Guenther Tanya, Sadruddin Salim, Chimuna Tiyese, Sichamba Bias, Yeboah-Antwi Kojo, Diakite Bamody, Modibo Bamadio, Swedberg Eric, Marsh David R
Am J Trop Med Hyg. 2012 Nov;87(5 Suppl):77-84. doi: 10.4269/ajtmh.2012.11-0747.
Health planners commonly use geographic proximity to define access to health services. However, effective access to case management requires reliable access to a trained, supplied provider. We defined effective access as the proportion of the study population with geographic access, corrected for other barriers, staffing patterns, and medicine availability. We measured effective access through a cross-sectional survey of 32 health facilities in Malawi, Mali, and Zambia and modeled the potential contribution of community case management (CCM). The population living within Ministry of Health (MOH)-defined geographic access was 43% overall (range = 18-52%), but effective access was only 14% overall (range = 9-17%). Implementing CCM as per MOH plans increased geographic access to 63-90% and effective access to 30-57%. Access to case management is much worse than typically estimated by distance. The CCM increases access dramatically, again if providers are available and supplied, and should be considered even for those within MOH-defined access areas.
卫生规划者通常使用地理距离来界定获得卫生服务的机会。然而，有效获得病例管理服务需要能够切实找到经过培训且有物资供应的提供者。我们将有效获得机会定义为研究人群中在地理上有机会获得服务的比例，并对其他障碍、人员配置模式和药品供应情况进行了校正。我们通过对马拉维、马里和赞比亚的32个卫生设施进行横断面调查来衡量有效获得机会，并对社区病例管理（CCM）的潜在贡献进行了建模。卫生部界定的地理可及范围内的总人口占比总体为43%（范围 = 18 - 52%），但有效获得机会总体仅为14%（范围 = 9 - 17%）。按照卫生部计划实施社区病例管理可使地理可及范围提高到63 - 90%，有效获得机会提高到30 - 57%。获得病例管理服务的情况比通常根据距离估算的要糟糕得多。如果有可用且有物资供应的提供者，社区病例管理可大幅增加获得机会，即使对于卫生部界定的可及范围内地区的人群也应考虑实施。
