Salud Mesoamerica 2015 Initiative: design, implementation, and baseline findings
Salud Mesoamerica 2015 Initiative: design, implementation, and baseline findings
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DOI：
10.1186/s12963-015-0034-4
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发表时间：
2015-02-07
影响因子：
3.3
通讯作者：
Regalia, Ferdinando
中科院分区：
文献类型：
--
作者：
Mokdad, Ali H.;Colson, Katherine Ellicott;Regalia, Ferdinando
背景：过去十年中，由墨西哥南部和中美洲组成的中美洲地区的健康状况显着改善。尽管取得了这些进展，但国家之间和国家内部在健康结果、医疗服务获取和质量方面仍然存在严重不平等。贫困人口、土著人口和农村人口的健康指标明显低于国家或地区平均水平。为了解决这些健康不平等问题，中美洲健康 2015 倡议（SM2015）应运而生，这是一项基于结果的融资倡议。 方法：为八个参与国家中的每一个国家设定了健康目标，以衡量该倡议在孕产妇和儿童健康改善方面取得的进展。为了建立基线，我们对中美洲最贫困地区的 90,000 个家庭进行了人口普查，完成了 20,225 个家庭访谈，并对 479 个卫生机构进行了调查。将卫生设施和家庭调查配对，使我们能够将护理和健康结果的障碍与卫生系统基础设施组成部分和卫生服务质量联系起来。结果：国家内部和国家之间的指标差异很大。贫血症在巴拿马最普遍，在洪都拉斯最不普遍。贫血因年龄而异，在所有环境中，0 至 11 个月大的儿童中贫血水平最高。伯利兹的机构分娩比例最高（99%），而危地马拉最低（24%）。在有熟练护理人员陪同下进行四次产前护理的妇女比例最高的是萨尔瓦多 (90%)，最低的是危地马拉 (20%)。避孕药具的供应情况也各不相同。安全套的供应率从尼加拉瓜的 83% 到洪都拉斯的 97% 不等。巴拿马只有 75% 的设施提供口服避孕药和注射避孕药。在萨尔瓦多接受调查的设施中，只有 21.5% 观察到了宫内节育器。结论：这些数据为整个中美洲的循证健康行动提供了急需的信息基线。我们的基线估计反映了国家内部和国家之间健康指标的巨大差异，并将有助于评估未来三到五年在该地区部署的干预措施和投资。 SM2015 的创新监测和评估框架将使资源有限的卫生官员能够确定并瞄准最需要的领域。
Background: Health has improved markedly in Mesoamerica, the region consisting of southern Mexico and Central America, over the past decade. Despite this progress, there remain substantial inequalities in health outcomes, access, and quality of medical care between and within countries. Poor, indigenous, and rural populations have considerably worse health indicators than national or regional averages. In an effort to address these health inequalities, the Salud Mesoamerica 2015 Initiative (SM2015), a results-based financing initiative, was established.Methods: For each of the eight participating countries, health targets were set to measure the progress of improvements in maternal and child health produced by the Initiative. To establish a baseline, we conducted censuses of 90,000 households, completed 20,225 household interviews, and surveyed 479 health facilities in the poorest areas of Mesoamerica. Pairing health facility and household surveys allows us to link barriers to care and health outcomes with health system infrastructure components and quality of health services.Results: Indicators varied significantly within and between countries. Anemia was most prevalent in Panama and least prevalent in Honduras. Anemia varied by age, with the highest levels observed among children aged 0 to 11 months in all settings. Belize had the highest proportion of institutional deliveries (99%), while Guatemala had the lowest (24%). The proportion of women with four antenatal care visits with a skilled attendant was highest in El Salvador (90%) and the lowest in Guatemala (20%). Availability of contraceptives also varied. The availability of condoms ranged from 83% in Nicaragua to 97% in Honduras. Oral contraceptive pills and injectable contraceptives were available in just 75% of facilities in Panama. IUDs were observed in only 21.5% of facilities surveyed in El Salvador.Conclusions: These data provide a baseline of much-needed information for evidence-based action on health throughout Mesoamerica. Our baseline estimates reflect large disparities in health indicators within and between countries and will facilitate the evaluation of interventions and investments deployed in the region over the next three to five years. SM2015's innovative monitoring and evaluation framework will allow health officials with limited resources to identify and target areas of greatest need.