Fragmented implementation of maternal and child health home-based records in Vietnam: need for integration.
Fragmented implementation of maternal and child health home-based records in Vietnam: need for integration.
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DOI：
10.3402/gha.v9.29924
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发表时间：
2016
影响因子：
2.6
通讯作者：
Nguyen LT
中科院分区：
文献类型：
--
作者：
Aiga H;Nguyen VD;Nguyen CD;Nguyen TT;Nguyen LT
家庭记录（HBR）作为鼓励孕妇和母亲及时、充分利用妇幼保健（MCH）服务的有效工具在全球范围内得到实施。虽然在几项早期研究中已经评估了具有全国代表性的 HBR 的可用性和利用率，但尚未报告或分析以不太协调的方式在地方实施的许多 HBR 的现实情况。本研究旨在估计越南 MCH 的 HBR 患病率以及不同 MCH 的 HBR 的分散程度和重叠程度。该研究进一步试图了解卫生工作者和母亲对 HBR 运营和利用的看法。向选定的 28 个省份的省级卫生部门发送了一份自填式调查问卷。从他们那里收集了每一份可用的《哈佛商业评论》的副本。在 28 个选定省份中的 4 个省份的农村社区，对卫生工作者和母亲进行了总共 20 次半结构化访谈。专门针对孕产妇保健和专门针对儿童健康开发的 HBR 分别在 4 个省份 (14%) 和 28 个省份 (100%) 提供，而同时针对孕产妇保健和儿童保健的 HBR 在 9 个省份 (32%) 提供。 28 个省份的 HBR 平均数量（=5.75）表明 HBR 过度可用。全国推广中三个不同卫生健康库的119项最低记录项目也全部纳入全国推广试点的《妇幼健康手册》。实施多个 HBR 可能不仅会让卫生工作者感到困惑，因为要求他们在多个 HBR 上记录相同的数据，而且还会让母亲们困惑，不知道自己在家应该参考和依赖哪个 HBR。为了使卫生工作者和孕妇能够只关注一种类型的 HBR，针对孕产妇和/或儿童健康的各省特定 HBR 需要在全国范围内标准化。此外，为了确保孕产妇、新生儿和儿童保健的连续性，目前分散在不同妇幼保健阶段（即妊娠、分娩、儿童免疫、儿童生长和儿童发育）的 HBR 应该进行整合。 HBR 的标准化和集成将有助于提高 HBR 运营的技术效率和财务可持续性。
Home-based records (HBRs) are globally implemented as the effective tools that encourage pregnant women and mothers to timely and adequately utilise maternal and child health (MCH) services. While availability and utilisation of nationally representative HBRs have been assessed in several earlier studies, the reality of a number of HBRs subnationally implemented in a less coordinated manner has been neither reported nor analysed. This study is aimed at estimating the prevalence of HBRs for MCH and the level of fragmentation of and overlapping between different HBRs for MCH in Vietnam. The study further attempts to identify health workers’ and mothers’ perceptions towards HBR operations and utilisations. A self-administered questionnaire was sent to the provincial health departments of 28 selected provinces. A copy of each HBR available was collected from them. A total of 20 semi-structured interviews with health workers and mothers were conducted at rural communities in four of 28 selected provinces. Whereas HBRs developed exclusively for maternal health and exclusively for child health were available in four provinces (14%) and in 28 provinces (100%), respectively, those for both maternal health and child health were available in nine provinces (32%). The mean number of HBRs in 28 provinces (=5.75) indicates over-availability of HBRs. All 119 minimum required items for recording found in three different HBRs under nationwide scale-up were also included in the Maternal and Child Health Handbook being piloted for nationwide scaling-up. Implementation of multiple HBRs is likely to confuse not only health workers by requiring them to record the same data on several HBRs but also mothers about which HBR they should refer to and rely on at home. To enable both health workers and pregnant women to focus on only one type of HBR, province-specific HBRs for maternal and/or child health need to be nationally standardised. Moreover, to ensure a continuum of maternal, newborn, and child health care, the HBRs currently fragmented into different MCH stages (i.e. pregnancy, delivery, child immunisation, child growth, and child development) should be integrated. Standardisation and integration of HBRs will help increase technical efficiency and financial sustainability of HBR operations.