目的:本研究的目的是评估怒江州通过多层次政府合作加强妇幼保健(MCH)系统的效果。中国。
方法:采用案例研究设计。
方法:以怒江妇幼保健综合干预项目的逻辑框架为指导,国家,省,和州政府部门共同在怒江州实施了全面的卫生系统加强(HSS)干预措施。在这个案例研究中,我们对33家当地妇幼保健机构进行了终点调查(2015年11月和2016年1月).我们还采访了35家MCH提供者,政府官员,妇幼保健设施的领导人,和项目专家。采用专题框架法对访谈数据进行分析,并对调查数据进行描述性分析。
结果:三个层次的政府合作有助于增加政府对当地妇幼保健系统的投资,并确保了项目的成功实施。参与式培训方法和适合当地情况的适当HSS干预措施对于提高妇幼保健提供者的知识和技能至关重要。合格的妇幼保健提供者的比例从2011年的70%增加到2015年的96%。由于知识的增加和所需设备的增加,更多的妇幼保健医院可以提供住院产科服务,更多的城镇诊所有能力提供基本的妇幼保健服务。制定适合当地情况的报销政策促进了医院内分娩。在项目结束时,产前保健的百分比,住院分娩,新生儿筛查增加了20.71%,18.12%,和278.62%,分别。三岁以下儿童的生长监测覆盖率稳定在90%左右。然而,妇幼保健系统受到劳动力短缺的负面影响。这些短缺是由于缺乏积极的招聘和保留以及激励政策造成的。
结论:通过多层次政府合作实施全面的HSS干预措施,可以改善偏远和低收入地区的MCH系统。
OBJECTIVE: The aim of the study was to assess the effects of the maternal and child health (MCH) system strengthening through multilevel governmental collaboration in Nujiang Prefecture, China.
METHODS: A
case study design was applied.
METHODS: Guided by the logical framework of the Nujiang MCH Comprehensive Intervention Project, national, provincial, and prefecture government sectors jointly implemented comprehensive health system strengthening (HSS) interventions in Nujiang Prefecture. In this
case study, we conducted the end point surveys (November 2015 and January 2016) with 33 local MCH facilities. We also interviewed 35 MCH providers, government officials, leaders of MCH facilities, and project specialists. The thematic framework method was used to analyze the interview data, and descriptive analysis was performed to analyze the survey data.
RESULTS: The three levels of governmental collaboration contributed to increased government investment in the local MCH system and ensured the successful implementation of the project. Participatory training methods and appropriate HSS interventions tailored to the local context were crucial to improve MCH providers\' knowledge and skills, with the proportion of qualified MCH providers increasing from 70% in 2011 to 96% in 2015. Owing to this increase in knowledge and the increase in needed equipment, more MCH hospitals could provide inpatient obstetric services, and more town health clinics were capable of providing basic MCH services. The development of a reimbursement policy tailored to the local context promoted in-hospital delivery. At the conclusion of the project, percentages of antenatal care, in-hospital delivery, and newborn screening increased by 20.71%, 18.12%, and 278.62%, respectively. Growth monitoring coverage for children younger than three years remained stable at around 90%. However, the MCH system was negatively impacted by the workforce shortage. Those shortages were caused by a lack of positive recruitment and retention and incentive policies.
CONCLUSIONS: Implementation of comprehensive HSS interventions through multilevel governmental collaboration improves the MCH system in remote and low-income areas.