The introduction of new policies and strategies to reduce inequities and improve child health in Kenya: A country case study on progress in child survival, 2000-2013.
The introduction of new policies and strategies to reduce inequities and improve child health in Kenya: A country case study on progress in child survival, 2000-2013.
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DOI：
10.1371/journal.pone.0181777
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Kipp AM
中科院分区：
文献类型：
--
作者：
Brault MA;Ngure K;Haley CA;Kabaka S;Sergon K;Desta T;Mwinga K;Vermund SH;Kipp AM
截至2015年，世界卫生组织非洲区域只有12个国家实现了到2015年将五岁以下儿童死亡率降低三分之二的千年发展目标4。鉴于整个非洲区域的差异，进行了一项四国研究，以审查2015年之前儿童生存的障碍和促进因素。肯尼亚是被选中进行深入案例研究的国家之一，因为该国在降低五岁以下儿童死亡率方面进展不足，1990年至2013年期间仅降低了28%。本文件介绍了各项指标、国家文件和定性数据，说明了促进和阻碍肯尼亚降低儿童死亡率努力的因素。数据中确定的主要障碍是在获得和利用孕产妇、新生儿和儿童保健（MNCH）方面普遍存在的社会经济和地理不平等。为了减少这些不公平现象，肯尼亚在研究期间实施了三项主要政策/战略：取消使用费、肯尼亚基本保健一揽子计划和社区保健战略。本文使用定性数据和政策审查，探讨这些努力的早期影响。取消使用费的执行情况并不均衡，因为病人仍然面临隐性费用。肯尼亚基本保健一揽子计划使许多地区的医疗保健设施得以建设和/或扩建，但这些设施难以提供紧急产科和新生儿护理、新生儿护理以及许多基本药物和商品。社区卫生战略似乎产生了最大的影响，改善了社区转诊和提供免疫接种、预防疟疾和预防母婴传播艾滋病毒。然而，社区卫生战略受到资源的限制，因此在许多地区的执行情况也不均衡。尽管在2015年之前取得的进展不足，但如果有更多的资源和进一步扩大新的政策和战略，肯尼亚可以在儿童生存方面取得进一步进展。
As of 2015, only 12 countries in the World Health Organization’s AFRO region had met Millennium Development Goal #4 (MDG#4) to reduce under-five mortality by two-thirds by 2015. Given the variability across the African region, a four-country study was undertaken to examine barriers and facilitators of child survival prior to 2015. Kenya was one of the countries selected for an in-depth case study due to its insufficient progress in reducing under-five mortality, with only a 28% reduction between 1990 and 2013. This paper presents indicators, national documents, and qualitative data describing the factors that have both facilitated and hindered Kenya’s efforts in reducing child mortality. Key barriers identified in the data were widespread socioeconomic and geographic inequities in access and utilization of maternal, neonatal, and child health (MNCH) care. To reduce these inequities, Kenya implemented three major policies/strategies during the study period: removal of user fees, the Kenya Essential Package for Health, and the Community Health Strategy. This paper uses qualitative data and a policy review to explore the early impacts of these efforts. The removal of user fees has been unevenly implemented as patients still face hidden expenses. The Kenya Essential Package for Health has enabled construction and/or expansion of healthcare facilities in many areas, but facilities struggle to provide Emergency Obstetric and Neonatal Care (EmONC), neonatal care, and many essential medicines and commodities. The Community Health Strategy appears to have had the most impact, improving referrals from the community and provision of immunizations, malaria prevention, and Prevention of Mother-to-Child Transmission of HIV. However, the Community Health Strategy is limited by resources and thus also unevenly implemented in many areas. Although insufficient progress was made pre-2015, with additional resources and further scale-up of new policies and strategies Kenya can make further progress in child survival.
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