International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
Division of Research, Monitoring and Evaluation, Government of the Republic of South Sudan Ministry of Health, Juba, South Sudan.
BMJ Glob Health. 2020 Apr 15;5(4):e002093. doi: 10.1136/bmjgh-2019-002093. eCollection 2020.
Is achievement of Sustainable Development Goal (SDG) 16 (building peaceful societies) a precondition for achieving SDG 3 (health and well-being in all societies, including conflict-affected countries)? Do health system investments in conflict-affected countries waste resources or benefit the public's health? To answer these questions, we examine the maternal, newborn, child and reproductive health (MNCRH) service provision during protracted conflicts and economic shocks in the Republic of South Sudan between 2011 (at independence) and 2015.
We conducted two national cross-sectional probability surveys in 10 states (2011) and nine states (2015). Trained state-level health workers collected data from households randomly selected using probability proportional to size sampling of villages in each county. County data were weighted by their population sizes to measure state and national MNCRH services coverage. A two-sample, two-sided Z-test of proportions tested for changes in national health service coverage between 2011 (n=11 800) and 2015 (n=10 792).
Twenty-two of 27 national indicator estimates (81.5%) of MNCRH service coverage improved significantly. Examples: malaria prophylaxis in pregnancy increased by 8.6% (p<0.001) to 33.1% (397/1199 mothers, 95% CI ±2.9%), institutional deliveries by 10.5% (p<0.001) to 20% (230/1199 mothers, ±2.6%) and measles vaccination coverage in children aged 12-23 months by 11.2% (p<0.001) to 49.7% (529/1064 children, ±2.3%). The largest increase (17.7%, p<0.001) occurred for mothers treating diarrhoea in children aged 0-59 months with oral rehydration salts to 51.4% (635/1235 children, ±2.9%). Antenatal and postnatal care, and contraceptive prevalence did not change significantly. Child vitamin A supplementation decreased. Despite significant increases, coverage remained low (median of all indicators = 31.3%, SD = 19.7). Coverage varied considerably by state (mean SD for all indicators and states=11.1%).
Health system strengthening is not a uniform process and not necessarily deterred by conflict. Despite the conflict, health system investments were not wasted; health service coverage increased.
实现可持续发展目标 16（建设和平社会）是否是实现可持续发展目标 3（所有社会的健康和福祉，包括受冲突影响的国家）的前提条件？在受冲突影响的国家投资于卫生系统是否浪费资源或有益于公众健康？为了回答这些问题，我们考察了 2011 年（独立时）至 2015 年期间南苏丹共和国在长期冲突和经济冲击期间提供孕产妇、新生儿、儿童和生殖健康（MNCRH）服务的情况。
我们在 2011 年和 2015 年在 10 个州（2011 年）和 9 个州（2015 年）进行了两次全国性的横断面概率调查。经过培训的州级卫生工作者从每个县的村庄使用按大小成比例抽样的随机家庭中收集数据。县数据按人口规模加权，以衡量州和国家 MNCRH 服务覆盖率。使用两样本双侧 Z 检验检验 2011 年（n=11800）和 2015 年（n=10792）之间国家卫生服务覆盖率的变化。
27 项 MNCRH 服务覆盖率国家指标估计值中有 22 项（81.5%）显著提高。例如，孕期疟疾预防措施增加了 8.6%（p<0.001），达到 33.1%（397/1199 名母亲，95%CI ±2.9%），机构分娩增加了 10.5%（p<0.001），达到 20%（230/1199 名母亲，±2.6%），儿童 12-23 个月麻疹疫苗接种覆盖率增加了 11.2%（p<0.001），达到 49.7%（529/1064 名儿童，±2.3%）。增幅最大（17.7%，p<0.001）的是 0-59 个月儿童腹泻时用口服补液盐治疗母亲的比例，达到 51.4%（635/1235 名儿童，±2.9%）。产前和产后护理以及避孕药具的普及率没有显著变化。儿童维生素 A 补充剂有所减少。尽管有显著增加，但覆盖率仍然很低（所有指标的中位数=31.3%，SD=19.7%）。覆盖范围因州而异（所有指标和州的平均值 SD=11.1%）。
卫生系统的加强不是一个统一的过程，不一定会因冲突而受阻。尽管存在冲突，但对卫生系统的投资并未浪费；卫生服务覆盖率有所提高。
