Scaling up the '24/7 BHU' strategy to provide round-the-clock maternity care in Punjab, Pakistan: A theory-driven, co-produced implementation study

扩大“24/7 BHU”战略，在巴基斯坦旁遮普邦提供全天候产妇护理：一项理论驱动、共同制作的实施研究

• 批准号: MR/R013810/1
• 负责人: Sarah Salway
• 金额: $ 103.71万
• 依托单位: University of Sheffield
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2018
• 资助国家: 英国
• 起止时间: 2018 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FR013810%2F1
• 关键词: Scaling; up; 24; BHU; strategy

Pakistan has a persistently high level of maternal deaths. Its government-run first-level health care facilities, the Basic Health Units (BHUs), are an important place for poor and rural women to receive skilled care during delivery and birth. However, BHUs have only been open from 8.00 am to 2.00 pm daily. The provincial government of Punjab has recognized that these hours of operation severely constrain access to maternity services. Therefore the Health Department is implementing the 24/7 BHU Initiative to upgrade BHUs to provide round-the-clock care. This scale-up is based on a successful pilot project but initial reports reveal challenges in rolling out the new approach. In this 54-month project we will work closely with the Punjab Health Department and other stakeholders to address a key concern: How can the 24/7 Basic Health Unit initiative be successfully implemented at scale to provide high quality, round-the-clock skilled maternity care in its first level care facilities in remote, rural Punjab? The project will include two overlapping work packages. The first will provide a detailed understanding of the current status of the initiative and the obstacles to successful roll out. The second will identify and test potential solutions to improve implementation. Work package 1 extends from months 1-36 and consists of 3 modules. First, we will look at policy documents and interview policy makers to draw up a clear description of what the 24/7 BHU Initiative consists of and how it is meant to operate. Next, we will assess how well the initiative is being rolled out across the province. We will analyze the government routine monitoring data, alongside data from our own survey of 1500 births in up to 50 BHUs. This will provide a picture of how many BHUs are performing well and how many are not. We will also be able to examine factors that are associated with better or worse performance. Finally, we will spend 4-6 months looking closely at what is going on in 4-5 BHUs in 3 districts. Observations, interviews and group discussions with healthcare providers, managers and patients will allow us to understand in detail the factors that support, or get in the way of, successful round-the-clock service provision. We will particularly look for the ways in which successful BHUs are operating and identify any innovations that help things work better.Work package 2 extends from months 24-54 and includes two modules. First, we will conduct two workshops and engage in regular meetings with government officers and other stakeholders to discuss the detailed knowledge of the 24/7 BHU initiative generated during work package 1. We will work collectively to identify a series of promising modifications that might be feasible to roll out more widely. Next, the study team will work with Punjab Health Department senior managers to select priority "change ideas" to test. We will also identify one district and 2-3 BHUs in which to carry out a pilot. We will then test the changes in a structured way, documenting how they work in practice, and working with stakeholders to agree on next steps. We will help Punjab Health Department and local stakeholders produce a longer term plan for implementing system-wide changes that are needed to make the 24/7 BHU initiative more successful. The project will be delivered by an experienced team of researchers. Several team members have worked successfully together on previous similar research in Pakistan. Team members also have excellent links to policy-makers and senior managers who will be closely involved through a Policy and Programming Research Stakeholders Group (PPRSG). A Project Advisory Group (PAG) will also be formed, including representatives of women's organisations, to provide guidance to the project. Research findings will be shared via a range of formats tailored to policy, practice and lay audiences, as well as academic articles and conference presentations.

巴基斯坦的孕产妇死亡率一直居高不下。其政府经营的一级保健设施----基本保健单位----是贫穷和农村妇女在分娩和生产期间获得熟练护理的重要场所。然而，BHU仅在每天上午8点至下午2点开放。旁遮普省政府已经认识到，这些工作时间严重限制了获得产妇服务的机会。因此，卫生部正在实施24/7基本保健单位倡议，以提升基本保健单位，提供24小时护理。这种扩大是基于一个成功的试点项目，但初步报告显示，在推出新方法方面存在挑战。在这个为期54个月的项目中，我们将与旁遮普卫生部门和其他利益相关者密切合作，解决一个关键问题：如何成功地大规模实施24/7基本卫生单位倡议，在偏远的旁遮普农村地区的一级保健设施中提供高质量、全天候的熟练产妇护理？该项目将包括两个重叠的工作包。第一部分将详细了解该举措的现状和成功推出的障碍。第二阶段将确定和测试改进执行情况的潜在解决方案。工作包1从1月至36月，包括3个单元。首先，我们将研究政策文件并采访政策制定者，以明确描述24/7 BHU倡议的组成以及如何运作。接下来，我们将评估该举措在全省的推广情况。我们将分析政府的常规监测数据，以及我们自己对50个基本保健单位1500名新生儿的调查数据。这将提供一个图片，有多少BHU是表现良好，有多少是不。我们还将能够检查与更好或更差的性能相关的因素。最后，我们将花4-6个月的时间密切关注3个地区4-5个基本保健单位的情况。通过与医疗服务提供者、管理者和患者的观察、访谈和小组讨论，我们将详细了解支持或阻碍成功提供全天候服务的因素。我们将特别寻找成功的BHU的运作方式，并确定任何有助于更好地工作的创新。工作包2从24-54个月开始，包括两个模块。首先，我们将举办两个研讨会，并与政府官员和其他利益相关者定期举行会议，讨论工作包1期间产生的24/7 BHU倡议的详细知识。我们将共同努力，确定一系列有希望的修改，这些修改可能可以更广泛地推广。接下来，学习小组将与旁遮普省卫生厅高级管理人员一起，选择优先“转变思路”进行测试。我们还将确定一个地区和2-3个基本保健单位进行试点。然后，我们将以结构化的方式测试这些更改，记录它们在实践中的工作方式，并与利益相关者合作，就下一步达成一致。我们将帮助旁遮普省卫生部和当地利益相关者制定一项长期计划，以实施使24/7 BHU倡议更加成功所需的全系统变革。该项目将由一个经验丰富的研究人员团队提供。几名小组成员以前曾在巴基斯坦成功地进行过类似的研究。小组成员还与政策制定者和高级管理人员建立了良好的联系，他们将通过政策和方案编制研究利益攸关方小组密切参与。还将成立一个包括妇女组织代表在内的项目咨询小组，为该项目提供指导。研究结果将通过一系列针对政策、实践和非专业受众的格式以及学术文章和会议报告进行分享。

项目成果

Scaling up the "24/7 BHU" strategy to provide round-the-clock maternity care in Punjab, Pakistan: a theory-driven, coproduced implementation study.

• DOI: 10.1186/s12961-022-00944-w
• 发表时间: 2022-12-28
• 期刊: HEALTH RESEARCH POLICY AND SYSTEMS
• 影响因子: 4
• 作者: Salway, Sarah;Mumtaz, Zubia;Bhatti, Afshan;Barnes, Amy;Dawson, Jeremy;Jhangri, Gian Singh
• 通讯作者: Jhangri, Gian Singh