New ERA, Rudramati Marga, Kalopul, Kathmandu, Nepal.
Ministry of Health and Population, Kathmandu, Nepal.
PLoS One. 2022 Feb 25;17(2):e0264417. doi: 10.1371/journal.pone.0264417. eCollection 2022.
This study aimed to build the emergent body of evidence of family planning and maternal and child health (FPMCH) service integration benefits that can be useful in reaching the target of sustainable development goals (SDGs).
We utilized data from the 2015 Nepal Health Facility Survey and used the World Health Organization service readiness manual for defining the service readiness indicator score of all services related to FPMCH integration. Composite readiness index for all services including family planning, antenatal care service, delivery and newborn service readiness index, and curative child care service readiness index was considered for the integration of all services (i.e. readiness for FPMCH). Multivariable linear regression models were fitted to examine the association between covariates and readiness score to provide integrated services.
The mean readiness score of integrated services in health facilities in Nepal was 52.1%. The services in private hospitals and peripheral health facilities had significantly lower readiness scores of integrated services compared to government hospitals. Compared to Province 3(Province 3 holds the national capital), Province 2 had significantly lower and Province 7 had significantly higher readiness scores. There is a marginally significantly higher readiness score of integrated services in the facilities where management meetings are held compared to where management meetings are never conducted. Interestingly, health facilities where external supervision occurred in the last 4 months had better service readiness of integrated services compared with those facilities with no external supervision. Similarly, the facilities that performed the routine quality assurance activities and facilities having a system for collecting opinion and being reviewed had a higher integrated services readiness score than their counterparts.
This study found a scope of improvement in management practices in the health sector of Nepal especially for supportive supervision, quality assurance (QA) activities, monthly management meetings, and a system of collecting and reviewing opinions from the clients. Strengthening management practices especially, promoting supportive supervision and adhering to QA protocols may improve HF readiness to implement integrated FPMCH in Nepal. Being low readiness, there is an urgent need for policy reform to improve the integrated service readiness, particularly in Province 2.
本研究旨在构建计划生育和母婴健康（FPMCH）服务整合效益的新兴证据体系，这对于实现可持续发展目标（SDGs）目标具有重要意义。
我们利用了 2015 年尼泊尔卫生机构调查的数据，并使用世界卫生组织服务准备手册来定义与 FPMCH 整合相关的所有服务的服务准备指标得分。我们考虑了所有服务（即计划生育、产前护理服务、分娩和新生儿服务准备指数以及治疗性儿童保健服务准备指数）的综合准备指数，以评估所有服务的整合情况。多变量线性回归模型用于检验协变量与准备得分之间的关系，以提供综合服务。
尼泊尔卫生机构整合服务的平均准备得分是 52.1%。与公立医院相比，私立医院和外围卫生机构的综合服务准备得分明显较低。与第三省（拥有国家首都）相比，第二省的综合服务准备得分明显较低，第七省的得分明显较高。在举行管理会议的机构中，综合服务的准备得分略高，而从不举行管理会议的机构得分较低。有趣的是，在过去 4 个月内接受外部监督的卫生机构的综合服务准备得分优于没有外部监督的机构。同样，定期开展质量保证活动的机构和有收集意见和审查制度的机构的综合服务准备得分高于其对应机构。
本研究发现，尼泊尔卫生部门的管理实践有改进的空间，特别是在支持性监督、质量保证（QA）活动、每月管理会议和收集和审查客户意见的系统方面。加强管理实践，特别是促进支持性监督和遵守 QA 协议，可能会提高尼泊尔卫生机构实施综合 FPMCH 的准备程度。由于准备程度较低，迫切需要政策改革来提高综合服务准备程度，特别是在第二省。
