Health, Nutrition and Population, The World Bank Group, Washington, DC, USA
Health, Nutrition and Population, The World Bank Group, Washington, DC, USA.
BMJ Open. 2023 Jan 31;13(1):e065223. doi: 10.1136/bmjopen-2022-065223.
To examine the capacity and quality of maternal and child health (MCH) services at the subnational primary healthcare (PHC) level in 12 low-income and middle-income countries (LMICs) and its association with intermediate health outputs such as coverage and access to care.
Observational cross-sectional study using matched subnational data from service provision assessment surveys and demographic health surveys from 2007 to 2019.
138 subnational areas with available survey data in 12 LMICs (Afghanistan, Bangladesh, Democratic Republic of Congo, Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania and Uganda).
Eight intermediate MCH outcomes/outputs were explored: (1) met need for family planning by modern methods; (2) attendance of four or more antenatal care visits; (3) perceived financial barriers to care; (4) perceived geographical barriers to care; (5) diphtheria-pertussis-tetanus (DPT) third dose coverage; (6) DPT dropout-rate; (7) care-seeking for pneumonia; and (8) oral rehydration solutions coverage.
Overall, moderate-to-poor PHC performance was observed across the 12 countries, with substantial heterogeneity between the different subnational areas in the same country as well as within the same subnational area across both capacity and quality subdomains. The analysis of the relationship between PHC service delivery and child health outcomes revealed that recent supervision (b=0.34, p<0.01) and supervisors' feedback (b=0.28, p<0.05) were each associated with increased care-seeking for pneumonia. We also observed the associations of several measures of capacity and quality with DPT immunisation. The analysis of maternal health outcomes yielded only a few statistically significant results at p<0.05 level, however, none remained significant after adjusting for other covariates.
The results of this analysis illustrate the heterogeneity in the capacity and quality of PHC service delivery within LMICs. Countries seeking to strengthen their PHC systems could improve PHC monitoring at the subnational level to better understand subnational bottlenecks in service delivery.
在 12 个低收入和中等收入国家（LMIC）的国家以下初级卫生保健（PHC）一级，评估妇幼保健（MCH）服务的能力和质量，并考察其与覆盖范围和获得服务等中间卫生产出的关系。
使用 2007 年至 2019 年来自服务提供评估调查和人口健康调查的国家以下一级匹配数据，进行观察性横断面研究。
在 12 个 LMIC 中，有 138 个国家以下地区提供了调查数据（阿富汗、孟加拉国、刚果民主共和国、海地、肯尼亚、马拉维、纳米比亚、尼泊尔、卢旺达、塞内加尔、坦桑尼亚和乌干达）。
探讨了 8 项中间 MCH 结果/产出：（1）现代方法满足计划生育需求；（2）接受 4 次或更多次产前保健访问；（3）认为获得医疗服务存在经济障碍；（4）认为获得医疗服务存在地理障碍；（5）白喉-百日咳-破伤风（DPT）第三剂覆盖率；（6）DPT 失访率；（7）肺炎就诊率；（8）口服补液盐覆盖率。
总体而言，12 个国家的 PHC 表现中等至较差，同一国家不同国家以下地区之间以及同一国家以下地区能力和质量子领域之间都存在很大差异。分析 PHC 服务提供与儿童健康结果之间的关系发现，最近的监督（b=0.34，p<0.01）和监督者的反馈（b=0.28，p<0.05）都与肺炎就诊率增加有关。我们还观察到，能力和质量的几个措施与 DPT 免疫接种有关。产妇健康结果的分析仅在 p<0.05 水平上得出了几个有统计学意义的结果，但在调整其他协变量后，没有结果具有统计学意义。
分析表明，在 LMIC 中，PHC 服务提供的能力和质量存在异质性。希望加强其 PHC 系统的国家可以在国家以下一级加强 PHC 监测，以更好地了解服务提供方面的国家以下瓶颈。
