Scaling-up a public health innovation: A comparative study of post-abortion care in Bolivia and Mexico
Scaling-up a public health innovation: A comparative study of post-abortion care in Bolivia and Mexico
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DOI：
10.1016/j.socscimed.2007.02.026
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发表时间：
2007-06-01
影响因子：
5.4
通讯作者：
Fetters, Tamara
中科院分区：
文献类型：
--
作者：
Billings, Deborah L.;Crane, Barbara B.;Fetters, Tamara
自1994年国际人口与发展会议（人发会议）以来，世界各地的公共卫生系统采用了堕胎后护理这一治疗妇女因不安全堕胎而出现并发症的创新办法。本文分析了扩大原始PAC模式的三个关键要素中的两个的过程：在玻利维亚和墨西哥为有堕胎并发症的妇女提供及时的临床治疗，并提供堕胎后避孕咨询和方法。从这种比较分析的概念框架，包括PAC规模扩大的环境背景下，启动，扩大和机构化的PAC的主要影响，和健康，金融和社会的影响，机构化。玻利维亚和墨西哥的启动得到了创新领导人或催化剂的推动，他们致力于将PAC服务引入公共卫生保健环境，国际组织和公共卫生机构之间的合作以及财政资源。成功地扩大泛太平洋方案的重要进程包括：通过研究、宣传和伙伴关系加强对泛太平洋方案服务的政治承诺;通过培训、监督和制定服务准则提高卫生系统的能力;促进卫生系统获得基本技术。根据一系列拟议指标的衡量，玻利维亚的儿童保育制度化比墨西哥更为成功。在玻利维亚和墨西哥，部分地衡量了将儿童艾滋病方案制度化对健康和财政的积极影响。其他假设，扩大PAC将显着降低孕产妇死亡率和发病率，减少与堕胎有关的耻辱，并准备努力改革限制性堕胎的法律和政策的方式，还有待检验。(c)2007爱思唯尔有限公司版权所有。
Post-abortion care (PAC), an innovation for treating women with complications of unsafe abortion, has been introduced in public health systems around the world since the 1994 International Conference on Population and Development (ICPD). This article analyzes the process of scaling-up two of the three key elements of the original PAC model: providing prompt clinical treatment to women with abortion complications and offering post-abortion contraceptive counseling and methods in Bolivia and Mexico. The conceptual framework developed from this comparative analysis includes the environmental context for PAC scale-up; the major influences on start-up, expansion, and institutionalization of PAC; and the health, financial, and social impacts of institutionalization. Start-up in both Bolivia and Mexico was facilitated by innovative leaders or catalyzers who were committed to introducing PAC services into public health care settings, collaboration between international organizations and public health institutions, and financial resources. Important processes for successful PAC expansion included strengthening political commitment to PAC services through research, advocacy, and partnerships; improving health system capacity through training, supervision, and development of service guidelines; and facilitating health system access to essential technologies. Institutionalization of PAC has been more successful in Bolivia than Mexico, as measured by a series of proposed indicators. The positive health and financial impacts of PAC institutionalization have been partially measured in Bolivia and Mexico. Other hypotheses that scaling-up PAC will significantly reduce maternal mortality and morbidity, decrease abortion-related stigma, and prepare the way for efforts to reform restrictive abortion laws and policies-have yet to be tested. (c) 2007 Elsevier Ltd. All rights reserved.