A Comprehensive Systems Analysis of Community Based Primary Health Care

基于社区的初级卫生保健的综合系统分析

• 批准号: 9019699
• 负责人: James Franklin Phillips
• 金额: $ 20万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-03 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9019699
• 关键词: Address; Africa South of the Sahara; Age; Age-Years; Behavior; Child; Child Mortality; Childhood; Communities; Community Health; Complex; Data; Demographic Survey; Development; Environmental Risk Factor; Evaluation; Evaluation Research; Exposure to; Fathers; Ghana; Goals; Health; Health Planning; Health Policy; Health Services; Health Services Accessibility; Health Status; Health behavior; Health care facility; Health system; Healthcare; Household; Individual; Influentials; Interview; Investments; Life; Link; Measures; Methodology; Methods; Modeling; Monitor; National Institute of Child Health and Human Development; Pattern; Policies; Primary Health Care; Procedures; Process; Public Health; Research; Resources; Rural; Science; Services; Social Environment; Social Interaction; Surveys; System; Systems Analysis; Time; United States Public Health Service; Woman; Work; advanced system; base; clinical care; contextual factors; dynamic system; geographic inaccessibility; health care service; health seeking behavior; interest; mathematical model; meetings; mortality; multilevel analysis; novel; programs; public health relevance; response; scale up; social; social health determinants; surveillance data; theories

 DESCRIPTION (provided by applicant): In sub-Saharan Africa, intense investment in community-based primary health care is aimed at reducing the high level of child mortality. Programs and policies currently promote the hiring and deployment of community health workers to village health posts. Such policies lack adequate grounding in statistically rigorous analyses of the interaction of social contextual factors with the programmatic strategies that are employed. In this setting, social systemic determinants of health behavior are highly influential i determining child survival, yet the link between health systems determinants and social system influences is often poorly understood. Moreover, socio-demographic studies fail to provide direct evidence of system strengthening effects, or to indicate which investments are most productive, because survey evaluation procedures are unconnected with service strengthening inputs. The means of optimizing health systems inputs are unassessed or only crudely elucidated by evaluation research. Therefore, the goal of our proposed research is to successfully model the complex relationships between the context of health services at the community and higher levels and the health seeking behavior of individuals and communities on child survival. The model we propose to develop will identify which health system strategies are responsible for improvements in health, given social contextual effects. We will develop and estimate a complex multilevel model of child survival and life years gained that represents a theory of health systems strengthening and health seeking behavior based on extant data from northern Ghana. This model will assess the relationship between mortality among children under five and the addition of community-engaged primary health care services during the development and scale-up of Ghana's national primary health care policy, known as the Community-based Health Planning and Services Initiative (CHPS), from 1994 to 2003. We will use existing multilevel, longitudinal data on health systems strengthening in conjunction with a decade of yearly socio-demographic survey data and demographic surveillance of over 6,000 children under five years of age in 257 communities zoned for primary health care scale-up in Ghana's Kassena-Nankana District. The proposed work will demonstrate practical means of combining survey research with programmatic monitoring data to study the impact of health systems strengthening inputs on health behavior. It will also bridge the gap between individual level behavior and service system dynamics. Using demographic methods, parameters measured through this analysis will be used to calculate child life years gained through health system investments at the community level. These data will allow us to elucidate the relationship between health system strengthening that addresses geographic inaccessibility, as well as social barriers to health care, individual and community level health behavior, and their effect on child mortality. We expect our results to provide keenly needed guidance to strategies for health systems strengthening in sub-Saharan Africa.

 描述（由申请人提供）：在撒哈拉以南非洲，对社区初级卫生保健的大量投资旨在降低儿童死亡率。目前的方案和政策鼓励雇用社区卫生工作者并将其部署到村卫生站。这些政策缺乏对社会背景因素与所采用的方案战略之间的相互作用进行严格统计分析的充分依据。在这种情况下，健康行为的社会系统性决定因素对儿童生存具有很大的影响力，但人们对健康系统决定因素和社会系统影响之间的联系往往知之甚少。此外，社会人口研究未能提供加强系统效果的直接证据，或表明哪些投资最有成效，因为调查评价程序与加强服务的投入无关。优化卫生系统投入的手段没有得到评估，或者只是通过评价研究得到粗略的说明。因此，我们提出的研究的目标是成功地模拟在社区和更高层次的健康服务的背景下，个人和社区的儿童生存的健康寻求行为之间的复杂关系。我们建议开发的模型将确定哪些卫生系统战略负责改善健康，社会背景的影响。我们将开发和估计一个复杂的儿童生存和生命年的多层次模型，代表了卫生系统的加强和健康寻求行为的基础上，从北方加纳的现存数据的理论。这一模式将评估1994年至2003年加纳国家初级保健政策（称为社区保健规划和服务倡议）制定和扩大期间五岁以下儿童死亡率与增加社区参与的初级保健服务之间的关系。我们将利用现有的关于加强卫生系统的多层次、纵向数据，结合十年来对加纳Kassena-Nankana区257个社区6 000多名五岁以下儿童的年度社会人口调查数据和人口监测，以扩大初级卫生保健规模。拟议的工作将展示将调查研究与方案监测数据相结合的实际手段，以研究卫生系统加强对卫生行为的投入的影响。它还将弥合个人水平行为与服务系统动态之间的差距。将利用人口统计方法，通过这一分析测量的参数，计算通过社区一级保健系统投资获得的儿童寿命年数。这些数据将使我们能够阐明加强卫生系统，解决地理上的不可及性，以及卫生保健的社会障碍，个人和社区层面的健康行为，以及它们对健康的影响之间的关系。 儿童死亡率。我们希望我们的研究结果能够为撒哈拉以南非洲加强卫生系统的战略提供迫切需要的指导。