Paudel Mohan, Javanparast Sara, Newman Lareen, Dasvarma Gouranga
Initiative for Research, Education and Community Health-Nepal, Kathmandu, Nepal.
Southgate Institute of Health, Society & Equity, Flinders University, Adelaide, Australia.
J Health Popul Nutr. 2018 Jul 5;37(1):16. doi: 10.1186/s41043-018-0148-y.
This paper aims to examine the health care contexts shaping perinatal survival in remote mountain villages of Nepal. Health care is provided through health services to a primary health care level-comprising district hospital, village health facilities and community-based health services. The paper discusses the implications for future policies and practice to improve health access and outcomes related to perinatal health. The study was conducted in two remote mountain villages in one of the most remote and disadvantaged mountain districts of Nepal. The district is reported to rank as the country's lowest on the Human Development Index and to have the worst child survival rates. The two villages provided a diversity of socio-cultural and health service contexts within a highly disadvantaged region.
The study findings are based on a qualitative study of 42 interviews with women and their families who had experienced perinatal deaths. These interviews were supplemented with 20 interviews with health service providers, female health volunteers, local stakeholders, traditional healers and other support staff. The data were analysed by employing an inductive thematic analysis technique.
Three key themes emerged from the study related to health care delivery contexts: (1) Primary health care approach: low focus on engagement and empowerment; (2) Quality of care: poor acceptance, feeling unsafe and uncomfortable in health facilities; and (3) Health governance: failures in delivering health services during pregnancy and childbirth.
The continuing high perinatal mortality rates in the mountains of Nepal are not being addressed due to declining standards in the primary health care approach, health providers' professional misbehaviour, local health governance failures, and the lack of cultural acceptance of formalised care by the local communities. In order to further accelerate perinatal survival in the region, policy makers and programme implementers need to immediately address these contextual factors at local health service delivery points.
本文旨在研究影响尼泊尔偏远山区围产期存活率的医疗保健环境。医疗保健通过初级卫生保健层面的卫生服务提供，包括地区医院、乡村卫生设施和社区卫生服务。本文讨论了对未来政策和实践的影响，以改善与围产期健康相关的医疗服务可及性和结果。该研究在尼泊尔最偏远、最贫困山区之一的两个偏远山村里进行。据报道，该地区在人类发展指数方面排名全国最低，儿童存活率也最差。这两个村庄在一个极度贫困的地区提供了多样化的社会文化和卫生服务环境。
研究结果基于对42名经历过围产期死亡的妇女及其家人进行的定性研究访谈。这些访谈还补充了对卫生服务提供者、女性健康志愿者、当地利益相关者、传统治疗师和其他支持人员的20次访谈。采用归纳主题分析技术对数据进行分析。
该研究出现了与医疗服务提供环境相关的三个关键主题：（1）初级卫生保健方法：对参与和赋权的关注度低；（2）护理质量：在卫生设施中接受度差、感觉不安全和不舒服；（3）卫生治理：孕期和分娩期间卫生服务提供失败。
由于初级卫生保健方法的标准下降、卫生服务提供者的职业不当行为、当地卫生治理失败以及当地社区对正规护理缺乏文化接受度，尼泊尔山区持续居高不下的围产期死亡率问题未得到解决。为了进一步提高该地区的围产期存活率，政策制定者和项目实施者需要立即在当地卫生服务提供点解决这些背景因素。
