PDF(Pubmed)
Abstract：
UNASSIGNED: The coronavirus disease 2019 (COVID-19) pandemic led to disruptions of health service delivery in many countries; some were more resilient in either limiting or rapidly responding to the disruption than others. We used mixed methods implementation research to understand factors and strategies associated with resiliency in Rwanda and Bangladesh, focussing on how evidence-based interventions targeting amenable under-five mortality that had been used during the Millennium Development Goal (MDG) period (2000-15) were maintained during the early period of COVID-19.
UNASSIGNED: We triangulated data from three sources - a desk review of available documents, existing quantitative data on evidence-based intervention coverage, and key informant interviews - to perform a comparative analysis using multiple case studies methodology, comparing contextual factors (barriers or facilitators), implementation strategies (existing from 2000-15, new, or adapted), and implementation outcomes across the two countries. We also analysed which health system resiliency capabilities were present in the two countries.
UNASSIGNED: Both countries experienced many of the same facilitators for resiliency of evidence-based interventions for children under five, as well as new, pandemic-specific barriers during the early COVID-19 period (March to December 2020) that required targeted implementation strategies in response. Common facilitators included leadership and governance and a culture of accountability, while common barriers included movement restrictions, workload, and staff shortages. We saw a continuity of implementation strategies that had been associated with success in care delivery during the MDG period, including data use for monitoring and decision-making, as well as building on community health worker programmes for community-based health care delivery. New or adapted strategies used in responding to new barriers included the expanded use of digital platforms. We found implementation outcomes and strong resilience capabilities, including awareness and adaptiveness, which were related to pre-existing facilitators and implementation strategies (continued and new).
UNASSIGNED: The strategies and contextual factors Rwanda and Bangladesh leveraged to build \'everyday resilience\' before COVID-19, i.e. during the MDG period, likely supported the maintained delivery of the evidence-based interventions targeting under-five mortality during the early stages of the pandemic. Expanding our understanding of pre-existing factors and strategies that contributed to resilience before and during the pandemic is important to support other countries\' efforts to incorporate \'everyday resilience\' into their health systems.
UNASSIGNED: We triangulated data from three sources - a desk review of available documents, existing quantitative data on evidence-based intervention coverage, and key informant interviews - to perform a comparative analysis using multiple case studies methodology, comparing contextual factors (barriers or facilitators), implementation strategies (existing from 2000-15, new, or adapted), and implementation outcomes across the two countries. We also analysed which health system resiliency capabilities were present in the two countries.
UNASSIGNED: Both countries experienced many of the same facilitators for resiliency of evidence-based interventions for children under five, as well as new, pandemic-specific barriers during the early COVID-19 period (March to December 2020) that required targeted implementation strategies in response. Common facilitators included leadership and governance and a culture of accountability, while common barriers included movement restrictions, workload, and staff shortages. We saw a continuity of implementation strategies that had been associated with success in care delivery during the MDG period, including data use for monitoring and decision-making, as well as building on community health worker programmes for community-based health care delivery. New or adapted strategies used in responding to new barriers included the expanded use of digital platforms. We found implementation outcomes and strong resilience capabilities, including awareness and adaptiveness, which were related to pre-existing facilitators and implementation strategies (continued and new).
UNASSIGNED: The strategies and contextual factors Rwanda and Bangladesh leveraged to build \'everyday resilience\' before COVID-19, i.e. during the MDG period, likely supported the maintained delivery of the evidence-based interventions targeting under-five mortality during the early stages of the pandemic. Expanding our understanding of pre-existing factors and strategies that contributed to resilience before and during the pandemic is important to support other countries\' efforts to incorporate \'everyday resilience\' into their health systems.
摘要：
■2019年冠状病毒病（COVID-19）大流行导致许多国家的医疗服务中断；一些国家在限制或迅速应对中断方面比其他国家更具弹性。我们使用混合方法实施研究来了解卢旺达和孟加拉国与弹性相关的因素和策略，重点关注在COVID-19早期期间如何维持在千年发展目标（MDG）期间（2000-15）使用的针对5岁以下儿童死亡率的循证干预措施。
■我们对三个来源的数据进行了三角测量——对现有文件的案头审查，关于循证干预覆盖率的现有定量数据，和关键线人访谈-使用多个案例研究方法进行比较分析，比较环境因素(障碍或促进者)，实施战略(现有的2000-15年，新的，或适应)，以及两国的实施成果。我们还分析了这两个国家存在哪些卫生系统弹性能力。
■这两个国家都经历了许多同样的促进因素，为五岁以下儿童提供基于证据的干预措施。以及新的，在COVID-19早期（2020年3月至12月）期间，大流行特有的障碍需要有针对性的实施策略来应对。共同促进者包括领导和治理以及问责文化，虽然常见的障碍包括行动限制，工作量,人员短缺。在千年发展目标期间，我们看到了与成功提供护理相关的实施战略的连续性，包括用于监测和决策的数据，以及建立社区卫生工作者计划，以社区为基础的医疗保健服务。用于应对新障碍的新的或经过调整的策略包括扩大数字平台的使用。我们发现了实施成果和强大的复原能力，包括意识和适应性，与先前存在的促进者和实施战略有关（续和新的）。
卢旺达和孟加拉国在COVID-19之前，即在千年发展目标期间，利用战略和环境因素建立“日常韧性”，可能支持在大流行的早期阶段持续实施针对5岁以下儿童死亡率的循证干预措施.扩大我们对在大流行之前和期间有助于恢复力的预先存在的因素和策略的理解，对于支持其他国家将“日常恢复力”纳入其卫生系统的努力非常重要。
■我们对三个来源的数据进行了三角测量——对现有文件的案头审查，关于循证干预覆盖率的现有定量数据，和关键线人访谈-使用多个案例研究方法进行比较分析，比较环境因素(障碍或促进者)，实施战略(现有的2000-15年，新的，或适应)，以及两国的实施成果。我们还分析了这两个国家存在哪些卫生系统弹性能力。
■这两个国家都经历了许多同样的促进因素，为五岁以下儿童提供基于证据的干预措施。以及新的，在COVID-19早期（2020年3月至12月）期间，大流行特有的障碍需要有针对性的实施策略来应对。共同促进者包括领导和治理以及问责文化，虽然常见的障碍包括行动限制，工作量,人员短缺。在千年发展目标期间，我们看到了与成功提供护理相关的实施战略的连续性，包括用于监测和决策的数据，以及建立社区卫生工作者计划，以社区为基础的医疗保健服务。用于应对新障碍的新的或经过调整的策略包括扩大数字平台的使用。我们发现了实施成果和强大的复原能力，包括意识和适应性，与先前存在的促进者和实施战略有关（续和新的）。
卢旺达和孟加拉国在COVID-19之前，即在千年发展目标期间，利用战略和环境因素建立“日常韧性”，可能支持在大流行的早期阶段持续实施针对5岁以下儿童死亡率的循证干预措施.扩大我们对在大流行之前和期间有助于恢复力的预先存在的因素和策略的理解，对于支持其他国家将“日常恢复力”纳入其卫生系统的努力非常重要。
