Implementation of WHO/PAHO Maternal Health Guidelines in the Dominican Republic

Abstract

Objective: To analyze the implementation of strong recommendations contained in the WHO and PAHO guidelines on maternal health in the Dominican Republic. Methods: A search was conducted for maternal health recommendations on the WHO's BIGG-REC platform. A total of 249 recommendations were identified: 215 strong recommendations in favor and 34 strong recommendations against, contained in 76 WHO guidelines formulated using the GRADE methodology from 2010 to 2022. These recommendations were classified into 6 domains: abortion, nutrition, hemorrhage, hypertension, infection, contraception, and public health. The characteristics and determinants that facilitate or hinder the implementation of these recommendations by the Dominican health system were analyzed. Results: 29 strong recommendations in favor were included, corresponding to the 6 domains. The recommendations with the highest level of implementation were those related to the management of obstetric hemorrhage and infection prevention. Recommendations related to abortion and public health programs had the lowest level of implementation. The main determinants for non-implementation are limitations in the legal or regulatory framework, disorganization of the service network, and social and cultural barriers. Discussion: Limitations persist in the Dominican Republic regarding the implementation of strong recommendations in maternal health from WHO guidelines. The results highlight the need to strengthen strategies for implementing recommendations in the areas of abortion care and public health interventions.