Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition
Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition
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DOI：
10.1016/s0140-6736(12)61423-8
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发表时间：
2012-10-13
期刊：
影响因子：
168.9
通讯作者：
Binkin, Nancy
中科院分区：
文献类型：
--
作者：
Chopra, Mickey;Sharkey, Alyssa;Binkin, Nancy
实施创新战略，扩大循证干预措施的覆盖面，特别是在最边缘化的人群中，是旨在改善儿童生存、健康和营养的政策制定者和规划者的一个关键重点。我们提出了一个分三步走的方法来提高基本干预措施的有效覆盖率。首先，我们确定了四个不同的干预提供渠道，即，临床或治疗，推广，以社区为基础的预防或宣传，立法或大众媒体。其次，我们对哪些干预措施的交付可以在其渠道内或通过切换到另一个渠道来改进或改变进行分类。最后，我们对已发表和未发表的综述进行了元综述，以研究旨在克服供需瓶颈的一系列策略的证据，以有效覆盖改善儿童生存，健康和营养的干预措施。尽管存在知识差距，但一些战略显示出改善有效干预措施覆盖面的希望-在某些情况下，改善儿童健康结果-包括扩大非专业卫生工作者的作用、任务转移、减少财政障碍、增加人力资源供应和地理可及性，以及利用私营部门。决策者和规划者在选择将其稀缺资源投入的战略时，应了解这一证据。
Implementation of innovative strategies to improve coverage of evidence-based interventions, especially in the most marginalised populations, is a key focus of policy makers and planners aiming to improve child survival, health, and nutrition. We present a three-step approach to improvement of the effective coverage of essential interventions. First, we identify four different intervention delivery channels-ie, clinical or curative, outreach, community-based preventive or promotional, and legislative or mass media. Second, we classify which interventions' deliveries can be improved or changed within their channel or by switching to another channel. Finally, we do a meta-review of both published and unpublished reviews to examine the evidence for a range of strategies designed to overcome supply and demand bottlenecks to effective coverage of interventions that improve child survival, health, and nutrition. Although knowledge gaps exist, several strategies show promise for improving coverage of effective interventions- and, in some cases, health outcomes in children-including expanded roles for lay health workers, task shifting, reduction of financial barriers, increases in human-resource availability and geographical access, and use of the private sector. Policy makers and planners should be informed of this evidence as they choose strategies in which to invest their scarce resources.