Improving health systems responsiveness to neglected health needs of vulnerable groups in Ghana and Vietnam

提高卫生系统对加纳和越南弱势群体被忽视的健康需求的响应能力

• 批准号: MR/T023481/1
• 负责人: Tolib Mirzoev
• 金额: $ 103.17万
• 依托单位: University of Leeds
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2020
• 资助国家: 英国
• 起止时间: 2020 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FT023481%2F1
• 关键词: Improving; health; systems; responsiveness; neglected

Responsive health systems improve utilisation of services and improve health outcomes. Yet, it is a least studied health systems goal, especially in low- and middle-income countries (LMICs).Despite significant progress, maternal health remains an international and national priority, and is highly inequitable in Ghana and Vietnam. However, mental health in pregnancy and postpartum are often neglected alongside the more mainstream maternal health priorities; this represents a challenge which responsive health systems should effectively address.This study seeks to improve health systems responsiveness to neglected health needs of vulnerable groups in LMICs. We will explore interpretations of responsiveness by key actors (people, healthcare providers, managers) to inform the design, implementation and pilot-testing of health systems interventions to make systems more responsive to the maternal, including neglected mental, health needs of women from vulnerable groups. We will work in Ghana and Vietnam, which were selected because their different commonalities and differences provide excellent cases for cross-country comparisons and developing transferable best practices, there is high interest from policymakers and our strong collaborations which will enhance South-South exchange and learning. In each country, we will select two districts. Within each district, we will intervene at district hospital, 2-4 primary health care facilities and communities. However, we will also engage with key decision-makers at the regional/province and national levels to maximise the interventions' sustainability, replication and scaling up.This 42-months study will be theory-driven, utilising our expertise in the realist approach and will include three Phases: In Phase 1 we will understand actors' expectations of responsive health systems, drawing on literature from realist synthesis will develop an initial working theory, will identify key priorities for the interventions and generate a baseline. We will review relevant documents and analyse facility records, conduct in-depth interviews, focus groups and community survey. Data will be analysed using a retroductive approach.In Phase 2, we will co-produce the context-sensitive interventions. We will consolidate, adapt and extend our experiences in Ghana and Vietnam to address key priority areas from Phase 1, relating these to responsiveness and our initial theory. These will inform meetings in each district with key actors to co-produce the interventions, to be led by the district health leadership and facilitated and documented by researchers. The interventions will focus on improving internal and external interactions from our framework, using low-cost participatory and interactive workshops with staff and communities. In Phase 3, we will implement and evaluate the interventions within local contexts. The implementation will be conducted through existing structures and processes. In the evaluation, we will test our theory through comparing the planned to the actual performance of the interventions through adapting and extending Phase 1 methods.Local, regional and national decision-makers will be engaged throughout, using the embedded approach to research and development. The key study's outcomes and impact will be two-fold: (1) improved health systems responsiveness to the complex health needs of vulnerable groups and therefore contribution to improved health equity in Ghana and Vietnam and (2) an empirically-grounded and theoretically-informed model of complex relations between the contexts, mechanisms and outcomes of the interventions, along with transferable best practices for scalability (i.e. expansion within similar contexts) and generalisability (i.e. expansion to different contexts, such as other health areas and other countries) for future health systems strengthening.

反应灵敏的卫生系统可以提高服务的利用率并改善健康结果。然而，这是一个研究最少的卫生系统目标，特别是在低收入和中等收入国家 (LMIC)。尽管取得了重大进展，孕产妇保健仍然是国际和国家的优先事项，并且在加纳和越南非常不公平。然而，与更主流的孕产妇健康优先事项相比，孕期和产后的心理健康往往被忽视；这是卫生系统应有效应对的挑战。本研究旨在提高卫生系统对中低收入国家弱势群体被忽视的健康需求的响应能力。我们将探讨关键参与者（人员、医疗保健提供者、管理人员）对响应能力的解释，为卫生系统干预措施的设计、实施和试点测试提供信息，使系统能够更好地满足孕产妇的需求，包括弱势群体妇女被忽视的心理和健康需求。我们将在加纳和越南开展工作，之所以选择这两个国家，是因为它们不同的共性和差异为跨国比较和开发可移植的最佳实践提供了极好的案例，政策制定者对此高度感兴趣，而且我们的强有力的合作将加强南南交流和学习。在每个国家，我们将选择两个地区。在每个地区内，我们将在地区医院、2-4个初级卫生保健机构和社区进行干预。然而，我们还将与地区/省和国家层面的关键决策者合作，以最大限度地提高干预措施的可持续性、复制性和扩大规模。这项为期 42 个月的研究将以理论为驱动，利用我们在现实主义方法方面的专业知识，并将包括三个阶段：在第一阶段，我们将了解行动者对响应型卫生系统的期望，借鉴现实主义综合文献，将制定初步工作理论，确定干预措施的关键优先事项。 干预措施并生成基线。我们将审查相关文件并分析设施记录，进行深入访谈、焦点小组和社区调查。将使用追溯方法对数据进行分析。在第二阶段，我们将共同制定情境敏感的干预措施。我们将巩固、调整和扩展我们在加纳和越南的经验，以解决第一阶段的关键优先领域，将这些领域与响应能力和我们的初步理论联系起来。这些将为每个地区与主要参与者举行的会议提供信息，以共同制定干预措施，由地区卫生领导层领导并由研究人员协助和记录。干预措施将侧重于通过与员工和社区举办低成本的参与性和互动研讨会，改善我们框架内的内部和外部互动。在第三阶段，我们将在当地情况下实施和评估干预措施。该实施将通过现有的结构和流程进行。在评估中，我们将通过调整和扩展第一阶段的方法，通过比较干预措施的计划与实际绩效来检验我们的理论。地方、区域和国家决策者将全程参与，使用嵌入式研究和开发方法。这项关键研究的成果和影响将有两个方面：(1) 提高卫生系统对弱势群体复杂健康需求的响应能力，从而有助于改善加纳和越南的健康公平；(2) 干预措施的背景、机制和结果之间的复杂关系的基于经验和理论的模型，以及可转移的可扩展性（即在类似背景下扩展）和普遍性的最佳实践 （即扩展到不同的背景，例如其他卫生领域和其他国家）以加强未来的卫生系统。

项目成果

Realist evaluation to improve health systems responsiveness to neglected health needs of vulnerable groups in Ghana and Vietnam: Study protocol.

• DOI: 10.1371/journal.pone.0245755
• 发表时间: 2021
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Mirzoev T;Manzano A;Ha BTT;Agyepong IA;Trang DTH;Danso-Appiah A;Thi LM;Ashinyo ME;Vui LT;Gyimah L;Chi NTQ;Yevoo L;Duong DTT;Awini E;Hicks JP;Cronin de Chavez A;Kane S
• 通讯作者: Kane S