Vallières Frédérique, Cassidy Emma Louise, McAuliffe Eilish, Gilmore Brynne, Bangura Allieu S, Musa Joseph
Centre for Global Health, Trinity College Dublin, University of Dublin, 7-9 Leinster Street South, Dublin 2, Ireland.
School of Psychology, Trinity College Dublin, University of Dublin, 2 College Green, Dublin 2, Ireland.
BMC Health Serv Res. 2016 Jul 13;16:258. doi: 10.1186/s12913-016-1496-1.
In 2010, the Ministry of Health and Sanitation in Sierra Leone launched their Free Health Care Initiative (FHCI) for pregnant and lactating mothers and children under-5. Despite an increase in the update of services, the inequitable distribution of health services and health facilities remain important factors underlying the poor performance of health systems to deliver effective services. This study identifies current gaps in service delivery across two rural locations served by the same District Health Management Team (DHMT).
We employed a cross-sectional household survey using a two-stage probability sampling method to obtain a sample of the population across two rural locations in Bonthe District: the riverine and the mainland. Overall, a total of 393 households across 121 villages were surveyed in the riverine and 397 households across 130 villages were sampled on the mainland. Maternal health, child health and sanitation indicators in Bonthe District were compared using Pearson Chi-Squared test with Yates' Continuity Correction across the two areas.
Women across the two regions self-reported significantly different uptake of family planning services. Children on the mainland had significantly greater rates of health facility based deliveries; being born in the presence of a skilled birth attendant; completed immunisation schedules; and higher rates of being brought to the health centre within 24 h of developing a fever or a suspected acute respiratory infection. Households on the mainland also reported significantly greater use of treated water and unrestricted access to a latrine.
If the government of Sierra Leone is going to deliver on their promise to free health care for pregnant women and their children, and do so in a way that reduces inequalities, greater attention must be paid to the existing service delivery gaps within each District. This is particularly relevant to health policy post-Ebola, as it highlights the need for more contextualised service delivery to ensure equitable access for women and children.
2010年，塞拉利昂卫生与环卫部针对孕妇、哺乳期妇女及5岁以下儿童发起了免费医疗保健倡议（FHCI）。尽管服务更新有所增加，但卫生服务和卫生设施的不公平分配仍是卫生系统在提供有效服务方面表现不佳的重要因素。本研究确定了由同一地区卫生管理团队（DHMT）服务的两个农村地区在服务提供方面当前存在的差距。
我们采用两阶段概率抽样方法进行横断面家庭调查，以获取邦特地区两个农村地区（河滨地区和内陆地区）的人口样本。总体而言，河滨地区对121个村庄的393户家庭进行了调查，内陆地区对130个村庄的397户家庭进行了抽样。使用Pearson卡方检验和Yates连续性校正对邦特地区两个区域的孕产妇健康、儿童健康和卫生指标进行比较。
两个地区的妇女自我报告的计划生育服务接受情况存在显著差异。内陆地区的儿童在医疗机构分娩的比例显著更高；在熟练助产士在场的情况下出生；完成免疫接种计划；以及在发烧或疑似急性呼吸道感染后24小时内被带到卫生中心的比例更高。内陆地区的家庭还报告称，经过处理的水的使用量显著更大，且可不受限制地使用厕所。
如果塞拉利昂政府要兑现为孕妇及其子女提供免费医疗保健的承诺，并以减少不平等的方式做到这一点，就必须更加关注每个地区现有的服务提供差距。这与埃博拉疫情后的卫生政策尤为相关，因为它凸显了需要提供更因地制宜的服务，以确保妇女和儿童能够公平获得医疗服务。
