An Interdisciplinary Paradigm of Mother-Child Health Needs
An Interdisciplinary Paradigm of Mother-Child Health Needs
Azher Hameed Qamar (www.drazher.com)
Health coverage is an important issue that public and private healthcare organization face while struggling to provide quality healthcare services to the targeted population. An effective coverage is defined as “the proportion of a population in need of a service that had a positive health outcome from the service” (Marsh et al., 2020: e732). Standardized cascade for measuring effective coverage as proposed by Effective Coverage Think Tank Group has seven steps beginning from the identification of the target population and finally reaching outcome-adjusted coverage. Outcome-adjusted coverage is the proportion of population that receives the quality care adhering to providers instructions. It is clearly indicated that proportion of population in need of health service will significantly decline reaching the final stage.
As mother-child health is one of the primary focus of the effective coverage, my interest in this article is related to address people’s adherence to health services in connection with their cultural context that is an interdisciplinary construct. Marsh et al. (2020) examined the sequence of patient and health system interaction in the ‘proposed standardized cascade for measuring effective coverage’ and provided a useful insight into health service coverage. It was an interesting article and I was able to recall my ethnographic experience investigating infant care belief practices in rural Punjab a few years ago. My findings were interesting as I explored the nexus between healthcare beliefs and health-seeking behavior that determines the specific health needs in the folk health care system.
Medical care (modern childcare practices) represents a highly technocratic model of physical well-being. The concept of the ‘technocratic model’ was first used by Davis-Floyd (1992) in the context of childbirth. In reproductive physiology, Obstetrics, and Pediatrics, the reality of the human body is a technocratic construct and human is an object. A young child (an infant) is a physically immature human-becoming and an absolute dependent human body. An expert-centered physiological exploration determines the planning and implementation of a quality healthcare system for young children. A universal conceptualization of the human body institutionalized by physicians and medical professionals drives the ‘globalization’ of developmental goals to ensure healthy lives across the globe. In this context a ‘numerical definition’ of the child determines the developmental status and needs of the child following the numerical age of the child. It is evident that the ‘quality health system’ is apprised as a universal paradigm to measure the progress of coverage and intervention plans and policies.
Based on my assumptions (stated above) about the technocratic model of healthcare services, I want to emphasize on step 6 of the proposed standardized cascade for measuring effective coverage, that is adherence-adjusted coverage. There are two main aspects of adherence-adjusted coverage. The first health care service should be according to the quality-of-care standards (as prescribed in WHO guidelines). Second adherence of the population (in need) to the service provider’s instruction. Quality-of-care standards emphasized on (WHO, 2016);
- Women’s positive experience of pregnancy, birth and postpartum motherhood based on women’s values in their context
- Including community participation and women voices in the planning, implementation, and monitoring of the healthcare system
In line with these recommendations for quality-of-care standards, the adherence to provider’s instruction requires a contextualized body of instructions that should reflect a shared understanding of the human body and health needs. Here, we move ahead of technocratic perspective on the human body and emphasize the socio-cultural perspective that sees human world realities as socially constructed and mother-child health as an interdisciplinary paradigm comprised of medical, psychological, and socio-cultural components of health needs (figure below).
In this perspective, the quality-of-care standard as well as the provider’s instruction should be grounded in the social and cultural context. The cultural competency of the providers will enhance the adherence of the target population. This is the concern that Marsh et al. (2020) pointed out as ‘less-tangible components of quality of care’. I endorse Marsh et al. mentioning the gaps between the target population and the population who contact for their health needs. This is a major issue that must be investigated through a qualitative exploration of the underlying reasons. The socio-cultural context is multi-layered, and each layer is a layer of interconnected meanings. Addressing this gap can help to increase a culturally supported adherence.
Despite the universality of physiological aspects of mother and child health, pregnancy, birth and postpartum experiences are not universal and involve a wide range of emotional, spiritual, and social aspects. Human health is more than a ‘medical art’ (Farber, 2011) and human health-seeking behavior is closely connected with their health needs and healthcare awareness. I see medical, psychological, and socio-cultural aspects of our health-related awareness as received, perceived, and internalized awareness respectively. An in-depth understanding of health-seeking behavior of the target population can be utilized to reduce the gaps between each step of the standardized cascade discussed in the article by Marsh et al. With my ethnographic research experience, I assume that a need-based survey may not help in improving the healthcare system, effective coverage, and expected positive outcome; unless health needs are not contextualized with evidence-based analysis of human health-seeking behavior in specific socio-cultural context. Methodological flexibility in data collection is important in this regard.
Davis-Floyd, R. E. (1992). Birth as an American Rite of Passage. Austin: University of Texas Press.
Farber, M. E. (2011). The technocratic birthing model as seen in reality television and its impact on young women age 18–24.
Marsh, A. D., Muzigaba, M., Diaz, T., Requejo, J., Jackson, D., Chou, D., … & Banerjee, A. 2020. Effective coverage measurement in maternal, newborn, child, and adolescent health and nutrition: progress, future prospects, and implications for quality health systems. The Lancet Global Health, 8(5), e730-e736.
WHO. 2016. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: World Health Organization.