Universidade Federal de Pelotas, Pelotas 96001-970, Brazil.
BMC Pregnancy Childbirth. 2010 Feb 23;10 Suppl 1(Suppl 1):S4. doi: 10.1186/1471-2393-10-S1-S4.
The efficacious interventions identified in the previous article of this report will fail unless they are delivered at high and equitable coverage. This article discusses critical delivery constraints and strategies.
Achieving universal coverage entails addressing major barriers at many levels. An overarching constraint is the lack of political will, resulting from the dearth of preterm birth and stillbirth data and the lack of visibility. Other barriers exist at the household and community levels, such as insufficient demand for interventions or sociocultural barriers; at the health services level, such as a lack of resources and trained healthcare providers; and at the health sector policy and management level, such as poorly functioning, centralized systems. Additional constraints involve weak governance and accountability, political instability, and challenges in the physical environment.
Scaling up maternal, newborn and child health interventions requires strengthening health systems, but there is also a role for focused, targeted interventions. Choosing a strategy involves identifying appropriate channels for reaching high coverage, which depends on many factors such as access to and attendance at healthcare facilities. Delivery channels vary, and may include facility- and community-based healthcare providers, mass media campaigns, and community-based approaches and marketing strategies. Issues related to scaling up are discussed in the context of four interventions that may be given to mothers at different stages throughout pregnancy or to newborns: (1) detection and treatment of syphilis; (2) emergency Cesarean section; (3) newborn resuscitation; and (4) kangaroo mother care. Systematic reviews of the literature and large-scale implementation studies are analyzed for each intervention.
Equitable and successful scale-up of preterm birth and stillbirth interventions will require addressing multiple barriers, and utilizing multiple delivery approaches and channels. Another important need is developing strategies to discontinue ineffective or harmful interventions. Preterm birth and stillbirth interventions must also be placed in the broader maternal, newborn and child health context to identify and prioritize those that will help improve several outcomes at the same time. The next article discusses advocacy challenges and opportunities.
除非这些干预措施能够以高覆盖率和公平覆盖的方式实施，否则之前报告中的有效干预措施将无法发挥作用。本文讨论了关键的实施障碍和策略。
实现普遍覆盖需要在多个层面上解决主要障碍。一个普遍的制约因素是缺乏政治意愿，这是由于缺乏早产和死产数据以及缺乏可见性所致。其他障碍存在于家庭和社区层面，如干预措施的需求不足或社会文化障碍；在卫生服务层面，如资源和训练有素的医疗保健提供者不足；以及在卫生部门政策和管理层面，如运作不佳、集中化的系统。其他限制因素包括薄弱的治理和问责制、政治不稳定以及自然环境的挑战。
扩大孕产妇、新生儿和儿童健康干预措施需要加强卫生系统，但也需要有针对性的重点干预措施。选择策略涉及确定实现高覆盖率的适当渠道，这取决于许多因素，如获得和参加医疗保健设施的机会。提供渠道各不相同，可能包括医疗机构和社区卫生提供者、大众媒体宣传活动以及社区方法和营销战略。本文在讨论可能在整个孕期的不同阶段给予母亲或新生儿的四项干预措施的背景下，讨论了扩大规模的相关问题：（1）梅毒的检测和治疗；（2）紧急剖宫产；（3）新生儿复苏；（4）袋鼠式护理。对文献的系统评价和大规模实施研究进行了分析。
公平和成功地扩大早产和死产干预措施的规模，需要解决多种障碍，并利用多种提供方法和渠道。另一个重要需求是制定策略来停止无效或有害的干预措施。还需要将早产和死产干预措施置于更广泛的孕产妇、新生儿和儿童健康背景下，以确定和优先考虑那些同时有助于改善多个结果的干预措施。下一篇文章讨论了宣传方面的挑战和机遇。
