Accelerating reproductive and child health programme impact with community-based services: the Navrongo experiment in Ghana
Accelerating reproductive and child health programme impact with community-based services: the Navrongo experiment in Ghana
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DOI：
10.2471/blt.06.030064
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发表时间：
2006-12-01
期刊：
影响因子：
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通讯作者：
Binka, Fred N
中科院分区：
文献类型：
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作者：
Phillips, James F;Bawah, Ayaga A;Binka, Fred N
目的了解卫生服务护士和志愿者到农村地区的人口学和健康影响，以期扩大效果。一个四细胞的可行性试验被用来测试调整社区卫生服务与传统的社会机构，组织村庄生活的影响，从纳夫龙戈人口监测系统的数据，跟踪生育率和死亡率的事件随着时间的推移被用来估计对生育率和死亡率的影响。在研究地区，社区护理人员在三年内将儿童死亡率降低了一半以上，并将实现儿童生存千年发展目标的时间缩短到8年。生育率也下降了15%，即总生育率下降了一个孩子。方案费用使人均初级保健费用增加了1.92美元，人均初级保健费用为6.80美元。将护士派遣到社区提供基本的治疗和预防护理，大大降低了儿童死亡率，加快了实现儿童生存千年发展目标的进展。然而，使用社区志愿者的方法对死亡率没有影响。研究结果还表明，仅仅增加避孕用品的供应无法解决生育率调节的社会成本。有效部署志愿人员和社区动员战略可以抵消社会对采取避孕措施的限制。因此，在Navrongo进行的研究表明，以负担得起和可持续的方式将护士服务与志愿行动结合起来，可以加快实现国际人口与发展会议议程和千年发展目标。
Objective To determine the demographic and health impact of deploying health service nurses and volunteers to village locations with a view to scaling up results.Methods. A four-celled plausibility trial was used for testing the impact of aligning community health services with the traditional social institutions that organize village life, Data from the Navrongo Demographic Surveillance System that tracks fertility and mortality events over time were used to estimate impact on fertility and mortality.Results. Assigning nurses to community locations reduced childhood mortality rates by over half in 3 years and accelerated the time taken for attainment of the child survival Millennium Development Goal (MDG) in the study areas to 8 years. Fertility was also reduced by 15%, representing a decline of one birth in the total fertility rate. Programme costs added US$ 1.92 per capita to the US$ 6.80 per capita primary health care budget.Conclusion. Assigning nurses to community locations where they provide basic curative and preventive care substantially reduces childhood mortality and accelerates progress towards attainment of the child survival MDG. Approaches using community volunteers, however, have no impact on mortality. The results also demonstrate that increasing access to contraceptive supplies alone fails to address the social costs of fertility regulation. Effective deployment of volunteers and community mobilization strategies offsets the social constraints on the adoption of contraception. The research in Navrongo thus demonstrates that affordable and sustainable means of combining nurse services with volunteer action can accelerate attainment of both the International Conference on Population and Development agenda and the MDGs.