Use of a Facilitated Group Process to Design and Implement a Group Antenatal and Postnatal Care Program in Rwanda
Use of a Facilitated Group Process to Design and Implement a Group Antenatal and Postnatal Care Program in Rwanda
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DOI：
10.1111/jmwh.12871
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发表时间：
2018-09-01
影响因子：
2.7
通讯作者：
Walker, Dilys
中科院分区：
文献类型：
--
作者：
Sayinzoga, Felix;Lundeen, Tiffany;Walker, Dilys
前言卢旺达政府正在探索降低早产儿和低出生体重儿发生率的策略。目前正在考虑在卢旺达国家保健系统范围内大规模实施集体产前护理和产后护理。为了在卢旺达的5个区启动ANC组和PNC组的整群随机对照试验，实施小组需要一个针对这一背景的定制的团体护理模式，并培训卫生保健工作者来实施该计划。一个由10名卢旺达妇幼保健利益攸关方组成的技术工作组在3个月期间举行了3次会议，每次会议4至8小时。他们的目标是考虑关于非国大集团的证据，商定非国大交付系统的优先事项和制约因素，并最终确定在卢旺达实施的非国大集团和国家非国大联合模式的内容和结构。结果在36个卫生中心的整群随机对照试验的背景下，制定了定制的群体ANC和PNC模型及其引入指南。本文描述了这一模式和实施计划。讨论我们的经验表明，对于成功的团体ANC和PNC来说，团体过程是在新的背景下定制和实施这一创新的卫生服务提供模式的有效方法，并且有助于实现地方所有权。
IntroductionThe government of Rwanda is exploring strategies that may reduce the incidence of prematurity and low birth weight. Large-scale implementation of group antenatal care (ANC) and postnatal care (PNC) within the context of the Rwanda national health care system is under consideration. To launch a cluster randomized controlled trial of group ANC and PNC in 5 districts in Rwanda, the implementation team needed a customized group care model for this context and trained health care workers to deliver the program.ProcessAdapting the group ANC and group PNC model for the Rwandan context was accomplished through a group process identical to that which is fundamental to group care. A technical working group composed of 10 Rwandan maternal-child health stakeholders met 3 times over the course of 3 months, for 4 to 8 hours each time. Their objectives were to consider the evidence on group ANC, agree on the priorities and constraints of their ANC delivery system, and ultimately define the content and structure of a combined group ANC and PNC model for implementation in Rwanda. The same group process was employed to train health care workers to act as group ANC facilitators.OutcomesA customized group ANC and PNC model and guidelines for its introduction were developed in the context of a cluster randomized controlled trial in 36 health centers. Descriptions of this model and the implementation plan are included in this article.DiscussionOur experience suggests that the group process fundamental to successful group ANC and PNC is an effective method to customize and implement this innovative health services delivery model in a new context and is instrumental in achieving local ownership.