Tracking progress towards safe motherhood: meeting the benchmark yet missing the goal? An appeal for better use of health-system output indicators with evidence from Zambia and Sri Lanka
Tracking progress towards safe motherhood: meeting the benchmark yet missing the goal? An appeal for better use of health-system output indicators with evidence from Zambia and Sri Lanka
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DOI：
10.1111/j.1365-3156.2011.02741.x
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发表时间：
2011-05-01
影响因子：
3.3
通讯作者：
Campbell, Oona M. R.
中科院分区：
文献类型：
--
作者：
Gabrysch, Sabine;Zanger, Philipp;Campbell, Oona M. R.
卫生系统产出指标，如产科急诊密度，已被提议用于监测降低孕产妇死亡率的进展情况，但目前使用不足。我们试图通过展示它们在次国家一级的使用，评估它们是否区分了产妇死亡率高的国家（赞比亚）和产妇死亡率低的国家（斯里兰卡），以及评估基准是否设定在正确的水平来促进它们。方法我们将国家和地方卫生设施、EmOC设施和卫生专业人员的密度与赞比亚和斯里兰卡的现行基准进行比较。对于赞比亚，我们还通过将卫生设施数据与人口数据联系起来，审查了地理可及性。结果两国在产科护理中心设施密度方面的表现相似，这意味着目前使用的这一指标未能区分产妇死亡率高和低的情况。在赞比亚，医生/助产士总体上达到了世卫组织的基准，但各省之间的分布极不平等。斯里兰卡的助产士超过建议基准3倍，医生超过基准30倍。在人口密度远低于斯里兰卡的赞比亚，地理上的可及性很差，不到一半的人口居住在距离EmOC设施15公里的范围内。结论现行的卫生系统产出指标和EmOC基准需要修订，以增强区别性，并应适应不同的人口密度。次国家分类和评估地理获取可以确定EmOC提供方面的差距，应定期审议。更多地使用一套改进的产出指标，对于指导减少产妇死亡率的国际努力至关重要。
Indicators of health-system outputs, such as Emergency Obstetric Care (EmOC) density, have been proposed for monitoring progress towards reducing maternal mortality, but are currently underused. We seek to promote them by demonstrating their use at subnational level, evaluating whether they differentiate between a high-maternal-mortality country (Zambia) and a low-maternal-mortality country (Sri Lanka) and assessing whether benchmarks are set at the right level.MethodsWe compared national and subnational density of health facilities, EmOC facilities and health professionals against current benchmarks for Zambia and Sri Lanka. For Zambia, we also examined geographical accessibility by linking health facility data to population data.ResultsBoth countries performed similarly in terms of EmOC facility density, implying this indicator, as currently used, fails to discriminate between high- and low-maternal-mortality settings. In Zambia, the WHO benchmarks for doctors/midwives were met overall, but distribution between provinces was highly unequal. Sri Lanka overshot the suggested benchmarks by three times for midwives and over 30 times for doctors. Geographical access in Zambia - which is much less densely populated than Sri Lanka - was poor, less than half the population lived within 15 km of an EmOC facility.ConclusionsCurrent health-system output indicators and benchmarks on EmOC need revision to enhance discriminatory power and should be adapted for different population densities. Subnational disaggregation and assessing geographical access can identify gaps in EmOC provision and should be routinely considered. Increased use of an improved set of output indicators is crucial for guiding international efforts towards reducing maternal mortality.