Tappis Hannah, Koblinsky Marge, Winch Peter J, Turkmani Sabera, Bartlett Linda
a Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
b Office of Health, Infectious Diseases and Nutrition , United States Agency for International Development , Washington , DC , USA.
Glob Public Health. 2016;11(4):387-406. doi: 10.1080/17441692.2015.1114657. Epub 2015 Dec 8.
Reducing preventable maternal mortality and achieving Sustainable Development Goal targets for 2030 will require increased investment in improving access to quality health services in fragile and conflict-affected states. This study explores the conditions that affect availability and utilisation of intrapartum care services in four districts of Afghanistan where mortality studies were conducted in 2002 and 2011. Information on changes in each district was collected through interviews with community members; service providers; and district, provincial and national officials. This information was then triangulated with programme and policy documentation to identify factors that affect the coverage of safe delivery and emergency obstetric care services. Comparison of barriers to maternal health service coverage across the four districts highlights the complexities of national health policy planning and resource allocation in Afghanistan, and provides examples of the types of challenges that must be addressed to extend the reach of life-saving maternal health interventions to women in fragile and conflict-affected states. Findings suggest that improvements in service coverage must be measured at a sub-national level, and context-specific service delivery models may be needed to effectively scale up intrapartum care services in extremely remote or insecure settings.
降低可预防的孕产妇死亡率并实现2030年可持续发展目标，需要增加投资，以改善脆弱和受冲突影响国家获得优质卫生服务的机会。本研究探讨了影响阿富汗四个地区分娩期护理服务可及性和利用率的条件，2002年和2011年在这些地区开展了死亡率研究。通过与社区成员、服务提供者以及地区、省级和国家级官员进行访谈，收集了每个地区的变化信息。然后，将这些信息与项目和政策文件进行三角互证，以确定影响安全分娩和紧急产科护理服务覆盖范围的因素。对四个地区孕产妇保健服务覆盖障碍的比较，凸显了阿富汗国家卫生政策规划和资源分配的复杂性，并提供了一些挑战类型的实例，要将挽救生命的孕产妇保健干预措施推广到脆弱和受冲突影响国家的妇女，就必须应对这些挑战。研究结果表明，必须在国家以下层面衡量服务覆盖范围的改善情况，可能需要因地制宜的服务提供模式，以便在极其偏远或不安全的地区有效扩大分娩期护理服务。
