Scaling up the "24/7 BHU" strategy to provide round-the-clock maternity care in Punjab, Pakistan: a theory-driven, coproduced implementation study.
Scaling up the "24/7 BHU" strategy to provide round-the-clock maternity care in Punjab, Pakistan: a theory-driven, coproduced implementation study.
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DOI：
10.1186/s12961-022-00944-w
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发表时间：
2022-12-28
影响因子：
4
通讯作者：
Jhangri, Gian Singh
中科院分区：
文献类型：
--
作者：
Salway, Sarah;Mumtaz, Zubia;Bhatti, Afshan;Barnes, Amy;Dawson, Jeremy;Jhangri, Gian Singh
关键词：
巴基斯坦的孕产妇死亡率仍然居高不下，每100 000例活产死亡186例。国家由政府管理的一级医疗机构-基层医疗单位是农村妇女获得孕产妇保健的重要来源。然而，BHU仅在工作日上午8：00至下午2：00营业。政府认识到这严重限制了获得孕产妇服务的机会，正在实施“24/7基本保健单位”倡议，以提升基本保健单位的水平，使其能够提供24小时护理。虽然以一个成功的试点项目为基础，但初步报告显示，在扩大这一举措方面存在挑战。该实施研究项目旨在解决旁遮普政府的一个关键问题：如何成功地大规模实施24/7 BHU倡议，在旁遮普农村地区提供高质量、全天候的熟练产妇护理？该项目包括两个重叠的工作包（WP）。WP 1包括三个模块，用于生成司级、地区级和基本保健单位级的数据。模块1使用文件分析和政策制定者访谈来阐明方案理论，并开始建立系统模型。模块2将政府收集的数据与对1500名新生儿的调查数据进行比较，以评估BHU的表现。模块3使用三个地区的4-5个基本保健单位的机构人种志，为理解和确定影响扩大规模的进程提供一个详细的系统。WP 2包含两个模块。首先，与利益攸关方举行两次讲习班和定期会议，整合第一工作方案的调查结果，确定可行的变革并确定优先事项。接下来，通过使用PDSA（计划-实施-研究-行动）改进方法的仔细记录的试点，选择“改变想法”在一个地区和2-3个基本保健单位进行测试。一个综合的知识转化方法将在整个项目中吸引关键的政策和实践利益攸关方的参与。这一理论驱动的实施研究项目将共同产生对24/7 BHU倡议正在实施的更广泛系统的重要新理解，以及可操作的知识，这些知识将突出实施过程可能被修改的方式，以使BHU能够满足服务提供目标。这项研究还将产生与其他南亚和中低收入国家相关的见解，这些国家在扩大方案规模和向偏远和边缘化社区提供孕产妇保健服务方面面临类似挑战。
Pakistan’s maternal mortality rate remains persistently high at 186/100,000 live births. The country’s government-run first-level healthcare facilities, the basic health units (BHUs), are an important source of maternity care for rural women. However,BHUsonly operate on working days from 8:00 am to 2:00 pm. Recognizing that this severely constrains access to maternity services, the government is implementing the “24/7 BHU” initiative to upgrade BHUs to provide round-the-clock care. Although based on a successful pilot project, initial reports reveal challenges in scaling up the initiative. This implementation research project aims to address a key concern of the Government of Punjab: How can the 24/7 BHU initiative be successfully implemented at scale to provide high-quality, round-the-clock skilled maternity care in rural Punjab? The project consists of two overlapping work packages (WP). WP1 includes three modules generating data at the directorate, district and BHU levels. Module 1 uses document analysis and policy-maker interviews to explicateprogrammetheory and begin to build a system model. Module 2 compares government-collected data with data generated from a survey of 1500 births to assess BHU performance. Module 3 uses institutional ethnographies in 4–5 BHUs in three districts to provide a detailed system for understanding and identifying processes that influence scale-up. WP2 includes two modules. First, two workshops and regular meetings with stakeholders integrate WP1 findings, identify feasible changes and establish priorities. Next, “change ideas” are selected for testing in one district and 2–3 BHUs through carefully documented pilots using the PDSA (plan–do–study–act) improvement approach. An integrated knowledge translation approach will engage key policy and practice stakeholders throughout the project. This theory-driven implementation research project willcoproducesignificant new understandings of the wider system in which the 24/7 BHU initiative is being implemented, and actionable knowledge that will highlight ways the implementation processes might be modified to enable BHUs to meet service provision goals. This study will also produce insights that will be relevant for other South Asian and low- and middle-income countries (LMICs) that experience similar challenges of programme scale-up and delivery of maternal health services to remote and marginalized communities.
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影响因子：
3.1
作者：
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