the probability an intervention may occur during inpatient postnatal care as a proxy for quality set to 1.0. • All consumable for inpatient postnatal care available within a given interaction. • In addition, effect of delay three is disabled meaning perfect availability of health care worker (HCW) time is assumed leading to no effect of the ‘squeezed’ health system on treatment effectiveness during care. Otherwise same as the Status Quo | |
No postnatal services (PN min.) | Postnatal services are not delivered to the population during the intervention period. This allows for estimation of the effect of current delivery of postnatal services on the population in the SQ scenario. | Changes in service utilisation/coverage: • No routine PNC occurs for any mother or newborn after birth. Changes in service quality: • Probability of maternal and neonatal care seeking for postnatal emergencies is set to 0, meaning no postnatal emergency inpatient care is delivered. Otherwise same as the Status Quo | |
Scenarios relating to all services: | Increased coverage and antenatal, postnatal services and improved availability of BEmONC interventions (All services coverage). | The changes to coverage of the services described in the scenarios AN coverage., IP BEmONC, and PN coverage., are enacted during the intervention period. | See scenarios AN coverage., IP BEmONC, and PN coverage. |
Increased coverage and quality of antenatal, postnatal services, and improved availability of CEmONC interventions (All services coverage and qual.) | The changes to coverage and quality of the services described in the scenarios AN coverage and qual., IP CEmONC, and PN coverage and qual., are enacted during the intervention period. | See scenarios AN coverage and qual., IP CEmONC, and PN coverage and qual. | |
Maximum availability of antenatal, intrapartum, and postnatal services (All services max). | The changes to coverage and quality of the services described in the scenarios AN max., IP max., and PN max. are enacted during the intervention period. | See scenarios AN max., IP max., and PN max. | |
No availability of antenatal, intrapartum, and postnatal services (All services min). | The changes to the availability of the services described in the scenarios AN min., IP min., and PN min. are enacted during the intervention period. | See scenarios AN min., IP min., and PN min. |
