Intersectoral Collaboration and Health Services during COVID19: A multi-stage, multi-level mixed-methods study in Ahmedabad, India

部门间卫生合作是初级卫生保健的关键原则之一，这是1978年在阿拉木图通过的一项全球规划，世界卫生组织至今一再重申这一原则。近年来，这种方法得到了来自“同一个健康”的新动力，在那里，人类、动物和环境卫生界面缺乏合作变得如此明显，以至于可以在这里特别好地研究其促成和阻碍因素。随后，拟议的研究将部门间合作如何在大流行病爆发期间最大限度地减少对基本卫生服务的干扰作为一个中心研究问题。我们已经对印度西部大城市艾哈迈达巴德的部门间卫生合作进行了研究，并利用各种定性和定量方法，以多阶段和多层次的方法对H5N1禽流感疫情（2017年）和随后的非疫情时期进行了比较。通过以类似的方式再次收集数据，将有可能实时检查Covid - 19大流行的影响，从而减少与2017年相比的回忆偏差，同时为与未来恢复期进行比较提供另一个机会。此外，大流行病对初级保健的影响可以同时探讨，几乎不需要额外的努力，以产妇服务为例。因此，该项目同时追求两个不同的目标，一方面集中关注人口保护和疫情控制方面的基本公共卫生任务，另一方面关注基本卫生保健服务：1)通过分析知识、经验和观点，评估2019冠状病毒病大流行期间卫生系统三个层面（即卫生行政、卫生服务提供者和社区）的部门间协作程度；将连杆的强度可视化。2)评估COVID-19大流行对公共和私营初级卫生保健服务提供的干扰程度，通过对产前护理、住院分娩和产后护理的影响来衡量，包括对SARS-CoV-2检测呈阴性和阳性的母亲的经历进行定性比较。

Intersectoral collaboration for health is one of the key principles of primary health care, as adopted as a global program in Alma Ata in 1978 and repeatedly reaffirmed by the World Health Organization to this day. This approach has received a new impetus in recent years from One Health, where the lack of collaboration at the interfaces of human, animal, and environmental health became so apparent that its enabling and hindering factors could be particularly well studied here.Subsequently, the proposed study pursues as a central research question how intersectoral collaboration can minimize the disruption of basic health services during a pandemic outbreak. Intersectoral collaboration for health in the western Indian metropolitan City of Ahmedabad has already been studied and compared by us for the avian influenza H5N1 outbreak (2017) and the subsequent non-outbreak period in a multi-stage and multi-level approach using various qualitative and quantitative methods. By collecting data again in a similar manner, it will be possible to examine the impact of the Covid 19 pandemic in real time, and thus with less recall bias than for 2017, while generating another opportunity for comparison with the future recovery period. In addition, the pandemic impact on primary health care can be explored simultaneously with little additional effort, using maternity services as an example.Therefore, the project simultaneously pursues two different objectives that centrally concern essential basic public health tasks in population protection and outbreak control on the one hand and basic health care services on the other:1) Assess the extent of intersectoral collaboration during the COVID-19 pandemic at three levels of the health system, i.e. health administration, health service providers, and community, by analyzing knowledge, experiences, and perspectives, and visualizing the intensity of linkages.2) Assess the extent to which the COVID-19 pandemic disrupted the delivery of primary health care services, both public and private, as measurable by the impact on ante-natal care, hospital delivery, and postpartum care, including qualitatively comparing the experiences of mothers who tested negative and positive for SARS-CoV-2.