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Improving healthcare services in the developing world remains a major goal for many organizations and despite enormous training and program investments from international organizations, service improvements have been modest. This study looks at how to improve results by examining the relationship between the conditions in a healthcare providers' work environment and his or her performance. Drawing upon a human performance model that assumes that "performance expectations, timely feedback, adequate environment, incentives, and skills and knowledge" are required for a worker to perform well, this study explores how these conditions might affect healthcare provider performance in four countries. The study successfully shows that although multiple conditions were deficient or missing in every country, significant association is found between the performance of workers and conditions in the workers environment. Further, when viewed across all countries, "non-monetary incentives" is the most powerful "predictor" of performance when compared with other factors. Of particular interest to Performance Improvement practitioners, "knowledge and skills" surfaced as important in only three of eight possible cases (with multiple cases in each country)--the least influential factor overall. (Contains 9 tables and 1 figure.)

Abstract Background Over the last five years, international development organizations began to modify and adapt the conventional Performance Improvement Model for use in low-resource settings. This model outlines the five key factors believed to influence performance outcomes: job expectations, performance feedback, environment and tools, motivation and incentives, and knowledge and skills. Each of these factors should be supplied by the organization in which the provider works, and thus, organizational support is considered as an overarching element for analysis. Little research, domestically or internationally, has been conducted on the actual effects of each of the factors on performance outcomes and most PI practitioners assume that all the factors are needed in order for performance to improve. This study presents a unique exploration of how the factors, individually as well as in combination, affect the performance of primary reproductive health providers (nurse-midwives) in two regions of Armenia. Methods Two hundred and eighty-five nurses and midwives were observed conducting real or simulated antenatal and postpartum/neonatal care services and interviewed about the presence or absence of the performance factors within their work environment. Results were analyzed to compare average performance with the existence or absence of the factors; then, multiple regression analysis was conducted with the merged datasets to obtain the best models of "predictors" of performance within each clinical service. Results Baseline results revealed that performance was sub-standard in several areas and several performance factors were deficient or nonexistent. The multivariate analysis showed that (a) training in the use of the clinic tools; and (b) receiving recognition from the employer or the client/community, are factors strongly associated with performance, followed by (c) receiving performance feedback in postpartum care. Other – extraneous – variables such as the facility type (antenatal care) and whether observation was on simulated vs. real patients (postpartum care) also had a role in observed performance. Conclusion This study concludes that the antenatal and postpartum care performance of health providers in Armenia is strongly associated with having the practical knowledge and skills to use everyday tools of the trade and with receiving recognition for their work, as well as having performance feedback. The paper recognized several limitations and expects further studies will illuminate this important topic further.

A continuous rise in the rate of cesarean deliveries has been reported in many countries over recent decades. This trend has prompted the emergence of a debate on the risks and benefits associated with cesarean section. The present study was designed to estimate cesarean section rates over time during the period between 2000 and 2010 in Peru and to present outcomes for each mode of delivery. This is a secondary analysis of a large database obtained from the Perinatal Information System, which includes 570,997 pregnant women and their babies from 43 Peruvian public health facilities in three geographical regions: coast, highlands, and jungle. Over 10 years, 558,901 women delivered 563,668 infants weighing at least 500 g. The cesarean section rate increased from 25.5% in 2000 to 29.9% in 2010 (26.9% average; P < 0.01). The rate of stillbirths was lower with cesarean than vaginal deliveries (P < 0.01). On the other hand, and as expected, the rates for preterm births, twin pregnancies, and preeclampsia were higher in women who delivered by cesarean section (P < 0.01). More importantly, the rate of maternal mortality was 5.5 times higher in the cesarean section group than in the vaginal delivery group. Data suggest that cesarean sections are associated with adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

The article focuses on the study that investigates ways on how to improve results in examining the relationship between the work environment and performance of healthcare providers in Armenia, Bangladesh, Bolivia, and Nigeria. It assumes that performance expectations, timely feedback, adequate environment, incentives, and skills and knowledge are necessary for an efficient performance of a worker. It reveals that there is a substantial connection between the performance of workers and the conditions in the work environment, even though many of the conditions were insufficient in every country. Furthermore, non-monetary incentives is the most influential factors among all the factors observed in the performance.