Impact evaluation of contracting primary health care services in urban Bangladesh
Impact evaluation of contracting primary health care services in urban Bangladesh
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DOI：
10.1186/s12913-019-4406-5
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发表时间：
2019-11-21
影响因子：
2.8
通讯作者：
Chin, Brian
中科院分区：
文献类型：
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作者：
Albis, Manuel Leonard F.;Bhadra, Subrata K.;Chin, Brian
背景：城市初级卫生保健项目(UPHCP)是孟加拉国政府为应对快速城市化和初级卫生保健机会和质量方面日益严重的不平等而实施的。该项目的目标是通过公私伙伴关系签约的非政府组织提供保健服务，改善居住在城市公司和市政当局的城市贫民的健康状况。该项目的第一阶段于1998年开始，目前处于第四阶段，比前三阶段复盖更多的城市地区。本研究评估第二阶段计划(UPHCP-II)对健康结果的影响，主要是儿童腹泻、急性呼吸道感染、产前和产后护理、熟练分娩、母乳喂养、避孕、性传播感染和艾滋病毒/艾滋病意识。方法：通过项目和非项目地区之间的倾向得分匹配来评估项目的效果，比较2006年至2012年6年间的基线调查和终线调查。这项研究的一个创新之处在于重新校准了抽样权重，允许在影响评估中使用这两个独立的调查。结果：在六年时间里，与非项目地区相比，UPHCP-II改善了项目区人口的健康状况。研究发现，在减少儿童腹泻和急性呼吸道感染方面，健康状况有了显著改善，这解释了儿童死亡率下降的趋势。此外，该项目还改善了产前护理和熟练的助产服务。避孕普及率、艾滋病毒/艾滋病知晓率和避孕率提高，性传播感染减少。结论：UPHCP-II在实现其健康结果目标方面是有效的，而以往的研究表明，它在提供卫生保健方面是有效的，客户非常满意，因为卫生设施很近，医生和工作人员在提供高质量护理方面反应迅速。这项研究的结果可能有助于为未来城市卫生干预措施的设计和实施提供参考，这些干预措施涉及在孟加拉国和其他类似环境中承包初级卫生保健服务的提供。
Background: The Urban Primary Health Care Project (UPHCP) was implemented by the Government of Bangladesh in response to rapid urbanization and growing inequalities in access to and quality of primary health care. The goal of the project was to improve health status of the urban poor living in city corporations and municipalities through the provision of health care services by NGOs that are contracted through public-private partnership. The first phase of the project started in 1998 and the project is currently in its fourth phase covering more urban areas than the first three phases. This study evaluates the impact of the second phase project (UPHCP-II) on health outcomes, mainly child diarrhea, acute respiratory infection, antenatal and postnatal care, skilled birth attendance, breastfeeding prevalence, contraceptive prevalence, sexually transmitted infections, and HIV/AIDS awareness.Methods: The effect of the project was estimated through propensity score matching between project and non-project areas comparing baseline and endline surveys over a six-year period from 2006 to 2012. An innovation of this study is the recalibration of the sampling weights that allows the use of these two independent surveys in impact evaluation.Results: Over the six-year period, UPHCP-II improved the health status of the population in project areas compared to non-project areas. The study found significant improvement in health outcomes in terms of reduced diarrhea and acute respiratory infection in children, which explains the downward trend in child mortality rate. Moreover, the project also improved antenatal care and skilled birth attendance. Contraceptive prevalence and HIV/AIDS awareness and avoidance increased, and sexually transmitted infections decreased.Conclusions: UPHCP-II was effective in achieving its health outcome targets, while previous studies show that it was efficient in the delivery of health care and clients were highly satisfied because health facilities were in close proximity, and doctors and staff were perceived as responsive in delivering high quality of care. The results of this study could help inform future design and implementation of urban health interventions that involve contracting primary health care service delivery in Bangladesh and other similar settings.