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

为提供低成本、有效的干预措施而进行的全球卫生投资显著增加，有助于 在千年发展目标结束前的25年中，五岁以下儿童死亡率下降了50%以上 2015年的目标。儿童死亡率下降的速度已经放缓，原因是新生儿死亡率高(年死亡率 出生后28天)，特别是在撒哈拉以南非洲资源匮乏的地区。在新生儿率高的国家 死亡率，提高卫生部指导方针的执行质量和覆盖面，包括 在出生时或出生前后提供的可用的循证干预措施有可能迅速启动 人口层面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他们的表现的反馈，以指导对实践的调整，并具有 有可能改进循证临床干预指南的常规实施 防止新生儿死亡。综合地区证据转化为行动(IDEAS)计划是一个多方面的、增强的计划 审计和反馈实施干预措施，旨在提高一揽子计划的覆盖面和质量 针对新生儿死亡的主要原因的现有循证临床干预措施。理念改变审计 并通过让设施、地区和省(而不是一线)的卫生管理人员参与提供反馈 隔离的卫生工作者)。此外，通过有系统地收集卫生服务准备情况来加强这一点 数据和例行分区到设施的支持性监督，为符合以下条件的设施人员提供持续支持 提供预防新生儿死亡的临床干预此应用程序的总体目标是收集 以地区管理团队为主导的理念审核与反馈干预传播证据 (而不是研究团队)，作为国家扩大的基础。我们建议在以下方面实施想法 莫桑比克中部的12个人口稠密地区，使用地区管理小组作为传播媒介， 世卫组织将在下属的卫生设施中实施这些想法。使用为期4.5年的准实验设计，混合- 方法评估干预对卫生系统响应性的影响，如 以及预防新生儿死亡的干预措施的质量和覆盖面。我们的具体目标是：目标1： 评估以地区为基础的想法干预的资助传播和实施战略，使用 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； 和目标2：通过基于活动的微观成本计算和健康结果建模，估计潜在预算和 与护理标准相比，从支付者的角度来看，计划对扩大规模的想法有影响。结果是 这项实施研究预计将产生具有全球意义的知识，并通过提供真正的- 世界实现模型的思想干预和程序相关的信息，是设计 在莫桑比克，以及更广泛的高增长国家，为未来的扩大带来快速的政策转换 新生儿死亡率和分娩系统薄弱。

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.