Ipas, Chapel Hill, NC, USA.
Int J Gynaecol Obstet. 2011 Dec;115(3):316-21. doi: 10.1016/j.ijgo.2011.09.003. Epub 2011 Oct 21.
To implement the Safe Abortion Care (SAC) model in public health facilities in the Tigray region of Ethiopia and document the availability, utilization, and quality of SAC services over time.
The project oriented providers in 50 public health facilities in Tigray to the SAC model. Changes in SAC indicators between baseline and endline were assessed using a retrospective review of procedure logbooks at baseline and prospective monitoring of procedure logbooks for facility performance after introduction of the SAC model.
Availability of SAC services increased from 39% to 86% of the recommended number of 5 facilities per 500000 population, primarily as a result of functional improvements at health centers. Decentralization was accompanied by a 94% increase in the annualized number of women who received services. The proportion of uterine evacuation procedures for induced abortion rose from 7% to 60% (P<0.01), and the proportion performed with recommended technology increased from 30% to 85% (P<0.01). The proportion of abortion patients who received modern contraception also increased from 31% to 78% (P<0.01).
While widespread service delivery improvements were recorded using the SAC monitoring approach, the project design was built around existing programmatic activities of the local health authority and reflects some related research limitations. For example, there was no comparison group of facilities, timing did not allow for prospective collection of the baseline data before the intervention, and facilities received different levels of monitoring support.
Using the SAC model, public health facilities tracked progress and made needed adjustments, which improved service delivery. Continued focus on critical safe abortion care elements should increase the availability, quality, and use of life-saving care to reduce preventable abortion mortality in the region.
在埃塞俄比亚提格雷地区的公共卫生机构实施安全人工流产护理（SAC）模式，并记录 SAC 服务的提供、利用和质量随时间的变化情况。
该项目引导提格雷地区的 50 家公共卫生机构采用 SAC 模式。通过回顾基线时的程序登记本和引入 SAC 模式后对设施绩效的前瞻性监测，评估 SAC 指标在基线和终线之间的变化情况。
SAC 服务的提供从每 50 万人口 5 个设施的建议数量的 39%增加到 86%，这主要是由于卫生中心的功能得到改善。权力下放伴随着接受服务的妇女人数年化增长率达到 94%。因人工流产而进行的子宫排空手术的比例从 7%上升到 60%（P<0.01），且采用推荐技术的比例从 30%上升到 85%（P<0.01）。接受现代避孕措施的人工流产患者比例也从 31%上升到 78%（P<0.01）。
虽然使用 SAC 监测方法记录了广泛的服务提供改进，但项目设计是围绕当地卫生当局的现有计划活动构建的，反映了一些相关研究的局限性。例如，没有设施的对照组，时间上不允许在干预前前瞻性地收集基线数据，并且各设施获得的监测支持水平不同。
公共卫生机构使用 SAC 模式跟踪进展并进行必要的调整，从而改善了服务提供。继续关注关键的安全人工流产护理要素应增加救命护理的提供、质量和利用，以减少该地区可预防的人工流产死亡。
