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Learning from health systems strengthening in maternal and newborn health (MNH) in China to inform accelerated progress for saving lives in Africa

向中国加强孕产妇和新生儿健康（MNH）的卫生系统学习，为非洲在拯救生命方面加快取得进展提供参考

基本信息

批准号：
MR/M01438X/1
负责人：
Carine Ronsmans
金额：
$ 62.83万
依托单位：
London School of Hygiene & Tropical Medicine
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%2FM01438X%2F1
关键词：
Learning health systems strengthening maternal

项目摘要

Globally, 289,000 women die each year due to complications of pregnancy and childbirth, and 2.9 million babies do not survive the first month of life. Sub-Saharan Africa - with only one tenth of the world's population - carries the greatest burden and there is little evidence of progress. Several strategies have been identified to accelerate progress in reducing maternal and newborn mortality, including increasing the number of health workers and upgrade specific skills for care at birth and exploring ways to attract health workers to rural areas, but how to implement these measures at large scale in sub-Saharan Africa remains uncertain.Sub-Saharan Africa can learn important lessons from China's progress in maternal and newborn health (MNH), in particular in terms of the process and the "how". Over the last twenty years, China's newborn and maternal mortality rate fell dramatically. The reasons for this success are multiple, but China's strategic investments in health systems strengthening have no doubt contributed, particularly in terms of building a strong midwifery workforce, encouraging women to give birth in hospital and making delivery care mostly free. Regional disparities in access to MNH care persist, but even the poorest regions, - which face geographical barriers not dissimilar to sub-Saharan Africa - have made substantial progress. The mortality difference between China and sub-Saharan Africa at national level is about 3-fold for newborn mortality and ten-fold for maternal mortality; and the current urban-rural maternal and newborn survival gap in China is about 3-fold. So evaluation of China's learning could serve to both accelerate progress for closing China's urban-rural gap and to the increasing momentum for change in Africa. The aim of this project is to use China's experience in MNH to answer a number of questions that are critical to understanding how similar progress can be achieved in sub-Saharan Africa, including:1. Do existing health systems indicators discriminate among areas with high and low maternal and newborn mortality? Can thresholds be set (e.g. density of providers per 1000 population) below which mortality cannot decline?2. What is the appropriate midwifery workforce, and how is it best deployed, to equitably deliver essential MNH interventions at scale and quality, and what resources and systems (financial, training, governance, supervision, etc.) need to be in place to achieve universal access to these interventions?3. How do existing structures and processes enable successful referral from the community to facilities offering obstetric care?4. What changes in the health financing system, including introduction of new insurance schemes, pooling arrangements, and provider payment mechanisms, have reduced financial barriers, thereby supporting the expansion of coverage of essential MNH services?5. What lessons from China can be transferred to Tanzania?We will answer the above questions through a number of studies. First, we will use China's unique and extensive routine data systems to examine the relationship between health systems inputs and maternal and newborn mortality across all counties. Second, we will collect data in eight counties in China's poorest Western provinces to provide an in depth understanding of the relationship between MNH inputs that are more difficult to capture through routine data sources, including the mix and levels of the midwifery workforce, referrals and levels and allocation of health care financing, and selected service coverage and outcome indicators. Third, we will examine whether the successful MNH strategies deployed in China can be implemented in Tanzania and whether the effectiveness would remain the same given Tanzania's different health and socio-economic context.

在全球范围内，每年有28.9万名妇女死于妊娠和分娩并发症，290万婴儿在出生后第一个月无法存活。撒哈拉以南非洲只有世界人口的十分之一，负担最重，几乎没有取得进展的证据。已经确定了几项战略，以加快在降低孕产妇和新生儿死亡率方面的进展，包括增加卫生工作者的人数和提高出生时护理的具体技能，以及探索将卫生工作者吸引到农村地区的方法，但如何在撒哈拉以南非洲大规模实施这些措施仍然不确定。撒哈拉以南非洲可以从中国在孕产妇和新生儿保健方面取得的进展中吸取重要教训，特别是在这一进程和“如何”方面。在过去的二十年里，中国的新生儿和孕产妇死亡率大幅下降。这一成功的原因是多方面的，但中国在加强卫生系统方面的战略投资无疑起到了作用，特别是在建立一支强大的助产士队伍、鼓励妇女在医院分娩以及使分娩护理基本上免费方面。在获得保健保健方面仍然存在区域差异，但即使是最贫穷的地区--它们面临的地理障碍与撒哈拉以南非洲相似--也取得了实质性进展。在国家层面上，中国与撒哈拉以南非洲地区的新生儿死亡率相差约3倍，孕产妇死亡率相差10倍左右；中国目前城乡孕产妇和新生儿存活率差距约为3倍。因此，对中国的学习进行评价，既可以加快中国缩小城乡差距的进程，也可以促进非洲日益增强的变革势头。这个项目的目的是利用中国在卫生保健方面的经验回答一些问题，这些问题对于了解撒哈拉以南非洲如何取得类似的进展至关重要，包括：1.现有的卫生系统指标是否区分孕产妇和新生儿死亡率高和低的地区？能否设定死亡率不能下降的门槛(例如每1000人的提供者密度)？2.适当的助产士队伍是什么，以及如何进行最佳配置，以公平地提供规模和质量的基本卫生保健干预措施，以及哪些资源和系统(财务、培训、治理、监督等)。需要采取什么措施来实现这些干预措施的普及？3.现有的结构和程序如何能够成功地从社区转诊到提供产科护理的机构？4.卫生筹资制度的哪些变化，包括引入新的保险计划、汇集安排和提供者支付机制，减少了财政障碍，从而支持扩大基本卫生保健服务的覆盖范围？5.中国的哪些经验教训可以传授给坦桑尼亚？我们将通过一些研究回答上述问题。首先，我们将使用中国独特而广泛的常规数据系统来检查所有县的卫生系统投入与孕产妇和新生儿死亡率之间的关系。其次，我们将在中国最贫穷的西部省份的八个县收集数据，以深入了解通过常规数据来源较难获得的卫生保健投入之间的关系，包括助产劳动力的组合和水平、转诊和医疗融资的水平和分配，以及选定的服务覆盖范围和结果指标。第三，我们将研究在中国部署的成功的卫生保健战略能否在坦桑尼亚实施，以及鉴于坦桑尼亚不同的卫生和社会经济背景，其有效性是否会保持不变。