Abt Associates, International Development Division, Rockville, Maryland, USA.
Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.
J Glob Health. 2020 Dec;10(2):021201. doi: 10.7189/jogh.10.021201.
The private health sector is an important source of sick child care, yet evidence gaps persist in best practices for integrated management of private sector child health services. Further, there is no prioritized research agenda to address these gaps. We used a Child Health and Nutrition Research Initiative (CHNRI) process to identify priority research questions in response to these evidence gaps. CHNRI is a consultative approach that entails prioritizing research questions by evaluating them against standardized criteria.
We engaged geographically and occupationally diverse experts in the private health sector and child health. Eighty-nine experts agreed to participate and provided 150 priority research questions. We consolidated submitted questions to reduce duplication into a final list of 50. We asked participants to complete an online survey to rank each question against 11 pre-determined criteria in four categories: (i) answerability, (ii) research feasibility, (iii) sustainability/equity, and (iv) importance/potential impact. Statistical data analysis was conducted in SAS 9.4 (SAS Institute Inc, Cary NC, USA). We weighted all 11 evaluation criteria equally to calculate the research priority score and average expert agreement for each question. We disaggregated results by location in high-income vs low- and middle-income countries.
Forty-nine participants (55.1%) completed the online survey, including 33 high-income and 16 low- and middle-income country respondents. The top, prioritized research question asks whether accreditation or regulation of private clinical and non-clinical sources of care would improve integrated management of childhood illness services. Four of the top ten research priorities were related to adherence to case management protocols. Other top research priorities were related to training and supportive supervision, digital health, and infant and newborn care. Research priorities among high-income and low- and middle-income country respondents were highly correlated.
To our knowledge, this is the first systematic exercise conducted to define research priorities for the management of childhood illness in the private sector. The research priorities put forth in this CHNRI exercise aim to stimulate interest from policy makers, program managers, researchers, and donors to respond to and help close evidence gaps hindering the acceleration of reductions in child mortality through private sector approaches.
私营医疗部门是儿童医疗服务的重要来源，但在私营部门儿童卫生服务综合管理的最佳实践方面仍存在证据空白。此外，没有针对这些空白的优先研究议程。我们使用儿童健康与营养研究倡议 (CHNRI) 流程来确定优先研究问题，以应对这些证据空白。CHNRI 是一种协商方法，通过根据标准化标准评估研究问题来确定研究问题的优先级。
我们邀请了私营医疗部门和儿童健康领域的地理和职业多样化的专家参与。89 名专家同意参与，并提出了 150 个优先研究问题。我们将提交的问题合并为一份最终清单，以减少重复，共 50 个。我们要求参与者完成一项在线调查，根据 11 个预先确定的标准对每个问题进行排名，分为四个类别：(i) 可回答性，(ii) 研究可行性，(iii) 可持续性/公平性，以及 (iv) 重要性/潜在影响。统计数据分析在 SAS 9.4（SAS Institute Inc，Cary NC，美国）中进行。我们对所有 11 个评估标准进行了同等加权，以计算每个问题的研究优先级得分和平均专家一致性。我们按高收入和低收入/中等收入国家的位置对结果进行了细分。
49 名参与者（55.1%）完成了在线调查，其中包括 33 名高收入和 16 名低收入/中等收入国家的受访者。排名第一的优先研究问题是，私营临床和非临床护理来源的认证或监管是否会改善儿童疾病服务的综合管理。十大优先研究重点中有四个与遵守病例管理方案有关。其他优先研究重点与培训和支持性监督、数字健康以及婴儿和新生儿护理有关。高收入和低收入/中等收入国家受访者的研究重点高度相关。
据我们所知，这是首次系统地开展私营部门儿童疾病管理研究重点的工作。CHNRI 活动提出的研究重点旨在引起决策者、项目管理人员、研究人员和捐助者的兴趣，以应对和帮助缩小阻碍通过私营部门方法加速降低儿童死亡率的证据空白。
