Valadez Joseph J, Hage Jerald, Vargas William
Global HIV/AIDS Monitoring and Evaluation Support Team, Global HIV/AIDS Program, The World Bank, Mail Stop G8-802, 1818 H Street NW, Washington, DC, USA.
Soc Sci Med. 2005 Sep;61(6):1356-68. doi: 10.1016/j.socscimed.2005.02.002. Epub 2005 Apr 26.
Few studies of community interventions examine independent effects of investments in: (1) capital (i.e., physical, human and social capital), and (2) management systems (e.g., monitoring and evaluation systems (M&E)) on maternal and child health behavior change. This paper does this in the context of an inter-organizational network. In Nicaragua, international non-governmental organizations (NGOs) and local NGOs formed the NicaSalud Federation. Using Lot Quality Assurance Sampling (LQAS), 14 member organizations took baselines measures of maternal safe motherhood and child health behavior indicators during November 1999 and August 2000, respectively, and final evaluation measures in December 2001. In April 2002, retrospective interviews were conducted with supervisors and managers in the 14 organizations to explore changes made to community health strategies, factors associated with the changes, and impacts they attributed to participating in NicaSalud. Physical capital (density of health huts), human capital (density and variety of paramedical personnel) and social capital (density of health committees) were associated with pregnant women attending antenatal care (ANC) 3+ times, and/or retaining ANC cards. The variety of paramedic personnel was also associated with women making post-partum visits to clinics. Physical capital (density of health huts) and social capital (density of health committees and mothers' clubs) were associated with child diarrhea case management indicators. One safe motherhood indicator (delivery of babies by a clinician) was not associated with intervention strategies. At the management level, NicaSalud's training of members to use LQAS for M&E was associated with the number of strategic and tactical changes they subsequently made to interventions (organizational learning). Organizational learning was related to changes in maternal and child health behaviors of the women (including changes in the proportion using post-partum care). As the latter result would not have occurred without NicaSalud, we conclude that this inter-organizational network provided added value by instigating organizational learning.
（1）资本（即物质资本、人力资本和社会资本），以及（2）管理系统（如监测和评估系统（M&E））对母婴健康行为改变的影响。本文在一个组织间网络的背景下进行了此项研究。在尼加拉瓜，国际非政府组织（NGO）和当地非政府组织组成了尼加萨尔ud联合会。14个成员组织分别在1999年11月和2000年8月使用批量质量保证抽样（LQAS）对孕产妇安全孕产和儿童健康行为指标进行了基线测量，并于2001年12月进行了最终评估测量。2002年4月，对这14个组织的主管和经理进行了回顾性访谈，以探讨社区卫生战略的变化、与这些变化相关的因素，以及他们认为参与尼加萨尔ud所带来的影响。物质资本（卫生站密度）、人力资本（辅助医务人员的密度和种类）和社会资本（卫生委员会的密度）与孕妇进行3次及以上产前检查和/或保留产前检查卡有关。辅助医务人员的种类也与妇女产后到诊所就诊有关。物质资本（卫生站密度）和社会资本（卫生委员会和母亲俱乐部的密度）与儿童腹泻病例管理指标有关。一项安全孕产指标（由临床医生接生）与干预策略无关。在管理层面，尼加萨尔ud对成员进行的使用LQAS进行监测和评估的培训与他们随后对干预措施所做的战略和战术变化数量（组织学习）有关。组织学习与妇女的母婴健康行为变化（包括使用产后护理比例的变化）有关。由于如果没有尼加萨尔ud，后一个结果就不会出现，我们得出结论，这个组织间网络通过促进组织学习提供了附加价值。
