Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
Boston Medical Center, 801 Massachusetts Avenue, Boston, MA, 02118, USA.
BMC Pregnancy Childbirth. 2017 Dec 19;17(1):428. doi: 10.1186/s12884-017-1599-7.
In Nepal, hypothermia is a major risk factor for newborn survival, but the country's public health care sector has insufficient capacity to improve newborn survival given the burden imposed by distance to health facilities and cost. Low-cost technology to provide newborn thermal care in resource-limited environments exists, but lacks effective distribution channels. This study aims to develop a private sector distribution model for dedicated newborn thermal care technology to ensure equitable access to thermal protection and ultimately improve newborn health in Nepal.
We conducted a document analysis of newborn health policy in Nepal and a scoping literature review of approaches to newborn hypothermia in the region, followed by qualitative interviews with key stakeholders of newborn health in Nepal.
Current solutions addressing newborn hypothermia range from high-technology, high-cost incubators to low-cost behavioral interventions such as skin-to-skin care. However, none of these interventions are currently implemented at scale. A distribution model that provides incentives for community health volunteers and existing public health services in Nepal can deliver existing low-cost infant warmers to disadvantaged mothers where and when needed. Newborn technology can serve as an adjunct to skin-to-skin care and potentially create demand for newborn care practices.
Harnessing market forces could promote public health by raising awareness of newborn challenges, such as newborn hypothermia, and triggering demand for appropriate health technology and related health promotion behaviors. Market approaches to promoting public health have been somewhat neglected, especially in economically disadvantaged and vulnerable populations, and deserve greater attention in Nepal and other settings with limited public health service delivery capacity.
在尼泊尔，体温过低是新生儿生存的主要风险因素，但由于距离医疗机构的距离和成本的原因，该国的公共医疗保健部门改善新生儿生存的能力不足。在资源有限的环境中提供新生儿保暖护理的低成本技术已经存在，但缺乏有效的分销渠道。本研究旨在为专门的新生儿保暖护理技术开发私营部门分销模式，以确保公平获得保暖护理，并最终改善尼泊尔新生儿的健康状况。
我们对尼泊尔新生儿健康政策进行了文件分析，并对该地区新生儿低体温症的方法进行了范围界定文献综述，随后对尼泊尔新生儿健康的主要利益攸关方进行了定性访谈。
目前解决新生儿低体温症的方法从高科技、高成本的孵化器到低成本的行为干预措施（如皮肤接触护理）都有。然而，目前这些干预措施都没有大规模实施。在尼泊尔，一种为社区卫生志愿者和现有的公共卫生服务提供激励的分销模式，可以在需要的时间和地点向弱势母亲提供现有的低成本婴儿保暖器。新生儿技术可以作为皮肤接触护理的辅助手段，并有可能为新生儿护理实践创造需求。
利用市场力量可以通过提高对新生儿挑战（如新生儿低体温症）的认识，并引发对适当卫生技术和相关卫生促进行为的需求，从而促进公共卫生。促进公共卫生的市场方法在一定程度上被忽视了，特别是在经济落后和弱势群体中，在尼泊尔和其他公共卫生服务提供能力有限的环境中，应该给予更多关注。
