Cooper Chelsea M, Ogutu Angella, Matiri Everlyn, Tappis Hannah, Mackenzie Devon, Pfitzer Anne, Galloway Rae
Maternal and Child Survival Program, Washington DC, USA.
Jhpiego, Baltimore, USA.
Matern Child Health J. 2017 Oct;21(10):1880-1889. doi: 10.1007/s10995-017-2341-9.
Purpose This article shares learning from an innovative demonstration program integrating maternal, infant, and young child nutrition (MIYCN) and family planning (FP) services in western Kenya, providing recommendations for future work to expand MIYCN and FP integration. Description Six health facilities reorganized to integrate MIYCN and FP services and community health volunteers (CHVs) promoted MIYCN and FP in adjacent communities in Bondo Sub-County over a 1-year period. At the facility level, each provider was directed to provide both sets of services in a single room during FP, antenatal care, postnatal care, or child consultation visits (a "one stop shop" approach). At community level, CHVs were to conduct household visits equipped with new integrated materials and incorporate MIYCN and FP within community activities. Assessment Although the "one stop shop" approach, where one provider offers all integrated services in one room, was initially proposed for all facilities, this worked most effectively in the dispensary and health centers. The sub-county hospital adapted the approach such that integrated services were offered by more than one provider during a visit, with clients linked from one provider to another through same-day intra-facility referrals. CHVs were generally able to incorporate MIYCN and FP content within household visits and community activities; however some knowledge gaps were noted after initial training, necessitating additional refresher training. Conclusion This demonstration experience revealed that future replication efforts should enable sub-county team leadership, assess facility readiness, streamline data collection, build local buy-in, and prioritize dispensaries and health centers with high client loads.
目的 本文分享了在肯尼亚西部将孕产妇、婴幼儿营养（MIYCN）和计划生育（FP）服务相结合的创新示范项目的经验教训，为未来扩大MIYCN与FP整合的工作提供建议。描述 在一年时间里，六个卫生设施进行了重组以整合MIYCN和FP服务，社区卫生志愿者（CHV）在邦多县相邻社区推广MIYCN和FP。在设施层面，要求每位提供者在计划生育、产前护理、产后护理或儿童咨询就诊期间，在一个房间内提供这两类服务（“一站式服务”方法）。在社区层面，CHV要带着新的综合资料进行家访，并将MIYCN和FP纳入社区活动。评估 尽管最初提议所有设施都采用“一站式服务”方法，即由一名提供者在一个房间内提供所有综合服务，但这种方法在诊疗所和卫生中心效果最佳。县医院调整了该方法，使得在一次就诊期间由不止一名提供者提供综合服务，患者通过当日机构内转诊从一名提供者转至另一名提供者。CHV一般能够在家访和社区活动中纳入MIYCN和FP内容；然而，在初始培训后发现了一些知识差距，需要进行额外的进修培训。结论 这一示范经验表明，未来的推广工作应赋予县团队领导权、评估设施的准备情况、简化数据收集、获得当地的支持，并优先考虑患者量大的诊疗所和卫生中心。
