Yawson A E, Awoonor-Williams J K, Sagoe-Moses I, Aboagye P K, Yawson A O, Senaya L K, Bonsu G, Eleeza J B, Agongo E E A, Banskota H K
Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana.
Regional Health Directorate, Ghana Health Service, Upper East Region, Ghana.
Public Health. 2016 Dec;141:245-254. doi: 10.1016/j.puhe.2016.09.026. Epub 2016 Nov 4.
The aim of this work is to describe application of a data-driven approach (bottleneck analysis [BNA] approach process) to accelerate newborn care services in two regions and what effect it had on national-level newborn care interventions in Ghana.
A mixed-method approach was used for the study. The BNA tool generated quantitative data and group discussions provided phenomenological explanations to identified service gaps.
Regional newborn care health service assessments were conducted in November 2013 through desk reviews, field and health facility visits and coaching/mentorship. The BNA tool (an excel-based tool) directly utilized service coverage data and programme monitoring and review reports in Ghana. Outputs were generated based on service coverage indicators: supply side/health system factors (commodities, human resource and access), demand side (service utilization) and quality/effective coverage. National targets were used as benchmarks to assess gaps in coverage indicators.
Key health system bottlenecks included absence/stock-out of essential newborn care commodities/resuscitation kits and absence of updated policies at services delivery points. In both regions, less than 55% of health facilities had at least 80% of midwives trained to provide essential obstetric and newborn care, management of preterm babies, resuscitation and inpatient paediatric care. In addition, less than 35% of pregnant women were assisted by a skilled birth attendant (midwife) and monitored with a partograph in the two regions. Demand-side bottlenecks included cultural preference for home deliveries, limited knowledge on importance of postnatal care and poor community involvement.The BNA approach in the two regions resulted in the development of national and other regional operational plans and monitoring and evaluation framework for newborn care services in Ghana over the period 2012-2016, and a relative improvement in neonatal mortality at the regional and national level.
The BNA tool and approach provided data-driven planning for newborn care service delivery in a low-income setting. It identified gaps in service coverage based on empirical data at lower levels of the health system and garnered strategies in addressing bottlenecks to newborn care services at the national level.
本研究旨在描述一种数据驱动方法（瓶颈分析[BNA]方法流程）在两个地区加速新生儿护理服务中的应用，以及该方法对加纳国家级新生儿护理干预措施产生的影响。
本研究采用了混合方法。BNA工具生成定量数据，小组讨论为识别出的服务差距提供现象学解释。
2013年11月，通过案头审查、实地和医疗机构走访以及培训/指导，对地区新生儿护理卫生服务进行了评估。BNA工具（一种基于Excel的工具）直接利用了加纳的服务覆盖数据以及项目监测和审查报告。根据服务覆盖指标生成了产出：供应方/卫生系统因素（物资、人力资源和可及性）、需求方（服务利用情况）以及质量/有效覆盖。以国家目标作为基准来评估覆盖指标方面的差距。
关键的卫生系统瓶颈包括基本新生儿护理物资/复苏套件的短缺/缺货，以及服务提供点缺乏更新的政策。在这两个地区，不到55%的医疗机构有至少80%的助产士接受过提供基本产科和新生儿护理、早产儿管理、复苏及住院儿科护理的培训。此外，在这两个地区，不到35%的孕妇得到了熟练接生员（助产士）的协助，并使用产程图进行监测。需求方瓶颈包括对在家分娩的文化偏好、对产后护理重要性的认识有限以及社区参与度低。这两个地区的BNA方法促成了2012 - 2016年期间加纳国家级和其他地区级新生儿护理服务运营计划以及监测和评估框架的制定，并且地区和国家级的新生儿死亡率都有了相对改善。
BNA工具和方法为低收入环境下的新生儿护理服务提供了数据驱动的规划。它基于卫生系统较低层面的实证数据识别出服务覆盖方面的差距，并在国家层面收集了解决新生儿护理服务瓶颈问题的策略。
