PDF(Pubmed)
Abstract：
MOMENTUM Safe Surgery in Family Planning and Obstetrics is a global project that strengthens surgical ecosystems through partnership with country institutions. In Nigeria, the project implements in Bauchi, Ebonyi, Kebbi and Sokoto states and the Federal Capital Territory, focusing on surgical obstetrics, holistic fistula care and female genital mutilation/cutting prevention and care. The project utilized participatory approaches during its design, planning and early implementation phases. During the design phase, the project employed a co-creation process featuring a desk review, key informant interviews and stakeholder workshops at community, facility, and government levels to actively listen to, identify and incorporate local perspectives on surgical ecosystem gaps and priorities. Initial findings, shared at state- and national-level workshops, helped collectively identify and prioritize context-specific interventions. The resulting co-created workplan features interventions to strengthen surgical services based on the National Surgical, Obstetrics, Anaesthesia and Nursing Plan (NSOANP). Upon workplan approval, the planning phase involved meeting with each State Ministry of Health (MOH) to prioritize workplan interventions for implementation and to define the finer details needed to drive early implementation processes. Preliminary achievements during early implementation include state commitments to include a costed facility NSOANP in 2023 annual operational plans, mitigation of health facility staffing shortages and review of national fistula and surgical Health Management Information System indicator data flow and advocacy to the Federal MOH resulting in improved fistula data quality and availability. Well-established state and national systems, structures, policies and guidelines enable this programming approach. Since communication between institutional actors is often limited, these approaches necessitate building and maintaining relationships and knowledge-sharing, which requires a significant up-front time investment that must be balanced with donor/partner desires for rapid deliverables. Linking different actors within the health system together through co-creation/co-implementation represents a crucial step in building sustainable country ownership and oversight for surgical ecosystems strengthening interventions.
摘要：
计划生育和产科MOMENTUM安全手术是一个全球项目，通过与国家机构的伙伴关系加强手术生态系统。在尼日利亚,该项目在包奇实施，Ebonyi,Kebbi和Sokoto州以及联邦首都地区，专注于外科产科，整体瘘管病护理和女性生殖器切割/切割预防和护理。该项目在设计过程中采用了参与式方法，规划和早期实施阶段。在设计阶段,该项目采用了一个共同创作过程，包括案头审查，社区的关键线人访谈和利益相关者研讨会，设施,和各级政府积极倾听，确定并纳入当地对外科生态系统差距和优先事项的观点。初步发现,在州和国家一级的研讨会上分享，帮助集体确定和优先考虑特定环境的干预措施。由此产生的共同创建的工作计划的干预措施，以加强基于国家外科，产科,麻醉和护理计划（NSOANP）。工作计划批准后，规划阶段涉及与每个国家卫生部(MOH)举行会议，优先考虑实施工作计划干预措施，并确定推动早期实施过程所需的更精细细节。早期实施期间的初步成就包括国家承诺在2023年年度运营计划中纳入成本估算的设施NSOANP，缓解卫生机构人员短缺，审查国家瘘管病和外科健康管理信息系统指标数据流，并向联邦卫生部进行宣传，从而提高瘘管病数据的质量和可用性。完善的国家和国家制度，结构,政策和指导方针使这种编程方法成为可能。由于机构行为者之间的沟通往往有限，这些方法需要建立和维护关系和知识共享，这需要大量的前期投资，必须与捐助者/合作伙伴对快速交付成果的渴望相平衡。通过共同创造/共同实施将卫生系统内的不同行为者联系在一起，是建立可持续的国家所有权和监督外科生态系统加强干预措施的关键步骤。
