Save the Children, Washington, D.C., USA.
School of Public Health, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Canada.
J Glob Health. 2018 Jun;8(1):010422. doi: 10.7189/jogh.08.010422.
Newborn mortality remains unacceptably high in many countries. Postnatal home visits (PNHVs) have been endorsed as a strategy for delivery of postnatal care (PNC) to reduce newborn mortality as well as to improve maternal outcomes. This paper reports on a review of coverage-related performance of such programs implemented at scale through government health services in Bangladesh, Ethiopia, Ghana, India, Indonesia, Malawi, Myanmar, Nepal, Pakistan, Rwanda, Sri Lanka and Uganda.
We undertook a multi-country, mixed-method program review and used available survey and administrative data and key informant interviews to characterize performance of postnatal home visitation programs. In results presented in this paper, we have relied primarily on population-based surveys, notably Demographic and Health Surveys and Multi-Indicator Cluster Surveys. In addition, based on key informant interviews, we sought to understand the implementation challenges experienced delivering PNHVs, as well as responses to those challenges, in order to provide useful insights to countries to design home visitation programming when they can meet requirements for effective delivery at scale - and to identify other options when they cannot.
Contact coverage of PNC within 48 hours of birth following home birth (the group most prioritized in these programs) is below 10% in most of the countries reviewed; in no country does it exceed 20%. Most country programs have been unable to achieve PNHV contact coverage that would have any meaningful impact on newborn or maternal mortality. Country responses to disappointing performance have varied: some continued programming unchanged, some suspended attempts to provide PNHVs, and others modified their strategies for providing postnatal care (PNC).
Policymakers and program managers need to consider seriously context and local feasibility when determining whether and how to use a strategy like PNHVs. At the global level, we need more than evidence of effectiveness (as determined through proof-of-concept trials) as a basis for formulating recommendations for how governments should provide services. We must also give serious attention to what can be learned from experience implementing at scale and place greater importance on feasibility of implementation in the real world.
许多国家的新生儿死亡率仍然高得令人无法接受。家庭访视（PNHV）已被认可为提供产后护理（PNC）的一种策略，以降低新生儿死亡率并改善产妇结局。本文报告了对孟加拉国、埃塞俄比亚、加纳、印度、印度尼西亚、马拉维、缅甸、尼泊尔、巴基斯坦、卢旺达、斯里兰卡和乌干达等国通过政府卫生服务大规模实施的此类方案的覆盖相关绩效进行的审查。
我们进行了一项多国混合方法方案审查，并利用现有的调查和行政数据以及关键知情人访谈来描述家庭访视方案的绩效。在本文中呈现的结果中，我们主要依赖于基于人群的调查，特别是人口与健康调查和多指标类集调查。此外，根据关键知情人访谈，我们试图了解在提供 PNHV 方面遇到的实施挑战，以及对这些挑战的应对，以便为各国提供有用的见解，以便在能够满足大规模有效交付要求时设计家庭访视方案 - 并在无法满足要求时确定其他选择。
在接受调查的大多数国家中，在家中分娩后的 48 小时内，48 小时内接受产后护理的人数（这些方案中最优先考虑的群体）不到 10%；没有一个国家超过 20%。大多数国家方案都无法实现 PNHV 接触覆盖，这对新生儿或产妇死亡率没有任何有意义的影响。各国对令人失望的表现的反应各不相同：一些国家继续保持方案不变，一些国家暂停提供 PNHV 的尝试，而其他国家则修改了提供产后护理的策略。
决策者和方案管理人员在确定是否以及如何使用 PNHV 等策略时，需要认真考虑背景和当地可行性。在全球层面上，我们需要的不仅仅是有效性的证据（通过概念验证试验确定）作为制定政府应如何提供服务的建议的基础。我们还必须认真关注从大规模实施中吸取的经验教训，并更加重视在现实世界中实施的可行性。
