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Stakeholder monitoring to improve quality of MNH care in public and private sector facilities following a district health systems approach

利益相关者按照地区卫生系统方法进行监测，以提高公共和私营部门设施中的 MNH 护理质量

基本信息

批准号：
MR/M001717/1
负责人：
A. T. M. Anwar
金额：
$ 17.07万
依托单位：
International Centre for Diarrhoeal Disease Research
依托单位国家：
英国
项目类别：
Research Grant
财政年份：
2015
资助国家：
英国
起止时间：
2015 至无数据
项目状态：
已结题

来源：
https://gtr.ukri.org/projects?ref=MR%2FM001717%2F1
关键词：
Stakeholder monitoring improve quality MNH

项目摘要

Improving the quality of care is emphasized in maternal and neonatal health (MNH) to enhance efficacy and effectiveness of interventions. However, there is neither any globally accepted definition, nor any standardized tool to monitor quality of care in MNH. Bangladesh is on-track in achieving the targets for Millennium Development Goal 4 & 5 with low institutional delivery rate (29%), the majority (18%) of which takes place in for-profit private sector facilities. Poor quality of care in public facilities compels pregnant women to use private facilities which may lead to catastrophic health expenditure. Users may perceive services from private sector facilities to be superior to services from public facilities due to incentive mechanism. The unregulated private sector is growing fast in the country and there are reports of overcharging and unnecessary caesarean sections in the private facilities. Dual practice is common among public sector providers and referral from public to private for financial benefit is not uncommon. Governance is weak to oversee the pluralistic health system where the private sector is increasingly contributing in the health care delivery. Innovative systems' approach needed for better integration of private sector inputs to maximize their contribution in achieving the national public health goals. Audit and feedback has demonstrated its feasibility and effectiveness in improving providers performances in clinical settings in high-income countries. Several global programs such as JHPIEGO (Johns Hopkins Program for International Education in Gynecology and Obstetrics) and AMDD (Averting Maternal Death and Disability) of the Columbia University have developed tools to monitor and improve quality of MNH care. In this study we plan to review the existing audit and quality improvement tools to adapt them in Bangladesh to test its feasibility, acceptability and effectiveness in improving quality of MNH care following a district health systems approach. The study will be conducted in a medium performing district of Bangladesh following a mixed method, pretest-post-test research design .The tools developed, will be contextualized through multiple stakeholders consultations and finalized after pretesting in a hypothetical field outside the study district. A baseline study will be conducted for needs assessment and benchmarking the quality indicators in public and private sector hospitals for future evaluations. Baseline study will include SWOT and Stakeholders Analysis to understand the context and building broader alliance to facilitate the implementation of the designed interventions. District Quality Assurance (QA) Team will be formed involving key stakeholders in the district, including the users. Developed monitoring and feedback tool will include key quality indicators covering structure, process and outcome dimensions of quality of care and will be implemented through joint quarterly visit of all public and private facilities by the district QA team members. Feedback will be given every 6 monthly through workshops and periodic quality monitoring reports. Process documentation will be the key method for evaluation. Qualitative Key Informants Interviews with explore the enabling and constraining factors impacting both implementation and making changes in quality of MNH care. The quantitative pre and post intervention surveys will be the other methods for assessing the change in quality of care (both technical and perceived) due to introduction of stakeholders' monitoring and feedback. A costing exercise will measure the cost of interventions to inform policy for scale-up and sustainability. Study outcome will be communicated to target audience using multiple channels such as journal articles, conference abstracts, policy briefs and newspaper articles. An implementation research protocol will be developed to inform policy for future scale-up nationwide to impact maternal and neonatal health outcomes.

在孕产妇和新生儿保健（MNH）中强调提高护理质量，以提高干预措施的效力和效果。然而，既没有任何全球公认的定义，也没有任何标准化工具来监测MNH的护理质量。孟加拉国正在按计划实现千年发展目标4和5的具体目标，但机构交付率较低（29%），其中大多数（18%）发生在营利性私营部门设施。公共设施的护理质量差，迫使孕妇使用私人设施，这可能导致灾难性的保健支出。由于激励机制的存在，用户可能会认为私营设施的服务优于公共设施的服务。不受监管的私营部门在该国发展迅速，有报道称，私营机构中存在收费过高和不必要的剖腹产。双重做法在公共部门提供者中很常见，从公共部门转到私营部门以获得经济利益的情况并不罕见。治理薄弱，无法监督多元化的卫生系统，私营部门在卫生保健提供方面的贡献越来越大。创新系统的方法需要更好地整合私营部门的投入，以最大限度地发挥其对实现国家公共卫生目标的贡献。审计和反馈证明了其在提高高收入国家临床环境中提供者绩效方面的可行性和有效性。一些全球项目，如约翰霍普金斯大学妇产科国际教育项目（JHPIEGO）和哥伦比亚大学避免产妇死亡和残疾项目（AMDD），已经开发出了监测和提高产妇保健质量的工具。在本研究中，我们计划审查现有的审计和质量改进工具，以使其在孟加拉国适应，以测试其可行性、可接受性和有效性，以改善地区卫生系统方法后的MNH护理质量。该研究将在孟加拉国的一个中等表现地区进行，采用混合方法，即前测试-后测试研究设计。开发的工具将通过多个利益相关者协商进行背景化，并在研究区以外的假设领域进行预测试后最终确定。将进行一项基线研究，以评估公立和私营部门医院的需求，并确定其质量指标的基准，以供今后评价。基线研究将包括SWOT和利益相关者分析，以了解背景并建立更广泛的联盟，以促进设计干预措施的实施。地区质素保证小组将成立，成员包括地区的主要持份者，包括使用者。制定的监测和反馈工具将包括主要质量指标，涵盖护理质量的结构、过程和结果维度，并将通过地区质量保证小组成员每季度联合访问所有公立和私立设施来实施。每6个月通过研讨会和定期质量监测报告进行反馈。过程文件将是评估的关键方法。访谈探讨了影响MNH护理质量实施和改变的有利因素和制约因素。定量干预前和干预后调查将是评估由于引入利益相关者的监测和反馈而导致的护理质量（技术和感知）变化的其他方法。一项成本核算工作将衡量干预措施的成本，为扩大规模和可持续性的政策提供信息。研究结果将通过期刊文章、会议摘要、政策简报和报纸文章等多种渠道传达给目标受众。将制定一项实施研究方案，为今后在全国范围内扩大影响孕产妇和新生儿健康结果的政策提供信息。