University College, London, UK.
BMC Pregnancy Childbirth. 2012 Jan 24;12:5. doi: 10.1186/1471-2393-12-5.
Program coverage is likely to be an important determinant of the effectiveness of community interventions to reduce neonatal mortality. Rigorous examination and documentation of methods to scale-up interventions and measure coverage are scarce, however. To address this knowledge gap, this paper describes the process and measurement of scaling-up coverage of a community mobilisation intervention for maternal, child and neonatal health in rural Bangladesh and critiques this real-life experience in relation to available literature on scaling-up.
Scale-up activities took place in nine unions in rural Bangladesh. Recruitment and training of those who deliver the intervention, communication and engagement with the community and other stakeholders and active dissemination of intervention activities are described. Process evaluation and population survey data are presented and used to measure coverage and the success of scale-up.
The intervention was scaled-up from 162 women's groups to 810, representing a five-fold increase in population coverage. The proportion of women of reproductive age and pregnant women who were engaged in the intervention increased from 9% and 3%, respectively, to 23% and 29%.
Examination and documentation of how scaling-up was successfully initiated, led, managed and monitored in rural Bangladesh provide a deeper knowledge base and valuable lessons.Strong operational capabilities and institutional knowledge of the implementing organisation were critical to the success of scale-up. It was possible to increase community engagement with the intervention without financial incentives and without an increase in managerial staff. Monitoring and feedback systems that allow for periodic programme corrections and continued innovation are central to successful scale-up and require programmatic and operational flexibility.
项目覆盖范围可能是减少新生儿死亡率的社区干预措施有效性的一个重要决定因素。然而，对于扩大干预措施和衡量覆盖范围的方法，严格的审查和记录却很少。为了解决这一知识空白，本文描述了在孟加拉国农村地区扩大一项针对母婴和新生儿健康的社区动员干预措施覆盖范围的过程和衡量方法，并根据现有扩大规模文献对这一真实经验进行了评价。
扩大规模活动在孟加拉国的 9 个联盟中进行。描述了对提供干预措施的人员的招聘和培训、与社区和其他利益攸关方的沟通和参与以及干预活动的积极传播。介绍了过程评估和人口调查数据，并用于衡量覆盖范围和扩大规模的成功。
该干预措施从 162 个妇女团体扩大到 810 个，使人口覆盖范围增加了五倍。参与干预的育龄妇女和孕妇的比例分别从 9%和 3%增加到 23%和 29%。
对孟加拉国农村地区如何成功启动、领导、管理和监测扩大规模的审查和记录提供了更深入的知识基础和宝贵经验。实施组织的强大运营能力和机构知识对扩大规模的成功至关重要。在没有财务激励和管理人员增加的情况下，有可能增加社区对干预措施的参与度。监测和反馈系统允许定期进行方案调整和持续创新，是成功扩大规模的核心，需要方案和运营灵活性。
