BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
Heidelberg Institute of Global Health, Heidelberg, Germany.
PLoS One. 2020 Mar 26;15(3):e0230732. doi: 10.1371/journal.pone.0230732. eCollection 2020.
The health status of Rohingya refugees or Forcibly Displaced Myanmar Nationals (FDMNs), especially women and children, is a significant challenge for humanitarian workers in Bangladesh. Though the Government of Bangladesh, in partnership with other organizations, is offering health care services to FDMNs, a comprehensive understanding of the program implementation is required for continuation in the future. This study explores the challenges and potential solutions for effective implementation of maternal, newborn, and child health (MNCH) programs for FDMNs residing in camps of Cox's Bazar, Bangladesh.
We conducted a qualitative study conducted in Cox's Bazar district, Bangladesh, which involved 34 interviews (15 key informant interviews and 19 in-depth interviews) with relevant persons working in organizations responsible for MNCH services to FDMNs. We relied on both inductive and deductive coding and applied the Consolidated Framework for Implementation Research (CFIR) as a guide to our thematic analysis and presentation of qualitative data.
Our study identified some key challenges hindering the effective implementation of MNCH service delivery for the FDMNs. High turnover and poor retention of staff, overlapping of service, weak referral mechanism, complex health information system, and lack of security of the front line health providers were some of the key challenges identified. Motivating the health workers, task shifting, capacity building on emergency obstetric care, training CHW & TBA on danger signs, and ensuring the security of the workers are the potential solutions suggested by the respondents. Selecting a few indicators and the introduction of E-tracker can harmonize the health information system.
Providing healthcare in an emergency setting has several associated challenges. Considering the CFIR as the base for identifying different challenges and their potential solutions at a different level of the program can prove to be an excellent asset for the program implementers in designing their plans. Two additional domains, context, and security should be included in the CFIR framework for any humanitarian settings.
罗兴亚难民或被迫流离失所的缅甸国民（FDMNs）的健康状况，尤其是妇女和儿童的健康状况，是孟加拉国人道主义工作者面临的重大挑战。尽管孟加拉国政府与其他组织合作，向 FDMNs 提供医疗保健服务，但为了未来的持续发展，需要全面了解该计划的实施情况。本研究探讨了在孟加拉国考克斯巴扎尔营地为居住在那里的 FDMNs 实施孕产妇、新生儿和儿童健康（MNCH）计划所面临的挑战和潜在解决方案。
我们在孟加拉国考克斯巴扎尔区进行了一项定性研究，涉及与负责为 FDMNs 提供 MNCH 服务的组织相关的 34 人（15 名关键知情人访谈和 19 名深入访谈）。我们依靠归纳和演绎编码，并将实施研究综合框架（CFIR）作为我们主题分析和定性数据呈现的指南。
我们的研究确定了一些阻碍为 FDMNs 有效实施 MNCH 服务提供的关键挑战。员工高流动率和低留用率、服务重叠、薄弱的转诊机制、复杂的卫生信息系统以及一线卫生工作者的安全缺乏是确定的一些关键挑战。受访者建议的潜在解决方案包括激励卫生工作者、任务转移、加强紧急产科护理能力建设、培训 CHW 和 TBA 识别危险信号以及确保工人安全。选择一些指标并引入电子追踪器可以协调卫生信息系统。
在紧急情况下提供医疗保健存在一些相关挑战。在不同层面的计划中，以 CFIR 为基础确定不同的挑战及其潜在解决方案，可以为计划执行者在设计计划时提供宝贵的资产。在任何人道主义环境中，CFIR 框架应增加两个额外的领域，即背景和安全。
