Virtual community health services - for equity and quality in health care in Mali

说明(申请人提供)：加强社区一级的保健方案在解决降低五岁以下儿童和孕产妇高死亡率方面发挥至关重要的作用 在非洲农村。基于社区的方法使社区卫生工作者(CHW)能够接触到家中需要护理的人，并为基于诊所的护理中可能缺乏的行为改变提供支持。解决的关键障碍是社区卫生工作者在常规项目中家访的效用和有效性有限。这一障碍是通过实施和评估虚拟社区卫生服务(VCHS)干预方案来解决的。这套干预措施包括1)战略部署CHW和移动技术投入的虚拟工作日，2)向受益人提供质量方面的即时反馈，3)每月由CHW领导的电话会议，4)改进的监督流程，以及5)移动资金激励。目的：1)制定针对社区卫生工作者的移动健康干预服务包(VCHS)，将主要联系人列为社区卫生工作者人际沟通的优先对象，转移向手机发送提醒信息的大部分负担，按孕期、子女年龄、季节调整咨询内容；2)通过准实验设计方法，评估干预服务包在扩大关键综合保健服务覆盖面和提高服务质量方面的有效性：研究将在位于巴马科西南120公里处的S�Lingu�卫生区进行。该地区包括5个社区卫生中心(CSCom)的集水区，覆盖5个卫生区，人口83 318人。在计划的第一年，我们会1)根据心理学和资讯理论发展一套量度工具，以评估家庭佣工在家访期间给予人际沟通的价值；以及2)预先测试和评估量度工具的可靠性和有效性，以评估干预措施的影响。在项目的第二年，我们将在两个卫生区(街道)实施干预方案，并评估其对关键结果的有效性，并进行过程评估，以了解干预方案的优势和劣势。伙伴关系：这项研究是约翰霍普金斯大学彭博公共卫生学院国际卫生系和巴马科大学公共卫生系之间的合作。这项研究建立在公共卫生培训以及疟疾和儿童健康研究方面的现有合作基础上。这项研究将在两年内进行，最后将在巴马科举办一次传播讲习班。调查结果将被用于倡导为这一人群提供更具响应性和更适当的社区健康。

DESCRIPTION (provided by applicant): Strengthening health programs at the community level can play a vital role in addressing reducing high levels of under-five and maternal mortality in rural Africa. Community-based approaches allow community health workers (CHWs) to reach people in need of care in their homes and to provide the support for behavior change that may be absent in clinic-based care. The critical barrier addressed is the limited utility and effectiveness of household visits by CHWs in routine programs. The barrier is addressed through implementation and evaluation of a Virtual Community Health Services (VCHS) intervention package. This package of interventions includes 1) virtual workday for strategic deployment of CHW and mobile technology inputs, 2) Immediate feedback to and from beneficiaries on quality, 3) Monthly CHW- led conference call, 4) Improved supervision processes, and 5) Mobile money incentives. Aims: 1) Develop an mHealth intervention package (VCHS) for CHWs that prioritizes key contacts for interpersonal communication by CHW, shifts much of the burden for provision of reminder messages to mobile phones, helps CHWs tailor the content of their counseling by stage of pregnancy, age of child, season; 2) Assess effectiveness of the intervention package in increasing coverage and quality of key IMCI services, through a quasi-experimental design Methods: The study will be carried out in the S�lingu� health district located 120 km south-west from Bamako. The district encompasses the catchment areas of 5 community health centers (CSCom), covering 5 health zones with a population of 83 318. In Year 1 of the project, we will 1) develop a measurement tool, informed by psychology and information theory, to assess the value assigned to interpersonal communication by CHWs during household visits; and 2) pretest and assess the reliability and validity of the measurement tools to assess intervention impact. In Year 2 of the project, we will implement the intervention package in two health zones (sub- districts) and assess its effectiveness on key outcomes, and conduct a process evaluation to understand strengths and weakness of the intervention package. Partnership: The study is a collaboration between the Johns Hopkins Bloomberg School of Public Health, Department of International Health, and the University of Bamako (USTTB), Department of Public Health. The study builds on existing collaborations in public health training and malaria and child health research. This study will be conducted over the course of two years and will conclude with a dissemination workshop in Bamako. Findings will be used for advocacy for more responsive and appropriate community health for this population.