A Systems Approach to Improving Rural Care in Ethiopia
A Systems Approach to Improving Rural Care in Ethiopia
复制标题
DOI：
10.1371/journal.pone.0035042
复制
发表时间：
2012-04-25
期刊：
影响因子：
3.7
通讯作者：
Curry, Leslie A.
中科院分区：
文献类型：
--
作者：
Bradley, Elizabeth H.;Byam, Patrick;Curry, Leslie A.
背景：为提高农村低收入地区初级卫生保健的质量、可及性和利用率，已经启动了多项干预措施；然而，这些干预措施的成功程度差异很大，即使在单个研究中，干预措施的测量影响因地点、中心和地区而异。因此，我们试图检查卫生系统加强干预的影响的差异，并了解可能解释初级卫生保健单位影响差异的因素。方法/主要研究结果：我们对埃塞俄比亚农村的20个初级卫生保健单位(PHCU)进行了一项混合方法的正偏差研究。使用埃塞俄比亚千年农村倡议(EMRI)的纵向数据，我们确定了在提供产前护理、产前护理中的艾滋病毒检测和熟练接生率方面绩效持续较高(n=2)、绩效最好(n=3)或持续较低(n=2)的初级保健单位。使用现场访问和深度访谈(n=51)的数据，我们应用定性数据分析的持续比较方法来确定区分不同绩效轨迹的PHCU的关键主题。区分PHCU的关键主题是1)管理问题解决能力，2)与Woreda(区)卫生办公室的关系，以及3)社区参与。在绩效较高的PHCU和EMRI干预后进步最大的PHCU中，卫生中心和卫生站工作人员解决日常问题的能力更强，工作人员与Woreda卫生官员的关系更好，PHCU社区领导层，特别是宗教领导层，强烈参与到健康改善工作中来。离最近城市的距离、道路和交通质量以及文化规范在不同的公立医院之间没有显著差异。结论/意义：有效的健康加强努力可能需要密集发展管理解决问题的技能，与监督一线提供者的政府部门建立牢固的关系，并致力于社区领导才能取得成功。
Background: Multiple interventions have been launched to improve the quality, access, and utilization of primary health care in rural, low-income settings; however, the success of these interventions varies substantially, even within single studies where the measured impact of interventions differs across sites, centers, and regions. Accordingly, we sought to examine the variation in impact of a health systems strengthening intervention and understand factors that might explain the variation in impact across primary health care units.Methodology/Principal Findings: We conducted a mixed methods positive deviance study of 20 Primary Health Care Units (PHCUs) in rural Ethiopia. Using longitudinal data from the Ethiopia Millennium Rural Initiative (EMRI), we identified PHCUs with consistently higher performance (n = 2), most improved performance (n = 3), or consistently lower performance (n = 2) in the provision of antenatal care, HIV testing in antenatal care, and skilled birth attendance rates. Using data from site visits and in-depth interviews (n = 51), we applied the constant comparative method of qualitative data analysis to identify key themes that distinguished PHCUs with different performance trajectories. Key themes that distinguished PHCUs were 1) managerial problem solving capacity, 2) relationship with the woreda (district) health office, and 3) community engagement. In higher performing PHCUs and those with the greatest improvement after the EMRI intervention, health center and health post staff were more able to solve day-to-day problems, staff had better relationships with the woreda health official, and PHCU communities' leadership, particularly religious leadership, were strongly engaged with the health improvement effort. Distance from the nearest city, quality of roads and transportation, and cultural norms did not differ substantially among PHCUs.Conclusions/Significance: Effective health strengthening efforts may require intensive development of managerial problem solving skills, strong relationships with government offices that oversee front-line providers, and committed community leadership to succeed.