'It's about time': policymakers' and health practitioners' perspectives on implementing fertility care in the Gambian health system.

Journal article


Afferri, A., Dierickx, Susan, Allen, Haddijatou, Bittaye, Mustapha, Marena, Musa, Pacey, Allan and Balen, Julie 2024. 'It's about time': policymakers' and health practitioners' perspectives on implementing fertility care in the Gambian health system. BMC Health Services Research. 24 (1), p. 282. https://doi.org/10.1186/s12913-024-10701-0
AuthorsAfferri, A., Dierickx, Susan, Allen, Haddijatou, Bittaye, Mustapha, Marena, Musa, Pacey, Allan and Balen, Julie
Abstract

Background
Infertility is a major health issue worldwide, yet very few examples of interventions addressing infertility in the Global South have been documented to date. In The Gambia, West Africa, infertility is recognised as a burden and the health authorities have included it in several health policies and the new National Reproductive Health Strategy however, a detailed operationalisation plan for fertility care has not yet been established. Here, we aim to understand and document the factors that influence the implementation of fertility care in The Gambia.

Methods
We conducted 46 semi-structured interviews with policymakers, implementers, and health practitioners in both the public and private sectors from July to November 2021. The interviews were transcribed, anonymised and analysed with NVivo Pro version 1.6.1. The analysis was initially inductive, with themes arising from the coding categorised according to the WHO health systems building blocks framework.

Results
This study identified several barriers to a successful implementation of fertility care in The Gambia, including (i) a lack of routinely collected infertility data; (ii) an absence of financial protection mechanisms for patients, and/or a specific budget for infertility; (iii) limited cooperation between the public and private sectors in the provision of fertility care; and (iv) gaps in fertility care training among health practitioners. Conversely, enablers included: (i) strong national infertility leadership; and (ii) the integration of infertility care within public reproductive health services.

Conclusion
The Gambian health system is not yet in the position to support a comprehensive fertility care package in its public health facilities. Several aspects of the implementation of fertility care must be considered in operationalising the health strategy including the systematic collection of infertility data, fertility awareness, and the provision of specialised fertility care training. Furthermore, a stronger partnership between the public and private sectors must be developed. Given the increasing availability of assisted reproductive technologies in the sub-Saharan Africa region, and the tendency to locate these technologies in the private sector, further research is needed to understand and identify the processes underlying the implementation of fertility care and to foster better integration with the existing health

KeywordsInfertility; Reproductive health; Qualitative research; The Gambia; Fertility Care; Fertility preservation
Year2024
JournalBMC Health Services Research
Journal citation24 (1), p. 282
ISSN1472-6963
Digital Object Identifier (DOI)https://doi.org/10.1186/s12913-024-10701-0
Official URLhttps://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-024-10701-0
FunderResearch England GCRF - Quality Related Sustainable Partnership Award
Publication dates
Online05 Mar 2024
Print01 Mar 2024
Publication process dates
Deposited18 Mar 2024
Publisher's version
License
File Access Level
Open
Output statusPublished
Permalink -

https://repository.canterbury.ac.uk/item/9764q/-it-s-about-time-policymakers-and-health-practitioners-perspectives-on-implementing-fertility-care-in-the-gambian-health-system

  • 28
    total views
  • 0
    total downloads
  • 1
    views this month
  • 0
    downloads this month

Export as

Related outputs

Beliefs surrounding the use of inhaled asthma medication in The Gambia: a qualitative study of asthma patients and healthcare workers.
Jayasooriya, S, Inoue, M, Allen, H, Bojang, M, Ceesay, A, Touray, S, Cooper, R, Mortimer, K and Balen, J 2024. Beliefs surrounding the use of inhaled asthma medication in The Gambia: a qualitative study of asthma patients and healthcare workers. npj: Primary Care Respiratory Medicine. 34 (1), p. 29. https://doi.org/10.1038/s41533-024-00390-x
Implementing fertility care: Insights from a participatory workshop in The Gambia
Afferri, A., Dierickx, Susan, Bittaye, Mustapha, Marena, Musa, Ceesay, Sainey M, Bittaye, Haddy, Pacey, Allan Antony and Balen, Julie 2024. Implementing fertility care: Insights from a participatory workshop in The Gambia. Reproduction and Fertility. https://doi.org/10.1530/raf-24-0029
A systematic review of public health interventions to address breast cancer inequalities in low- and middle-income countries
Chanakira, E., Thomas, Chloe V, Balen, Julie and Mandrik, Olena 2024. A systematic review of public health interventions to address breast cancer inequalities in low- and middle-income countries. Systematic Reviews. 13 (1), p. 195. https://doi.org/10.1186/s13643-024-02620-2
Policy action points and approaches to promote fertility care in The Gambia: Findings from a mixed-methods study
Afferi, A., Dierickx, S., Bittaye, M., Marena, M., Pacey, A. A. and Balen, J. 2024. Policy action points and approaches to promote fertility care in The Gambia: Findings from a mixed-methods study. PLoS ONE.
COVID-19 as a challenge to Nepal’s newly federalized health system: Capacities, responsibilities, and mindsets
Koirala, B., Rushton, Simon, Adhikary, Pratik, Balen, Julie, Basnet, Srijana, Joshi, Saugat, Karki, A., Lee, Andrew, Rijal, B., Simkhada, P., Subedi, Madhusudan, van Teijlingen, Edwin and Karki, Jiban 2024. COVID-19 as a challenge to Nepal’s newly federalized health system: Capacities, responsibilities, and mindsets. Asia Pacific Journal of Public Health. 36 (5), pp. 513-515. https://doi.org/10.1177/10105395241250123
Perception and experiences of adolescent mothers and communities in caring for their preterm babies: findings from an in-depth study in rural Bangladesh
Salam, Shumona Sharmin, Rahman, Ahmed Ehsanur, Mhajabin, Shema, Mazumder, Tapas, Majid, Tamanna, Samad Talha, Md Taqbir Us, Haider, Rajib, Chowdhury, Anika Tasneem, Islam, Sharmin, Ameen, Shafiqul, Jabeen, Sabrina, Balen, Julie, Arifeen, Shams El, Nahar, Quamrun and Anumba, D. 2024. Perception and experiences of adolescent mothers and communities in caring for their preterm babies: findings from an in-depth study in rural Bangladesh. BMC Pregnancy and Childbirth. 24 (1), p. 145. https://doi.org/10.1186/s12884-024-06345-x
Participatory policy analysis in health policy and systems research: reflections from a study in Nepal.
Sapkota, S., Rushton, S., van Teijilingen, E., Subedi, M., Balen, J., Gautam, S., Adhikary, P., Simkhada, P., Wasti, S. P., Karki, J. K., Panday, S., Karki, A., Rijal, B., Joshi, S., Basnet, S. and Marahatta, S. B. 2024. Participatory policy analysis in health policy and systems research: reflections from a study in Nepal. Health Research Policy and Systems. 22 (7), pp. 1-15. https://doi.org/10.1186/s12961-023-01092-5
Selection of study sites and participants for research into Nepal’s federal health system
Wasti, Sharada Prasad, van Teijlingen, Edwin, Simkhada, Padam, Rushton, Simon, Balen, Julie, Subedi, Madhusudan, Karki, Jiban, Adhikary, Pratik, Sapkota, Sujata, Gautam, Sujan, Marahatta, Sujan, Panday, Sarita, Bajracharya, Bikesh and Vaidya, Anju 2024. Selection of study sites and participants for research into Nepal’s federal health system. WHO South-East Asia Journal of Public Health. 12 (2), pp. 116-119. https://doi.org/10.4103/who-seajph.who-seajph_169_22
The impact of decentralisation on health systems: a systematic review of reviews
Sapkota, S., Dhakal, Amshu, Rushton, S., van Teijlingen, E., Marahatta, S., Balen, J., Lee, A. and Nepal Federal Health System Team 2023. The impact of decentralisation on health systems: a systematic review of reviews. BMJ Global Health. 8 (12), p. e013317. https://doi.org/10.1136/bmjgh-2023-013317
Overcoming the challenges facing Nepal's health system during federalisation: an analysis of health system building blocks.
Wasti, S., van Teijlingen, E., Rushton, S., Subedi, M., Simkhada, P., Balen, J. and Nepal Federal Health System Team 2023. Overcoming the challenges facing Nepal's health system during federalisation: an analysis of health system building blocks. Health Research Policy and Systems. 21 (1), p. 117. https://doi.org/10.1186/s12961-023-01033-2
Research prioritisation on prevention and management of preterm birth in low and middle-income countries (LMICs) with a special focus on Bangladesh using the Child Health and Nutrition Research Initiative (CHNRI) method
Salam, Shumona Sharmin, Ameen, Shafiqul, Balen, Julie, Nahar, Quamrun, Jabeen, Sabrina, Ahmed, Anisuddin, Gillespie, Bronwen, Chauke, Lawrence, Mannan, Abdul, Hoque, Mahbubul, Dey, Sanjoy Kumer, Islam, Jahurul, Ashrafee, Sabina, Alam, Husam Md Shah, Saberin, Ashfia, Saha, Palash Kumar, Sarkar, Supriya, Alim, Azizul, Islam, Muhammad Shariful, Gray, Clive, El Arifeen, Shams, Rahman, Ahmed Ehsanur and Anumba, Dilly OC 2023. Research prioritisation on prevention and management of preterm birth in low and middle-income countries (LMICs) with a special focus on Bangladesh using the Child Health and Nutrition Research Initiative (CHNRI) method. Journal of Global Health. 13, p. 07004. https://doi.org/10.7189/jogh.13.07004