Eckerle Michelle, Crouse Heather L, Chiume Msandeni, Phiri Ajib, Kazembe Peter N, Friesen Hanny, Mvalo Tisungane, Rus Marideth C, Fitzgerald Elizabeth F, McKenney Allyson, Hoffman Irving F, Coe Megan, Mkandawire Beatrice M, Schubert Charles
Department of Pediatrics, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, TX, United States.
Front Public Health. 2017 Jul 27;5:183. doi: 10.3389/fpubh.2017.00183. eCollection 2017.
To achieve sustained reductions in child mortality in low- and middle-income countries, increased local capacity is necessary. One approach to capacity building is support offered partnerships with institutions in high-income countries. However, lack of cooperation between institutions can create barriers to successful implementation of programs and may inadvertently weaken the health system they are striving to improve. A coordinated approach is necessary.
Three U.S.-based institutions have separately supported various aspects of pediatric care at Kamuzu Central Hospital (KCH), the main government referral hospital in the central region of Malawi, for several years. Within each institution's experience, common themes were recognized, which required attention in order to sustain improvements in care. Each recognized that support of clinical care is a necessary cornerstone before initiating educational or training efforts. In particular, the support of emergency and acute care is paramount in order to decrease in-hospital mortality. Through the combined efforts of Malawian partners and the US-based institutions, the pediatric mortality rate has decreased from >10 to <4% since 2011, yet critical gaps remain. To achieve further improvements, representatives with expertise in pediatric emergency medicine (PEM) from each US-based institution hypothesized that coordinated efforts would be most effective, decrease duplication, improve communication, and ensure that investments in education and training are aligned with local priorities.
Together with local stakeholders, the three US-based partners created a multi-institutional partnership, Pediatric Alliance for Child Health Improvement in Malawi at Kamuzu Central Hospital and Environs (PACHIMAKE). Representatives from each institution gathered in Malawi late 2016 and sought input and support from local partners at all levels to prioritize interventions, which could be collectively undertaken by this consortium. Long- and short-term goals were identified and approved by local partners and will be implemented through a phased approach.
The development of a novel partnership between relevant stakeholders in Malawi and US-based partners with expertise in PEM should help to further decrease pediatric mortality through the coordinated provision of acute care expertise and training as well as investment in the development of educational, research, and clinical efforts in PEM at KCH.
为了在低收入和中等收入国家持续降低儿童死亡率，有必要提高当地能力。能力建设的一种方法是与高收入国家的机构建立伙伴关系并提供支持。然而，机构之间缺乏合作可能会给项目的成功实施带来障碍，并可能无意中削弱他们努力改善的卫生系统。采取协调一致的方法很有必要。
美国的三个机构多年来分别在马拉维中部地区的主要政府转诊医院——卡穆祖中央医院（KCH）支持儿科护理的各个方面。在每个机构的经验中，都认识到了一些共同主题，为了维持护理水平的提高，需要加以关注。每个机构都认识到，在开展教育或培训工作之前，支持临床护理是必要的基石。特别是，支持急诊和急性护理对于降低住院死亡率至关重要。通过马拉维伙伴和美国机构的共同努力，自2011年以来，儿科死亡率已从>10%降至<4%，但关键差距仍然存在。为了实现进一步改善，来自每个美国机构的儿科急诊医学（PEM）专家代表推测，协调努力将最有效，减少重复，改善沟通，并确保对教育和培训的投资与当地优先事项保持一致。
这三个美国伙伴与当地利益相关者共同创建了一个多机构伙伴关系，即卡穆祖中央医院及周边地区马拉维儿童健康改善儿科联盟（PACHIMAKE）。每个机构的代表于2016年底齐聚马拉维，寻求各级当地伙伴的意见和支持，以确定干预措施的优先次序，该联盟可以共同开展这些干预措施。确定了长期和短期目标，并得到了当地伙伴的批准，将分阶段实施。
马拉维相关利益者与具有PEM专业知识 的美国伙伴之间建立新型伙伴关系，应有助于通过协调提供急性护理专业知识和培训，以及投资于KCH的PEM教育、研究和临床工作的发展，进一步降低儿科死亡率。
