Spreading the Integrated District Evidence-to-Action Program for Neonatal Mortality Reduction (IDEAs) in Mozambique

全球卫生投资大幅增加，以提供低成本、有效的干预措施， 在千年发展目标结束之前的25年里， 2015年的目标。由于新生儿死亡率高，儿童死亡率下降的速度有所减缓（2005年至2009年的死亡率为1.4%）。 出生后头28天），特别是在撒哈拉以南非洲的低资源环境中。在新生儿死亡率高的国家， 提高卫生部指导方针的执行质量和覆盖面， 在出生时或出生前后提供的可用的、基于证据的干预措施有可能启动 人口水平的儿童死亡率下降停滞不前。审计和反馈方法系统地评估和 向卫生专业人员提供关于其绩效的反馈，以指导对实践的调整， 有可能改善临床干预循证指南的常规实施， 预防新生儿死亡。综合区行动证据（IDEAS）计划是一个多方面的，加强 审计和反馈实施干预，旨在提高一揽子计划的覆盖面和质量， 针对新生儿死亡主要原因的现有循证临床干预措施。IDEA修改审计 并通过让各级机构、地区和省（而不是一线）的卫生管理人员参与反馈 卫生工作者隔离）。此外，通过系统收集卫生服务准备情况， 数据和常规地区对设施的支持性监督，为设施人员提供持续支持， 提供预防新生儿死亡的临床干预措施，该应用程序的总体目标是收集 由地区管理团队领导的IDEA审计和反馈干预的传播证据 （而不是研究小组），作为国家扩大规模的基础。我们建议在下列地区推行IDEA 莫桑比克中部12个人口稠密区利用区管理队作为传播媒介， 在下属医疗机构实施IDEA的人使用4.5年的准实验设计，混合- 方法评价将用于评估干预措施对卫生系统反应能力的影响， 以及预防新生儿死亡干预措施的质量和覆盖面。我们的具体目标是：目标1： 评估一个以地区为基础的资助传播和实施战略，以促进国际发展教育评估的干预， RE-AIM模型，用于评估计划的覆盖范围、有效性、采用、实施和维护; 目标2：通过基于活动的微观成本计算和健康结果建模，估计潜在预算， 从付款人的角度来看，计划的影响，以扩大IDEA相比，护理标准。的结果 这项实施研究预计将产生具有全球意义的知识，并通过提供一个真实的- 为IDEA干预和编程相关信息设计了一个世界实施模型 在莫桑比克以及更广泛的高收入国家， 新生儿死亡率和薄弱的分娩系统。

Significant increases in global health investment to deliver low-cost, efficacious interventions contributed to an over 50% reduction in under-five mortality in the 25 years leading up to the end of the Millennium Development Goals in 2015. The rate of decline in child mortality has slowed due to high neonatal mortality (mortality in the first 28 days of life), especially in low resource settings in sub-Saharan Africa. In countries with high neonatal mortality, improving the quality and coverage of implementation of Ministry of Health guidelines that include available, evidence-based interventions delivered at or around the time of birth has the potential to jump start stalled population-level child mortality reductions. Audit and feedback approaches systematically assess and provide feedback to health professionals on their performance to guide adjustments to practice, and have the potential to improve the routine implementation of evidence-based guidelines for clinical interventions that prevent neonatal deaths. The Integrated District Evidence to Action (IDEAs) program is a multifaceted, enhanced audit and feedback implementation intervention that aims to improve the coverage and quality of a package of existing, evidence-based clinical interventions targeting major causes of neonatal mortality. IDEAs modifies audit and feedback by engaging health managers across the tiers of facility, district and province (rather than front line health workers in isolation). Furthermore, it is enhanced with systematically collected health service readiness data and routine district to facility supportive supervision to provide ongoing support to facility personnel who deliver clinical interventions that prevent neonatal deaths The overall goal of this application is to gather evidence on spreading the IDEAs audit and feedback intervention that is led by district management teams (rather than research teams), to serve as a foundation for national scale-up. We propose to implement IDEAs in 12 high population districts in central Mozambique using district management teams as disseminating agents, who will implement IDEAs in subordinate health facilities. Using a 4.5-year quasi-experimental design, a mixed- methods evaluation will be used to assess the impact of the intervention on health system responsiveness, as well as quality and coverage of interventions to prevent neonatal deaths. Our specific aims are to: Aim 1: Evaluate a funded district-based dissemination and implementation strategy for the IDEAs intervention, using the RE-AIM model to assess the program’s Reach, Effectiveness, Adoption, Implementation, and Maintenance; and Aim 2: Via activity based micro-costing and health outcomes modeling, estimate the potential budget and program impact from the payer perspective to scale-up IDEAs compared to the standard of care. The results of this implementation research are expected to generate knowledge of global significance, and by providing a real- world implementation model for the IDEAs intervention and programmatically relevant information, is designed to lead to rapid policy translation for future scale-up in Mozambique, and more broadly in countries with high neonatal mortality and weak delivery systems.