Supported by the Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), (CIN 13-410) at the Durham VA Health Care System, Durham, USA.
Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, USA.
BMC Public Health. 2021 Jul 12;21(1):1379. doi: 10.1186/s12889-021-11436-x.
Unmet need for postpartum contraception is high. Integration of family planning with routine child immunization services may help to satisfy unmet need. However, evidence about the determinants and effects of integration has been inconsistent, and more evidence is required to ascertain whether and how to invest in integration. In this study, facility-level family planning and immunization integration index scores are used to: (1) determine whether integration changes over time and (2) identify whether facility-level characteristics, including exposure to the Nigerian Urban Reproductive Health Initiative (NURHI), are associated with integration across facilities in six urban areas of Nigeria.
This study utilizes health facility data collected at baseline (n = 400) and endline (n = 385) for the NURHI impact evaluation. Difference-in-differences models estimate the associations between facility-level characteristics, including exposure to NURHI, and Provider and Facility Integration Index scores. The two outcome measures, Provider and Facility Integration Index scores, reflect attributes that support integrated service delivery. These indexes, which range from 0 (low) to 10 (high), were constructed using principal component analysis. Scores were calculated for each facility. Independent variables are (1) time period, (2) whether the facility received the NURHI intervention, and (3) additional facility-level characteristics.
Within intervention facilities, mean Provider Integration Index scores were 6.46 at baseline and 6.79 at endline; mean Facility Integration Index scores were 7.16 (baseline) and 7.36 (endline). Within non-intervention facilities, mean Provider Integration Index scores were 5.01 at baseline and 6.25 at endline; mean Facility Integration Index scores were 5.83 (baseline) and 6.12 (endline). Provider Integration Index scores increased significantly (p = 0.00) among non-intervention facilities. Facility Integration Index scores did not increase significantly in either group. Results identify facility-level characteristics associated with higher levels of integration, including smaller family planning client load, family planning training among providers, and public facility ownership. Exposure to NURHI was not associated with integration index scores.
Programs aiming to increase integration of family planning and immunization services should monitor and provide targeted support for the implementation of a well-defined integration strategy that considers the influence of facility characteristics and concurrent initiatives.
产后避孕需求未得到满足的情况较为严重。将计划生育与常规儿童免疫服务相结合，可能有助于满足未得到满足的需求。然而，有关整合的决定因素和效果的证据一直不一致，需要更多的证据来确定是否以及如何投资于整合。在这项研究中，使用机构层面的计划生育和免疫整合指数得分来：（1）确定整合是否随时间变化，以及（2）确定机构层面的特征，包括接触尼日利亚城市生殖健康倡议（NURHI），是否与尼日利亚六个城市地区的机构间整合相关。
本研究利用 NURHI 影响评估基线（n=400）和终点（n=385）收集的卫生机构数据。差异-差异模型估计了机构层面的特征，包括接触 NURHI，与提供者和机构整合指数得分之间的关联。两个结果衡量指标，提供者和机构整合指数得分，反映了支持综合服务提供的属性。这些指数的范围从 0（低）到 10（高），是通过主成分分析构建的。为每个机构计算得分。自变量是（1）时间阶段，（2）机构是否接受 NURHI 干预，以及（3）其他机构层面的特征。
在干预机构内，提供者整合指数的平均得分在基线时为 6.46，在终点时为 6.79；机构整合指数的平均得分在基线时为 7.16（基线）和 7.36（终点）。在非干预机构内，提供者整合指数的平均得分在基线时为 5.01，在终点时为 6.25；机构整合指数的平均得分在基线时为 5.83（基线）和 6.12（终点）。提供者整合指数在非干预机构中显著增加（p=0.00）。在两组中，机构整合指数都没有显著增加。研究结果确定了与更高整合水平相关的机构层面特征，包括计划生育客户人数较少、提供者接受计划生育培训以及公共机构所有权。接触 NURHI 与整合指数得分无关。
旨在增加计划生育和免疫服务整合的计划应监测并为实施明确的整合战略提供有针对性的支持，该战略应考虑到机构特征和同时进行的举措的影响。
