Murray S F, Davies S, Phiri R K, Ahmed Y
Institute of Child Health, University College London, London, UK.
Health Policy Plan. 2001 Dec;16(4):353-61. doi: 10.1093/heapol/16.4.353.
It is widely accepted that substantial reductions in maternal mortality and severe morbidity are impossible to achieve without an effective referral system for complicated cases. Early detection and referral to higher levels of care might also substantially reduce neonatal deaths due to the complications of childbirth. The general goal of such a referral system is that patients are dealt with in the right place with effective treatment provided at the minimum of cost. There are real challenges, however, in monitoring the effectiveness of such referral systems once put in place. This paper describes some of the tools used to review pregnancy-related referrals in Lusaka, Zambia. The tool-mix used provided information for monitoring five different aspects of the referral system: the distribution of births across levels of facility and population coverage; the use of essential obstetric care (EOC) level facilities by women with complications; the progress towards a reduction of maternal mortality at referral facility level; inappropriate use of EOC level facility; and perinatal outcomes at peripheral facility level. Apart from the information on coverage, the data came from routinely collected facility statistics, registers and medical notes. Findings for Lusaka are reported. Consideration is given to issues of interpretation of specific indicators, and to how such tools might be used in conjunction with others, in order to help district managers to monitor the effectiveness of district maternity referral systems.
人们普遍认为，如果没有针对复杂病例的有效转诊系统，就不可能大幅降低孕产妇死亡率和严重发病率。早期发现并转诊至更高水平的医疗机构，也可能大幅减少分娩并发症导致的新生儿死亡。这种转诊系统的总体目标是，让患者在合适的地方接受治疗，并以最低成本提供有效治疗。然而，一旦建立起这样的转诊系统，在监测其有效性方面存在实际挑战。本文介绍了赞比亚卢萨卡用于审查与妊娠相关转诊的一些工具。所使用的工具组合提供了用于监测转诊系统五个不同方面的信息：不同级别医疗机构的分娩分布情况和人口覆盖范围；有并发症的妇女对基本产科护理（EOC）级别的医疗机构的使用情况；在转诊医疗机构层面降低孕产妇死亡率方面的进展；对EOC级别医疗机构的不当使用；以及基层医疗机构层面的围产期结局。除了覆盖范围信息外，数据来自常规收集的医疗机构统计数据、登记簿和病历。报告了卢萨卡的调查结果。考虑了特定指标的解释问题，以及如何将这些工具与其他工具结合使用，以帮助地区管理人员监测地区孕产妇转诊系统的有效性。
