Improving neonatal health in remote rural areas in China and Vietnam

改善中国和越南偏远农村地区的新生儿健康

• 批准号: MR/M002624/1
• 负责人: Tim Martineau
• 金额: $ 8.77万
• 依托单位: Liverpool School of Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2014
• 资助国家: 英国
• 起止时间: 2014 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FM002624%2F1
• 关键词: Improving; neonatal; health; remote; rural

Newborn (first 4 weeks of life) health remains a significant problem in China and Vietnam, especially in rural areas where they are 3 to 4 times more likely to die than in more developed areas. Most newborns can be treated with cost-effective interventions at facility and community levels, which do not require high-level training or costly equipment. Achieving high coverage of these interventions in the poorest areas could reduce neonatal deaths by at least 70%. While NH practice guidelines exist in China and Vietnam at national and local levels to guide on appropriate care and treatment, a major problem is ineffective implementation of the guidelines.This development study will assess the feasibility of using a participatory problem-solving intervention with local health managers to improve NH guideline implementation. If feasible, it will inform the design of a full-scale study to evaluate the effectiveness of the intervention. In the full-scale study, the research team would support local health managers through problem-solving and planning workshops, mentoring and capacity development to (1) assess the effectiveness of current guidelines; (2) identify barriers to improved implementation relating to service delivery (e.g. workforce issues, transport, equipment and supplies) and service demand (limited by remote access and traditional beliefs); (3) develop feasible strategies within current resource constraints e.g. re-organising services and the workforce, and using suitable community engagement models to stimulate demand for improved services; and 4) develop appropriate methods to monitor impact and unintended consequences.To assess the intervention's feasibility in remote, rural China and Vietnam the development study must address 4 questions:1. What are the current health service management practices and the degree of freedom for decision-making at different systems levels for improving NH outcomes?2. What are the opportunities for developing or strengthening community actions to support improved NH outcomes?3. What is the potential for monitoring NH outcomes and measuring cost-effectiveness of interventions at different health systems levels?4. What is the feasibility for local managers to use a participatory problem-solving intervention to implement existing practice guidelines for improving NH outcomes covering community, primary and referral levels and what would be the best vehicle for the intervention?We plan to conduct desk-based reviews of NH practice guidelines, challenges of monitoring NH impact in remote areas and NH intervention cost-effectiveness, before holding a 2-day workshop in Beijing to refine our field work plan and data collection tools and conduct 3 national key informant interviews (KIIs). We will then collect data in Guizhou, China using 4 methods: (i) KIIs: community level representatives, local health service managers, frontline health workers and provincial level policy makers and senior health officials; (ii) focus group discussions: recent mothers and community members; (iii) document review of community action agreements and provincial/national policies and plans; (iv) observation of health management information systems (HMIS) and accounting systems. A smaller research team will repeat this data collection protocol in Tay Nguyen, Vietnam, before analysing the two country datasets.This will inform the design the full-scale study and facilitate stakeholder engagement. We will produce 3 outputs on monitoring NH services in remote areas; practicalities of monitoring NH in remote China and Vietnam; and national policy space and local decision making freedom to improve NH services. Three levels of stakeholders will benefit: local (health service managers and staff), national (policy makers in China's MCH centres and Vietnam's NH technical working group) and international (e.g. Unicef, WHO, PMNCH and implementation science groups like WHO-led Implementation Research Platform).

在中国和越南，新生儿（出生后前4周）的健康仍然是一个重大问题，特别是在农村地区，他们的死亡率是发达地区的3至4倍。大多数新生儿可以在设施和社区一级采用具有成本效益的干预措施进行治疗，不需要高水平的培训或昂贵的设备。在最贫困地区实现这些干预措施的高覆盖率可以将新生儿死亡率降低至少70%。虽然NH实践指南在中国和越南在国家和地方层面上存在，以指导适当的护理和治疗，一个主要的问题是执行不力的guidelines.This发展研究将评估使用参与式问题解决干预与当地健康管理人员，以改善NH指南的实施的可行性。如果可行，它将为全面研究的设计提供信息，以评估干预措施的有效性。在全面研究中，研究小组将通过解决问题和规划讲习班、辅导和能力发展，支持地方保健管理人员：（1）评估现行准则的效力;（2）查明妨碍改进提供服务方面的执行工作的障碍（如劳动力问题、运输、设备和用品）和服务需求（受远程访问和传统信仰的限制）;（3）在目前资源有限的情况下，制订可行的策略，例如重组服务和人手，以及使用合适的社区参与模式来刺激对改善服务的需求;以及4）开发适当的方法来监测影响和意外后果。为了评估干预在中国偏远农村和越南的可行性，发展研究必须解决4个问题：1.目前的卫生服务管理实践和不同系统层面的决策自由度如何改善NH结果？2.发展或加强社区行动以支持改善NH成果的机会是什么？3.在不同的卫生系统层面，监测NH结果和衡量干预措施的成本效益的潜力是什么？4.地方管理人员使用参与性解决问题的干预措施来实施现有的实践指南以改善社区、初级和转诊各级的卫生成果的可行性如何？我们计划在北京举行为期两天的研讨会，以完善我们的实地工作计划和数据收集工具，并进行3次全国关键知情人访谈（KII）之前，对NH实践指南、监测偏远地区NH影响的挑战和NH干预的成本效益进行案头审查。然后，我们将使用4种方法收集中国贵州的数据：（i）KII：社区代表，当地卫生服务管理人员，一线卫生工作者和省级决策者和高级卫生官员;（ii）焦点小组讨论：最近的母亲和社区成员;（iii）社区行动协议和省/国家政策和计划的文件审查; ㈣观察保健管理信息系统和会计系统。一个较小的研究团队将在分析这两个国家的数据集之前，在越南的太原重复这一数据收集方案。这将为全面研究的设计提供信息，并促进利益相关者的参与。我们将在监测偏远地区的卫生保健服务、监测中国和越南偏远地区卫生保健服务的可行性以及改善卫生保健服务的国家政策空间和地方决策自由度方面产生3项成果。三个层次的利益相关者将受益：地方（卫生服务管理人员和工作人员），国家（中国妇幼保健中心和越南卫生技术工作组的决策者）和国际（例如联合国儿童基金会，世卫组织，PMNCH和实施科学团体，如世卫组织领导的实施研究平台）。

项目成果

Additional file 1: of Using guidelines to improve neonatal health in China and Vietnam: a qualitative study

附加文件 1：利用指南改善中国和越南新生儿健康：一项定性研究

• DOI: 10.6084/m9.figshare.c.3608048_d1
• 发表时间: 2016
• 作者: Raven J

Using guidelines to improve neonatal health in China and Vietnam: a qualitative study.

• DOI: 10.1186/s12913-016-1900-x
• 发表时间: 2016-11-11
• 期刊: BMC health services research
• 影响因子: 2.8
• 作者: Raven J;Liu X;Hu D;Zhu W;Hoa DT;Thi LM;Duong DT;Alonso-Garbayo A;Martineau T
• 通讯作者: Martineau T

BARRIERS TO IMPLEMENT THE NATIONAL GUIDELINES ON NEWBORN CARE IN A RURAL MOUNTAINOUS PROVINCE OF VIETNAM.

在越南山区农村省实施国家新生儿护理指南的障碍。

• 发表时间: 2015
• 期刊: Tap chi y te cong cong
• 作者: Thi LM