Improving maternal health: Getting what works to happen
Improving maternal health: Getting what works to happen
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DOI：
10.1016/s0968-8080(07)30335-2
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发表时间：
2007-11-01
影响因子：
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通讯作者：
Parkhurst, Justin
中科院分区：
文献类型：
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作者：
Penn-Kekana, Loveday;McPake, Barbara;Parkhurst, Justin
在许多国家，孕产妇死亡率的降低是不可能的，尽管提供廉价，有效的干预措施，核心的官方政策的一部分。本文探讨了原因，基于对孟加拉国，俄罗斯，南非和乌干达的孕产妇服务的研究。一个简单的动态反应模式表明，理解执行方面挑战的关键在于卫生工作者和社区成员对政策和方案作出的反射性、复杂和动态反应。这些反应是“动态的”，因为它们是由于系统内外的力量而产生的，反过来又会施加它们自己的力量。它们造成政策中设想的卫生系统与卫生工作者实施的和用户体验的卫生系统之间的差异。旨在改善产妇保健的方案不仅是技术性的，而且也是社会干预措施，需要使用为评价旨在带来变化的复杂社会干预措施而制定的方法进行评价。有效方案的组成部分已在全球范围内界定，但在实现有效方案方面，背景很重要。因此，技术顾问需要更谨慎地提出“建议”，当地方案管理人员必须有能力不断作出改进方案的调整，评价中必须记录与过程而不仅仅是结果有关的细节。(c)2007年生殖健康问题。All rights reserved.
Maternal mortality reduction in many countries is unlikely despite the availability of inexpensive, efficacious interventions that ore part of official policy This article explores the reasons why, based on research on maternity services in Bangladesh, Russia, South Africa and Uganda. A simple dynamic responses model shows that the key to understanding challenges in implementation lies in the reflexive, complex and dynamic responses of health workers and community members to policies and programmes. These responses ore "dynamic" in that they arise due to forces from within and outside the system, and in turn exert forces of their own. They result in the difference between the health system that is envisaged in policy, and what is implemented by health workers and experienced by users. Programmes aiming to improve maternal health are not only technical but also social interventions that need to be evaluated as such, using methodologies that have been developed for evaluating complex social interventions whose aim is to bring about change. The components of effective programmes have been defined globally However in getting what works to happen, context matters. Thus, technical advisors need to give "advice" more circumspectly, local programme managers must be capacitated to make programme-improving adjustments continuously, and the detail related to process not just outcomes, must be documented in evaluations. (c) 2007 Reproductive Health Matters. All rights reserved.