Aradeon Susan B, Doctor Henry V
Freelance International Consultant (Social and Behavioral Change Communication), Aventura, FL, USA.
Department of Information, Evidence and Research, Regional Office for the Eastern Mediterranean, World Health Organization, Nasr City, Cairo, Egypt.
Int J Womens Health. 2016 Mar 16;8:77-92. doi: 10.2147/IJWH.S94823. eCollection 2016.
The Sustainable Development Goal (SDG) maternal mortality target risks being underachieved like its Millennium Development Goal (MDG) predecessor. The MDG skilled birth attendant (SBA) strategy proved inadequate to end preventable maternal deaths for the millions of rural women living in resource-constrained settings. This equity gap has been successfully addressed by integrating a community-based emergency obstetric care strategy into the intrapartum care SBA delivery strategy in a large scale, northern Nigerian health systems strengthening project. The Community Communication Emergency Referral (CCER) strategy catalyzes community capacity for timely evacuations to emergency obstetric care facilities instead of promoting SBA deliveries in environments where SBA availability and accessibility will remain inadequate for the near and medium term. Community Communication is an innovative, efficient, equitable, and culturally appropriate community mobilization approach that empowers low- and nonliterate community members to become the communicators. For the CCER strategy, this community mobilization approach was used to establish and maintain emergency maternal care support structures. Public health evidence demonstrates the success of integrating the CCER strategy into the SBA strategy and the practicability of this combined strategy at scale. In intervention sites, the maternal mortality ratio reduced by 16.8% from extremely high levels within 4 years. Significantly, the CCER strategy contributed to saving one-third of the lives saved in the project sites, thereby maximizing the effectiveness of the SBAs and upgraded emergency obstetric care facilities. Pre- and postimplementation Knowledge, Attitude, and Practice Survey results and qualitative assessments support the CCER theory of change. This theory of change rests on a set of implementation steps that rely on three innovative components: Community Communication, Rapid Imitation Practice, and CCER support structures. Innovative communication body tools and the rote learning Rapid Imitation Practice training methodology enabled low-literate volunteers to saturate their communities with informed group discussions transferring communication capacity and ownership to the discussion participants. CCER is especially efficient because virtually every timely, community referral for emergency maternal care results in a saved life, whereas on average, only one in every eight births delivered by an SBA (12%) is expected to be a delivery-associated complication requiring lifesaving care.
可持续发展目标（SDG）中的孕产妇死亡率目标有可能像其前身千年发展目标（MDG）一样无法实现。事实证明，千年发展目标中的熟练接生员（SBA）战略不足以消除数百万生活在资源匮乏地区的农村妇女可预防的孕产妇死亡。在尼日利亚北部一个大规模的卫生系统强化项目中，通过将基于社区的紧急产科护理战略纳入产时护理SBA提供战略，成功解决了这一公平差距问题。社区沟通紧急转诊（CCER）战略激发了社区及时将产妇疏散到紧急产科护理设施的能力，而不是在近期和中期SBA的可及性仍将不足的环境中推广SBA接生。社区沟通是一种创新、高效、公平且符合文化习惯的社区动员方法，它使低文化水平和不识字的社区成员能够成为传播者。对于CCER战略，这种社区动员方法被用于建立和维持紧急孕产妇护理支持结构。公共卫生证据表明，将CCER战略纳入SBA战略是成功的，并且这种联合战略在大规模实施时具有可行性。在干预地点，孕产妇死亡率在4年内从极高水平下降了16.8%。值得注意的是，CCER战略促成了项目地点三分之一的挽救生命，从而最大限度地提高了SBA和升级后的紧急产科护理设施的有效性。实施前和实施后的知识、态度和实践调查结果以及定性评估支持了CCER的变革理论。这种变革理论基于一系列实施步骤，这些步骤依赖于三个创新要素：社区沟通、快速模仿实践和CCER支持结构。创新的沟通主体工具和死记硬背式的快速模仿实践培训方法，使低文化水平的志愿者能够通过开展有见地的小组讨论，将沟通能力和主导权传递给讨论参与者，从而使他们所在的社区充分了解相关信息。CCER特别有效，因为几乎每次及时的社区紧急孕产妇护理转诊都能挽救一条生命，而平均而言，SBA接生的每八次分娩中只有一次（12%）预计会出现需要挽救生命护理的分娩相关并发症。
