The Ghana essential health interventions program: a plausibility trial of the impact of health systems strengthening on maternal & child survival.
The Ghana essential health interventions program: a plausibility trial of the impact of health systems strengthening on maternal & child survival.
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DOI：
10.1186/1472-6963-13-s2-s3
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发表时间：
2013
影响因子：
2.8
通讯作者：
Phillips JF
中科院分区：
文献类型：
--
作者：
Awoonor-Williams JK;Bawah AA;Nyonator FK;Asuru R;Oduro A;Ofosu A;Phillips JF
20世纪90年代，加纳北方纳夫龙戈健康研究中心的研究人员制定了一项非常成功的社区健康计划。Navrongo方法的重点是向村庄部署被称为社区卫生干事的护士。一项试验表明，与仅依靠现有服务的地区相比，该方法将儿童死亡率降低了一半，孕产妇死亡率降低了40%，生育率降低了近一个婴儿--仅在五年内总生育率就从5.5下降到了5.5。2000年，加纳政府启动了一项名为社区卫生规划和服务（CHPS）的国家计划，以扩大Navrongo模式。然而，在首次开展“纳夫龙戈实验”的上东地区以外的地区，卫生和公共卫生服务的推广速度缓慢。本文介绍了加纳基本健康干预项目（GEHIP），加强CHPS战略的可行性试验，特别是在孕产妇和新生儿健康领域，并产生政治意愿，以扩大该计划的战略是忠实于原始设计。GEHIP通过以下方式改进CHPS模式：1）扩大新生儿服务的范围和质量; 2）培训社区志愿者进行世界卫生组织的服务方案，即儿童疾病综合管理（IMCI）; 3）简化健康管理信息的收集并确保其用于决策; 4）使社区保健护士能够处理紧急情况，特别是产科并发症，并毫不拖延地转诊; 5）每年为地区预算增加人均0.85美元，并动员基层政治承诺为CHPS的实施提供资金;以及6）加强CHPS在系统各级的领导。通过进行基线和底线调查研究，并计算Heckman“差异中的差异”检验法，对三个干预区与四个比较区的5岁以下儿童死亡率的健康状况和存活率的核心指标进行比较，从而评估GEHIP的影响。为了阐明结果，分层儿童生存风险模型将估计纳入措施的卫生系统的实力作为生存的决定因素，调整父母和家庭特征的潜在混杂效应。定性系统评估程序将用于监测和解释GEHIP实施创新、限制和进展。通过展示加强现实世界卫生系统的实际手段，同时监测费用和评估孕产妇和儿童生存影响，GEHIP预计将有助于加快千年发展目标进展所需的国家卫生政策、规划和资源分配。
During the 1990s, researchers at the Navrongo Health Research Centre in northern Ghana developed a highly successful community health program. The keystone of the Navrongo approach was the deployment of nurses termed community health officers to village locations. A trial showed that, compared to areas relying on existing services alone, the approach reduced child mortality by half, maternal mortality by 40%, and fertility by nearly a birth — from a total fertility rate of 5.5 in only five years. In 2000, the government of Ghana launched a national program called Community-based Health Planning and Services (CHPS) to scale up the Navrongo model. However, CHPS scale-up has been slow in districts located outside of the Upper East Region, where the “Navrongo Experiment” was first carried out. This paper describes the Ghana Essential Health Intervention Project (GEHIP), a plausibility trial of strategies for strengthening CHPS, especially in the areas of maternal and newborn health, and generating the political will to scale up the program with strategies that are faithful to the original design. GEHIP improves the CHPS model by 1) extending the range and quality of services for newborns; 2) training community volunteers to conduct the World Health Organization service regimen known as integrated management of childhood illness (IMCI); 3) simplifying the collection of health management information and ensuring its use for decision making; 4) enabling community health nurses to manage emergencies, particularly obstetric complications and refer cases without delay; 5) adding $0.85 per capita annually to district budgets and marshalling grassroots political commitment to financing CHPS implementation; and 6) strengthening CHPS leadership at all levels of the system. GEHIP impact is assessed by conducting baseline and endline survey research and computing the Heckman “difference in difference” test for under-5 mortality in three intervention districts relative to four comparison districts for core indicators of health status and survival rates. To elucidate results, hierarchical child survival hazard models will be estimated that incorporate measures of health system strength as survival determinants, adjusting for the potentially confounding effects of parental and household characteristics. Qualitative systems appraisal procedures will be used to monitor and explain GEHIP implementation innovations, constraints, and progress. By demonstrating practical means of strengthening a real-world health system while monitoring costs and assessing maternal and child survival impact, GEHIP is expected to contribute to national health policy, planning, and resource allocation that will be needed to accelerate progress with the Millennium Development Goals.