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/T023481/2
• 负责人: Tolib Mirzoev
• 金额: $ 93.54万
• 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: 2021
• 资助国家: 英国
• 起止时间: 2021 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FT023481%2F2
• 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提高服务利用率，改善卫生成果。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（LMICs），尽管取得了重大进展，孕产妇健康仍然是国际和国家的优先事项，在加纳和越南是非常不公平的。然而，在怀孕和产后的心理健康往往被忽视的同时，更主流的孕产妇保健优先事项，这是一个挑战，响应卫生系统应有效地address.This研究旨在提高卫生系统响应被忽视的弱势群体在中低收入国家的健康需求。我们将探讨关键行为者（人，医疗保健提供者，管理人员）的响应解释，为卫生系统干预措施的设计，实施和试点测试提供信息，使系统更能满足弱势群体妇女的孕产妇，包括被忽视的心理健康需求。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转让的最佳实践提供了很好的案例，政策制定者对这两个国家很感兴趣，我们的密切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，我们将在地区医院、2 - 4个初级保健设施和社区进行干预。然而，我们也将与地区/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、复制性和规模性。这项为期42个月的研究将以理论为导向，利用我们在现实主义方法方面的专业知识，将包括三个阶段：在第一阶段，我们将了解行动者对响应性卫生系统的期望，根据现实主义综合文献，将制定初步工作理论，确定干预措施的关键优先事项，并制定基线。我们会审阅有关文件及分析设施纪录，并进行深入访问、焦点小组及社区调查。数据将采用回溯法进行分析。在第二阶段，我们将共同制作对背景敏感的干预措施。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，将这些与响应能力和我们的初始理论联系起来。这些将为每个地区与主要行为者举行的会议提供信息，以共同制定干预措施，这些干预措施将由地区卫生领导人领导，并由研究人员提供便利和记录。这些干预措施将侧重于利用与工作人员和社区的低成本参与性和互动性讲习班，改善我们框架内的内部和外部互动。在第三阶段，我们将根据当地情况实施和评估干预措施。将通过现有结构和程序实施。在评估中，我们将通过调整和扩展第一阶段的方法，将计划的干预措施与实际绩效进行比较，以测试我们的理论。地方、区域和国家决策者将全程参与，使用嵌入式方法进行研究和开发。关键研究的成果和影响将是双重的：（1）提高卫生系统对弱势群体复杂卫生需求的响应能力，从而有助于改善加纳和越南的卫生公平性;（2）建立一个基于实践和理论的干预措施背景、机制和结果之间复杂关系的模型，沿着可推广的最佳做法，以实现可扩展性（即在类似情况下的扩展）和可推广性（即扩展到不同情况，如其他卫生领域和其他国家），促进今后加强卫生系统。

项目成果

A critical interpretive synthesis of migrants' experiences of the Australian health system.

• DOI: 10.1186/s12939-022-01821-2
• 发表时间: 2023-01-09
• 期刊: International journal for equity in health
• 影响因子: 4.8
• 作者: Lakin K;Kane S
• 通讯作者: Kane S

Using the WHO Self-Reporting Questionnaire-20 (SRQ-20) to Detect Symptoms of Common Mental Disorders among Pregnant Women in Vietnam: a Validation Study.

• DOI: 10.2147/ijwh.s404993
• 发表时间: 2023
• 期刊: International journal of women's health

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

"We can't expect much": Childbearing women's 'horizon of expectations' of the health system in rural Vietnam

• DOI: 10.1016/j.healthplace.2023.103166
• 发表时间: 2023-12-14
• 期刊: HEALTH & PLACE
• 影响因子: 4.8
• 作者: Lakin，Kimberly;Ha，Dinh Thu;Kane，Sumit
• 通讯作者: Kane，Sumit

Burden of mental health problems among pregnant and postpartum women in sub-Saharan Africa: systematic review and meta-analysis protocol.

• DOI: 10.1136/bmjopen-2022-069545
• 发表时间: 2023-06-07
• 期刊: BMJ open
• 影响因子: 2.9