Averting Maternal Death and Disability Program, Columbia University Mailman School of Public Health, New York, NY, USA.
Save the Children US, Washington, DC, USA.
Global Health. 2022 Apr 28;18(1):46. doi: 10.1186/s12992-022-00830-8.
Urbanization challenges the assumptions that have traditionally influenced maternal and newborn health (MNH) programs. This landscaping outlines how current mental models for MNH programs have fallen short for urban slum populations and identifies implications for the global community. We employed a three-pronged approach, including a literature review, key informant interviews with global- and national-level experts, and a case study in Bangladesh.
Our findings highlight that the current mental model for MNH is inadequate to address the needs of the urban poor. Implementation challenges have arisen from using traditional methods that are not well adapted to traits inherent in slum settings. A re-thinking of implementation strategies will also need to consider a paucity of available routine data, lack of formal coordination between stakeholders and providers, and challenging municipal government structures. Innovative approaches, including with communications, outreach, and technology, will be necessary to move beyond traditional rural-centric approaches to MNH. As populations continue to urbanize, common slum dynamics will challenge conventional strategies for health service delivery. In addition, the COVID-19 pandemic has exposed weaknesses in a system that requires intersectoral collaborations to deliver quality care.
Programs will need to be iterative and adaptive, reflective of sociodemographic features. Integrating the social determinants of health into evaluations, using participatory human-centered design processes, and innovative public-private partnerships may prove beneficial in slum settings. But a willingness to rethink the roles of all actors within the delivery system overall may be needed most.
城市化挑战了传统上影响母婴健康 (MNH) 项目的假设。本景观概述了当前 MNH 项目的思维模式如何未能满足城市贫民窟人口的需求，并指出了对全球社会的影响。我们采用了三管齐下的方法，包括文献综述、全球和国家层面专家的关键意见访谈以及孟加拉国的案例研究。
我们的研究结果表明，当前的 MNH 思维模式不足以满足城市贫困人口的需求。由于使用了不适应贫民窟环境固有特征的传统方法，实施挑战已经出现。重新思考实施策略还需要考虑到可用常规数据的匮乏、利益相关者和提供者之间缺乏正式协调以及具有挑战性的市政府结构。需要创新方法，包括沟通、外展和技术，以超越传统的以农村为中心的 MNH 方法。随着人口继续向城市迁移，常见的贫民窟动态将挑战传统的卫生服务提供策略。此外，COVID-19 大流行暴露了需要部门间合作提供优质护理的系统的弱点。
项目需要具有迭代性和适应性，反映社会人口特征。将健康的社会决定因素纳入评估中，使用参与式以人为中心的设计过程，以及创新的公私伙伴关系，在贫民窟环境中可能证明是有益的。但也许最需要的是重新思考整个交付系统中所有参与者的角色。
