背景:孕产妇和围产期健康是人类发展的基础。然而,在资源匮乏的地区,如撒哈拉以南非洲(SSA),在减少孕产妇方面仍然存在重大挑战,新生,和儿童死亡率。为了实现可持续发展目标3(SDG3)和全民健康覆盖(UHC)的目标,改善获得持续的孕产妇和围产期保健服务(CMPHS)已被视为一项关键战略。
目的:本研究旨在提供一种广泛适用的程序,以阐明当前在确保育龄妇女获得CMPHS方面的挑战。调查结果旨在为在低资源环境中确定资源分配优先次序和制定政策提供有针对性的建议。
方法:根据世界卫生组织指南和现有文献,并考虑到莫桑比克向育龄妇女提供CMPHS的当地情况,我们首先提出将CMPHS标识为3个独立服务包的连续体,即产前保健(ANC),机构交付(ID),产后护理(PNC)。然后,我们使用最近邻方法(NNM)来评估对3个服务包中每个服务包的空间访问。最后,我们进行了重叠分析,以确定8种资源短缺区。
结果:育龄妇女获得ANC的最短旅行时间中位数,ID,PNC为2.38(IQR1.38-3.89)小时,3.69(IQR1.87-5.82)小时,和4.16(IQR2.48-6.67)小时,分别。育龄妇女进入ANC的空间障碍,ID,和PNC显示出区域之间和区域内的巨大差异。马普托市的旅行时间最短,区域内的公平性最好(0.46,IQR0.26-0.69小时;0.74,IQR0.47-1.04小时;1.34,IQR0.83-1.85小时,分别),而尼亚萨省(4.07,IQR2.41-6.63小时;18.20,IQR11.67-24.65小时;和7.69,IQR4.74-13.05小时,分别)和伊尼扬巴内(2.69,IQR1.49-3.91小时;4.43,IQR2.37-7.16小时;和10.76,IQR7.73-13.66小时,分别)在这两个方面都明显落后。总的来说,超过51%的育龄妇女,居住在莫桑比克83.25%的土地面积,无法及时(在2小时内)访问CMPHS的任何服务包,虽然只有大约21%,生活在莫桑比克2.69%的土地面积,包括马普托,可以及时访问CMPHS。
结论:莫桑比克CMPHS的空间可达性和公平性在实现SDG3和UHC方面提出了重大挑战,尤其是在伊尼扬巴内和尼亚萨地区。对于伊尼扬巴内来说,政策制定者应优先执行权力下放分配战略,以通过升级现有医疗保健设施来增加覆盖面和公平性。对于尼亚萨来说,应优先培养训练有素的助产士,他们可以在家中提供挨家挨户的ANC和PNC,强调加强社区的参与。拟议的两步程序应在其他低资源环境中实施,以促进实现SDG3。
BACKGROUND: Maternal and perinatal health are fundamental to human development. However, in low-resource settings such as sub-Saharan Africa (SSA), significant challenges persist in reducing maternal, newborn, and child mortality. To achieve the targets of the sustainable development goal 3 (SDG3) and universal health coverage (UHC), improving access to continuous maternal and perinatal health care services (CMPHS) has been addressed as a critical strategy.
OBJECTIVE: This study aims to provide a widely applicable procedure to illuminate the current challenges in ensuring access to CMPHS for women of reproductive age. The findings are intended to inform targeted recommendations for prioritizing resource allocation and policy making in low-resource settings.
METHODS: In accordance with the World Health Organization guidelines and existing literature, and taking into account the local context of CMPHS delivery to women of reproductive age in Mozambique, we first proposed the identification of CMPHS as the continuum of 3 independent service packages, namely antenatal care (ANC), institutional delivery (ID), and postnatal care (PNC). Then, we used the nearest-neighbor method (NNM) to assess spatial access to each of the 3 service packages. Lastly, we carried out an overlap analysis to identify 8 types of resource-shortage zones.
RESULTS: The median shortest travel times for women of reproductive age to access ANC, ID, and PNC were 2.38 (IQR 1.38-3.89) hours, 3.69 (IQR 1.87-5.82) hours, and 4.16 (IQR 2.48-6.67) hours, respectively. Spatial barriers for women of reproductive age accessing ANC, ID, and PNC demonstrated large variations both among and within regions. Maputo City showed the shortest travel time and the best equity within the regions (0.46, IQR 0.26-0.69 hours; 0.74, IQR 0.47-1.04 hours; and 1.34, IQR 0.83-1.85 hours, respectively), while the provinces of Niassa (4.07, IQR 2.41-6.63 hours; 18.20, IQR 11.67-24.65 hours; and 7.69, IQR 4.74-13.05 hours, respectively) and Inhambane (2.69, IQR 1.49-3.91 hours; 4.43, IQR 2.37-7.16 hours; and 10.76, IQR 7.73-13.66 hours, respectively) lagged behind significantly in both aspects. In general, more than 51% of the women of reproductive age, residing in 83.25% of Mozambique\'s land area, were unable to access any service package of CMPHS in time (within 2 hours), while only about 21%, living in 2.69% of Mozambique\'s land area, including Maputo, could access timely CMPHS.
CONCLUSIONS: The spatial accessibility and equity of CMPHS in Mozambique present significant challenges in achieving SDG3 and UHC, especially in the Inhambane and Niassa regions. For Inhambane, policy makers should prioritize the implementation of a decentralization allocation strategy to increase coverage and equity through upgrading existing health care facilities. For Niassa, the cultivation of well-trained midwives who can provide door-to-door ANC and PNC at home should be prioritized, with an emphasis on strengthening communities\' engagement. The proposed 2-step procedure should be implemented in other low-resource settings to promote the achievement of SDG3.