Deconinck Hedwig, Hallarou Mahaman, Criel Bart, Donnen Philippe, Macq Jean
Institut de recherche santé et société, Université catholique de Louvain, Clos Chapelle-aux-Champs 30, Brussels, 1200, Belgium.
Ecole de santé publique, Université libre de Bruxelles, route de Lennik 808, Brussels, 1070, Belgium.
BMC Public Health. 2016 Mar 10;16:249. doi: 10.1186/s12889-016-2903-6.
Since 2007, integrated care of acute malnutrition has been promoted in Niger, a country affected by high burden of disease. This policy change aimed at strengthening capacity and ownership to manage the condition. Integration was neither defined nor planned but assumed to have been achieved. This paper studied the level and progress of integration of acute malnutrition interventions into key health system functions.
The qualitative study method involved literature searches on acute malnutrition interventions for children under 5 in low-income countries to develop a matrix of integration. Integration indicators defined three levels of integration of acute malnutrition interventions into health system functions-full, partial or none. Indicators of health services and health status were added to describe health system improvements. Data from qualitative and quantitative studies conducted in Niger between 2007 and 2013 were used to measure the indicators for the years under study.
Results showed a mosaic of integration levels across key health system functions. Four indicators showed full integration, 22 showed partial integration and three showed no integration. Two-thirds of system functions showed progress in assimilating acute malnutrition interventions, while six persistently stagnated over time. There was variation within and across health system domains, with governance and health information functions scoring highest and financing lowest. Steady improvements were noted in geographic coverage, access and under-5 mortality risk.
This study provided useful information to inform policy makers and guide strategic planning to improve integration of acute malnutrition interventions in Niger. The proposed method of assessing the extent of integration and monitoring progress may be adapted and used in Niger and other low-income countries that are integrating or intending to integrate acute malnutrition interventions.
自2007年以来，尼日尔一直在推广急性营养不良的综合护理，该国疾病负担沉重。这一政策变化旨在加强管理该病症的能力和自主权。整合既未明确界定也未进行规划，但假定已经实现。本文研究了急性营养不良干预措施融入关键卫生系统功能的程度和进展情况。
定性研究方法包括对低收入国家5岁以下儿童急性营养不良干预措施进行文献检索，以制定整合矩阵。整合指标将急性营养不良干预措施融入卫生系统功能的程度分为三个级别——完全整合、部分整合或未整合。增加了卫生服务和健康状况指标以描述卫生系统的改善情况。利用2007年至2013年在尼日尔进行的定性和定量研究数据来衡量所研究年份的各项指标。
结果显示，关键卫生系统功能的整合水平参差不齐。四个指标显示完全整合，22个指标显示部分整合，三个指标显示未整合。三分之二的系统功能在吸收急性营养不良干预措施方面取得了进展，而六个系统功能长期停滞不前。卫生系统各领域内部和之间存在差异，治理和卫生信息功能得分最高，融资功能得分最低。地理覆盖范围、可及性和5岁以下儿童死亡风险方面有稳步改善。
本研究提供了有用信息，可为政策制定者提供参考，并指导战略规划，以改善尼日尔急性营养不良干预措施的整合情况。所提议的评估整合程度和监测进展情况的方法可加以调整，用于尼日尔以及其他正在整合或打算整合急性营养不良干预措施的低收入国家。
