背景:在2000-2017年期间,尼泊尔的孕产妇死亡率从每10万活产553例下降到186例(下降66%)。在2000年至2018年期间,新生儿死亡率从每1000名活产儿40人降至21人(下降48%)。在2000年至2019年期间,每1000名新生儿死胎从28名下降到18名(下降34%)。经经济增长调整后,尼泊尔在这些死亡率改善方面优于其他国家,让尼泊尔成为“成功”。我们的研究描述了促成这些成就的机制。
方法:使用混合方法案例研究来确定死亡率下降的驱动因素。使用的方法包括文献综述,关键线人采访,焦点小组讨论,数据集的二次分析,和验证研讨会。
结果:尽管面临地理挑战和政治不稳定时期,在2000年至2019年期间,尼泊尔大幅提高了在医疗机构中提供熟练接生服务的妇女比例。尽管挑战依然存在,还有证据表明,产前护理和分娩服务的质量和获得公平.研究发现,政策制定和实施过程是适应性的,证据知情,利用数据和研究,并涉及政府内外的参与者。一贯注重减少不平等。
结论:尼泊尔在2000年至2020年期间实施的改善孕产妇和新生儿健康结果的政策和方案并非独一无二。在本文中,我们认为,尼泊尔能够在死亡率过渡框架中迅速从第二阶段过渡到第三阶段,不是因为他们所做的,而是他们是怎么做到的.尽管取得了成就,尼泊尔在确保所有妇女和新生儿平等获得优质护理方面仍然面临许多挑战。
BACKGROUND: Maternal mortality in Nepal dropped from 553 to 186 per 100 000 live births during 2000-2017 (66% decline). Neonatal mortality dropped from 40 to 21 per 1000 live births during 2000-2018 (48% decline). Stillbirths dropped from 28 to 18 per 1000 births during 2000-2019 (34% decline). Nepal outperformed other countries in these mortality improvements when adjusted for economic growth, making Nepal a \'success\'. Our study describes mechanisms which contributed to these achievements.
METHODS: A mixed-method case study was used to identify drivers of mortality decline. Methods used included a literature review, key-informant interviews, focus-group discussions, secondary analysis of datasets, and validation workshops.
RESULTS: Despite geographical challenges and periods of political instability, Nepal massively increased the percentage of women delivering in health facilities with skilled birth attendance between 2000 and 2019. Although challenges remain, there was also evidence in improved quality and equity-of-access to antenatal care and childbirth services. The study found policymaking and implementation processes were adaptive, evidence-informed, made use of data and research, and involved participants inside and outside government. There was a consistent focus on reducing inequalities.
CONCLUSIONS: Policies and programmes Nepal implemented between 2000 and 2020 to improve maternal and newborn health outcomes were not unique. In this paper, we argue that Nepal was able to move rapidly from stage 2 to stage 3 in the mortality transition framework not because of what they did, but how they did it. Despite its achievements, Nepal still faces many challenges in ensuring equal access to quality-care for all women and newborns.