Inpatient care of small and sick newborns: a multi-country analysis of health system bottlenecks and potential solutions.
Inpatient care of small and sick newborns: a multi-country analysis of health system bottlenecks and potential solutions.
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DOI：
10.1186/1471-2393-15-s2-s7
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发表时间：
2015
影响因子：
3.1
通讯作者：
Blencowe H
中科院分区：
文献类型：
--
作者：
Moxon SG;Lawn JE;Dickson KE;Simen-Kapeu A;Gupta G;Deorari A;Singhal N;New K;Kenner C;Bhutani V;Kumar R;Molyneux E;Blencowe H
早产是全世界儿童死亡的主要原因。弱小和患病的新生儿需要及时、高质量的住院治疗才能生存。这包括提供温暖、喂养支持、安全的氧气治疗和有效的光疗，以预防和治疗感染。新生儿的住院护理需要专门的病房空间，配备受过专业培训和技能的卫生工作者。据估计，每年有280万新生儿死亡，其中许多人无法获得这种专门护理。瓶颈分析工具已在非洲和亚洲的12个国家应用，作为“每个新生儿行动计划”进程的一部分。国家讲习班有技术专家参与，以完成调查工具，该工具旨在综合和分级卫生系统的“瓶颈”（或阻碍扩大孕产妇-新生儿干预措施的因素）。在本文中，我们采用定量和定性的方法分析瓶颈数据，并结合文献综述，提出与不同卫生系统构建块有关的优先瓶颈和行动，以促进小新生儿和患病新生儿的住院护理。所有国家讲习班参与者都强调，对幼小和患病新生儿的住院护理是一项干预措施，因为它面临着重大的卫生系统挑战。具有最高等级（重大或重大）瓶颈的卫生系统构成要素是卫生人力（12个国家中有10个）和卫生筹资（12个国家中有10个），其次是社区所有权和伙伴关系（12个国家中有9个）。讨论了基于这些瓶颈的解决方案主题的优先级操作。虽然目前存在扩大优质新生儿住院护理的主要瓶颈，但存在有效的解决办法。包括所有国家在内，都迫切需要新生儿护理干部。年幼和患病的新生儿需要更多、持续的资金，并提供具体的保险计划，以支付住院治疗费用，并避免灾难性的自付费用。应按护理水平确定核心能力，以便像产科急诊一样监测新生儿住院护理。社区干预措施需要创造对可获得的、高质量的、以家庭为中心的住院护理的需求，包括袋鼠妈妈护理，而不是认为年幼和患病的新生儿会死亡的宿命论，以便每个新生儿都能生存和茁壮成长。
Preterm birth is the leading cause of child death worldwide. Small and sick newborns require timely, high-quality inpatient care to survive. This includes provision of warmth, feeding support, safe oxygen therapy and effective phototherapy with prevention and treatment of infections. Inpatient care for newborns requires dedicated ward space, staffed by health workers with specialist training and skills. Many of the estimated 2.8 million newborns that die every year do not have access to such specialised care. The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops involved technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks" (or factors that hinder the scale up) of maternal-newborn intervention packages. For this paper, we used quantitative and qualitative methods to analyse the bottleneck data, and combined these with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for inpatient care of small and sick newborns. Inpatient care of small and sick newborns is an intervention package highlighted by all country workshop participants as having critical health system challenges. Health system building blocks with the highest graded (significant or major) bottlenecks were health workforce (10 out of 12 countries) and health financing (10 out of 12 countries), followed by community ownership and partnership (9 out of 12 countries). Priority actions based on solution themes for these bottlenecks are discussed. Whilst major bottlenecks to the scale-up of quality inpatient newborn care are present, effective solutions exist. For all countries included, there is a critical need for a neonatal nursing cadre. Small and sick newborns require increased, sustained funding with specific insurance schemes to cover inpatient care and avoid catastrophic out-of-pocket payments. Core competencies, by level of care, should be defined for monitoring of newborn inpatient care, as with emergency obstetric care. Rather than fatalism that small and sick newborns will die, community interventions need to create demand for accessible, high-quality, family-centred inpatient care, including kangaroo mother care, so that every newborn can survive and thrive.