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

描述（由申请人提供）：加强社区一级的卫生方案可以在降低五岁以下儿童和孕产妇死亡率方面发挥至关重要的作用 在非洲农村。以社区为基础的方法使社区卫生工作者（CHW）能够在家中接触到需要护理的人，并为临床护理中可能缺乏的行为改变提供支持。所解决的关键障碍是社区卫生工作者在常规方案中家访的效用和有效性有限。通过实施和评估虚拟社区卫生服务干预方案，消除了这一障碍。这套干预措施包括：1）CHW和移动的技术投入战略部署的虚拟工作日; 2）与受益人之间的质量即时反馈; 3）每月由CHW牵头的电话会议; 4）改进监督流程; 5）移动的金钱激励。目的：1）为社区卫生工作者制定移动健康干预包，优先考虑社区卫生工作者人际沟通的关键联系人，将提供提醒信息的大部分负担转移到移动的手机上，帮助社区卫生工作者根据怀孕阶段、儿童年龄和季节调整咨询内容; 2）通过准实验设计，评估干预措施在扩大儿童疾病综合管理主要服务的覆盖面和提高其质量方面的效果。这项研究将在位于巴马科西南120公里处的S林古卫生区进行。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。在项目的第一年，我们将1）开发一个基于心理学和信息论的测量工具，以评估社区卫生工作者在家访时对人际沟通的价值;以及2）预先测试和评估测量工具的可靠性和有效性，以评估干预效果。在项目的第二年，我们将在两个卫生区（分区）实施干预方案，并评估其在关键成果方面的有效性，并进行过程评估，以了解干预方案的优缺点。合作伙伴：这项研究是约翰霍普金斯彭博公共卫生学院国际卫生系和巴马科大学公共卫生系的合作。这项研究建立在公共卫生培训和疟疾及儿童健康研究的现有合作基础上。这项研究将进行两年，最后将在巴马科举办一次传播讲习班。调查结果将用于宣传更敏感和适当的社区卫生为这一人群。

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.