Institute for Health Metrics and Evaluation. Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA.
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
BMC Pregnancy Childbirth. 2022 Jan 3;22(1):5. doi: 10.1186/s12884-021-04279-2.
The Salud Mesoamérica Initiative (SMI) is a public-private collaboration aimed to improve maternal and child health conditions in the poorest populations of Mesoamerica through a results-based aid mechanism. We assess the impact of SMI on the staffing and availability of equipment and supplies for delivery care, the proportion of institutional deliveries, and the proportion of women who choose a facility other than the one closest to their locality of residence for delivery.
We used a quasi-experimental design, including baseline and follow-up measurements between 2013 and 2018 in intervention and comparison areas of Guatemala, Nicaragua, and Honduras. We collected information on 8754 births linked to the health facility closest to the mother's locality of residence and the facility where the delivery took place (if attended in a health facility). We fit difference-in-difference models, adjusting for women's characteristics (age, parity, education), household characteristics, exposure to health promotion interventions, health facility level, and country.
Equipment, inputs, and staffing of facilities improved after the Initiative in both intervention and comparison areas. After adjustment for covariates, institutional delivery increased between baseline and follow-up by 3.1 percentage points (β = 0.031, 95% CI -0.03, 0.09) more in intervention areas than in comparison areas. The proportion of women in intervention areas who chose a facility other than their closest one to attend the delivery decreased between baseline and follow-up by 13 percentage points (β = - 0.130, 95% CI -0.23, - 0.03) more than in the comparison group.
Results indicate that women in intervention areas of SMI are more likely to go to their closest facility to attend delivery after the Initiative has improved facilities' capacity, suggesting that results-based aid initiatives targeting poor populations, like SMI, can increase the use of facilities closest to the place of residence for delivery care services. This should be considered in the design of interventions after the COVID-19 pandemic may have changed health and social conditions.
中美洲健康倡议（SMI）是一个公私合作项目，旨在通过基于成果的援助机制改善中美洲最贫困人群的母婴健康状况。我们评估了 SMI 对分娩护理人员配备和设备及用品供应、机构分娩比例以及选择居住地附近以外的医疗机构分娩的产妇比例的影响。
我们采用准实验设计，在 2013 年至 2018 年期间在干预和对照地区（危地马拉、尼加拉瓜和洪都拉斯）进行了基线和随访测量。我们收集了与母亲居住地最近的卫生机构以及分娩发生的机构（如果在卫生机构分娩）相关的 8754 例分娩信息。我们拟合了差值差异模型，调整了妇女的特征（年龄、生育次数、教育程度）、家庭特征、健康促进干预措施的暴露程度、卫生机构水平和国家。
在倡议实施后，干预和对照地区的设施设备、投入和人员配备都有所改善。在调整了协变量后，与对照地区相比，干预地区的机构分娩率在基线和随访期间增加了 3.1 个百分点（β=0.031，95%CI-0.03，0.09）。在干预地区，选择居住地以外的医疗机构分娩的产妇比例在基线和随访期间下降了 13 个百分点（β=-0.130，95%CI-0.23，-0.03），比对照组下降幅度更大。
结果表明，在 SMI 干预地区，由于设施能力得到了改善，选择居住地最近的医疗机构分娩的产妇比例增加，这表明针对贫困人群的基于成果的援助倡议，如 SMI，可以增加对居住地附近的分娩护理服务机构的利用。在 COVID-19 大流行可能改变健康和社会状况之后，在设计干预措施时应考虑到这一点。
