Peters Grace, Doctor Henry, Afenyadu Godwin, Findley Sally, Ager Alastair
Program for the Revitalization of Routine Immunization-Maternal Neonatal Child Health Initiative, Mallam Bakatsine Street, Nassarawa GRA, Kano, Nigeria and Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, NY 10032, USA.
Program for the Revitalization of Routine Immunization-Maternal Neonatal Child Health Initiative, Mallam Bakatsine Street, Nassarawa GRA, Kano, Nigeria and Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, NY 10032, USAProgram for the Revitalization of Routine Immunization-Maternal Neonatal Child Health Initiative, Mallam Bakatsine Street, Nassarawa GRA, Kano, Nigeria and Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, NY 10032, USA.
Health Policy Plan. 2014 Aug;29(5):642-9. doi: 10.1093/heapol/czt052. Epub 2013 Jul 26.
Topographical, cultural, socio-economic and developmental factors combine to create significant barriers to health services delivery in areas of Northern Nigeria, resulting in poor health outcomes in states such as Katsina. The Katsina State Ministry of Health has introduced a mobile clinic service to provide primary health care to particularly inaccessible communities. This study reports early evidence of beneficiary and provider perceptions of the service, and indicators of initial coverage.
Key informant interviews were held with community leaders and service providers from communities receiving mobile clinic services from across six local government areas (LGAs), selected to represent diversity of conditions across the state. Exit interviews were conducted with 455 service users across three sites. Data on utilization were collated from routine service records and from a survey of a representative sample of households across the six LGAs.
Beneficiaries reported high levels of satisfaction with respect to most aspects of the mobile clinic service. However, there was significant variation in ratings of service quality. Concerns for beneficiaries included the lack of privacy provided, waiting times and lack of guidance on follow-up care. Providers of the service reported high levels of satisfaction with the work, highlighting the reach of services and the teamwork involved. Antenatal care (ANC) coverage of 30% of pregnant women-well above the average for the northern states-was achieved in one LGA, though much lower rates were secured elsewhere.
Data indicate that while services are generally well-received there are clear opportunities for strengthening quality of service provision. Improved service supervision and monitoring-potentially linked to performance-based financing mechanisms-promise to raise general quality of care to that demonstrated as attainable in the best performing LGAs. Provider reports suggesting high levels of motivation are notable in a general healthcare work environment with high rates of absenteeism.
地形、文化、社会经济和发展因素共同构成了尼日利亚北部地区卫生服务提供的重大障碍，导致卡齐纳等州的健康状况不佳。卡齐纳州卫生部推出了一项流动诊所服务，为特别难以到达的社区提供初级卫生保健。本研究报告了受益人和提供者对该服务的看法的早期证据以及初始覆盖指标。
与来自六个地方政府区域（LGA）接受流动诊所服务的社区的社区领袖和服务提供者进行了关键信息访谈，这些区域的选择旨在代表该州不同的情况。在三个地点对455名服务使用者进行了出院访谈。利用常规服务记录以及对六个LGA中有代表性的家庭样本进行的调查，整理了关于服务利用的数据。
受益人对流动诊所服务的大多数方面表示高度满意。然而，服务质量评级存在显著差异。受益人关注的问题包括缺乏隐私、等待时间以及后续护理缺乏指导。该服务的提供者对工作表示高度满意，强调了服务的覆盖范围和团队合作。在一个LGA中，30%的孕妇获得了产前护理（ANC）——远高于北部各州的平均水平——尽管其他地方的比例要低得多。
数据表明，虽然服务总体上受到好评，但在加强服务提供质量方面仍有明显机会。改进服务监督和监测——可能与基于绩效的融资机制相关——有望将总体护理质量提高到表现最佳的LGA所达到的水平。在旷工率很高的一般医疗工作环境中，提供者报告显示出高度的积极性，这一点值得注意。
