Improving neonatal health in remote rural areas in China and Vietnam

在中国和越南，新生儿(出生前4周)的健康仍然是一个严重的问题，特别是在农村地区，他们死亡的可能性是更发达地区的3到4倍。大多数新生儿可以在设施和社区一级通过成本效益高的干预措施进行治疗，这不需要高水平的培训或昂贵的设备。在最贫穷地区实现这些干预措施的高覆盖率可以将新生儿死亡人数减少至少70%。虽然中国和越南在国家和地方各级都有NH实践指南，以指导适当的护理和治疗，但一个主要问题是指南的执行不力。这项发展研究将评估与当地卫生管理人员一起使用参与式问题解决干预措施来改善NH指南实施的可行性。如果可行，它将为设计一项全面研究提供信息，以评估干预的有效性。在这项全面研究中，研究小组将透过解决问题和规划工作坊、辅导和能力发展，为当地健康管理人员提供支援，以(1)评估现行指引的成效；(2)找出改善实施服务的障碍(例如，劳动力问题、交通、设备和用品)和服务需求(受远程接达和传统信念的限制)；(3)在现有资源限制下，制订可行的策略，例如重组服务和劳动力，以及使用适当的社区参与模式，以刺激对改善服务的需求；以及4)开发适当的方法来监控影响和意外后果。中国和越南农村发展研究必须解决4个问题：1.当前的卫生服务管理做法和在不同系统层面上为改善卫生保健成果而进行决策的自由度是什么？2.制定或加强社区行动以支持改善卫生保健成果的机会是什么？3.监测卫生保健成果和衡量不同卫生系统各级干预措施的成本效益的潜力有多大？4.地方管理人员使用参与性问题解决干预措施来实施现有的实践指南以改善覆盖社区的卫生保健成果的可行性是什么？我们计划在北京举办为期两天的研讨会，以完善我们的现场工作计划和数据收集工具，并进行3次全国关键信息者访谈(KIIS)。然后，我们将使用4种方法在贵州收集数据：(I)KIIS：社区代表、当地卫生服务管理者、一线卫生工作者和省级政策制定者和高级卫生官员；(Ii)焦点小组讨论：最近的母亲和社区成员；(Iii)对社区行动协议和省/国家政策和计划的文件审查；(Iv)观察卫生管理信息系统和会计系统。一个较小的研究小组将在越南泰阮重复这一数据收集方案，然后分析两个国家的数据集。这将为设计全面研究提供信息，并促进利益相关者的参与。我们将产生三项成果：监测偏远地区的卫生服务；监测偏远的中国和越南的卫生服务的可行性；以及改善卫生服务的国家政策空间和地方决策自由。三级利益攸关方将受益：当地(卫生服务管理人员和工作人员)、国家(中国妇幼保健中心和越南NH技术工作组的政策制定者)和国际(例如联合国儿童基金会、世卫组织、PMNCH和世卫组织领导的实施研究平台等实施科学组织)。

Newborn (first 4 weeks of life) health remains a significant problem in China and Vietnam, especially in rural areas where they are 3 to 4 times more likely to die than in more developed areas. Most newborns can be treated with cost-effective interventions at facility and community levels, which do not require high-level training or costly equipment. Achieving high coverage of these interventions in the poorest areas could reduce neonatal deaths by at least 70%. While NH practice guidelines exist in China and Vietnam at national and local levels to guide on appropriate care and treatment, a major problem is ineffective implementation of the guidelines.This development study will assess the feasibility of using a participatory problem-solving intervention with local health managers to improve NH guideline implementation. If feasible, it will inform the design of a full-scale study to evaluate the effectiveness of the intervention. In the full-scale study, the research team would support local health managers through problem-solving and planning workshops, mentoring and capacity development to (1) assess the effectiveness of current guidelines; (2) identify barriers to improved implementation relating to service delivery (e.g. workforce issues, transport, equipment and supplies) and service demand (limited by remote access and traditional beliefs); (3) develop feasible strategies within current resource constraints e.g. re-organising services and the workforce, and using suitable community engagement models to stimulate demand for improved services; and 4) develop appropriate methods to monitor impact and unintended consequences.To assess the intervention's feasibility in remote, rural China and Vietnam the development study must address 4 questions:1. What are the current health service management practices and the degree of freedom for decision-making at different systems levels for improving NH outcomes?2. What are the opportunities for developing or strengthening community actions to support improved NH outcomes?3. What is the potential for monitoring NH outcomes and measuring cost-effectiveness of interventions at different health systems levels?4. What is the feasibility for local managers to use a participatory problem-solving intervention to implement existing practice guidelines for improving NH outcomes covering community, primary and referral levels and what would be the best vehicle for the intervention?We plan to conduct desk-based reviews of NH practice guidelines, challenges of monitoring NH impact in remote areas and NH intervention cost-effectiveness, before holding a 2-day workshop in Beijing to refine our field work plan and data collection tools and conduct 3 national key informant interviews (KIIs). We will then collect data in Guizhou, China using 4 methods: (i) KIIs: community level representatives, local health service managers, frontline health workers and provincial level policy makers and senior health officials; (ii) focus group discussions: recent mothers and community members; (iii) document review of community action agreements and provincial/national policies and plans; (iv) observation of health management information systems (HMIS) and accounting systems. A smaller research team will repeat this data collection protocol in Tay Nguyen, Vietnam, before analysing the two country datasets.This will inform the design the full-scale study and facilitate stakeholder engagement. We will produce 3 outputs on monitoring NH services in remote areas; practicalities of monitoring NH in remote China and Vietnam; and national policy space and local decision making freedom to improve NH services. Three levels of stakeholders will benefit: local (health service managers and staff), national (policy makers in China's MCH centres and Vietnam's NH technical working group) and international (e.g. Unicef, WHO, PMNCH and implementation science groups like WHO-led Implementation Research Platform).