Global Access Research, International AIDS Vaccine Initiative (IAVI), New Delhi, India.
Department of Pediatrics, Indira Gandhi Medical College, Shimla, India.
Indian J Pediatr. 2023 Dec;90(Suppl 1):71-76. doi: 10.1007/s12098-023-04712-8. Epub 2023 Aug 4.
Despite significant efforts and progress made in newborn care programs in India, implementation gaps persist across the continuum of care. The present case studies of two districts in Himachal Pradesh revealed that pathways of care were often fragmented with inconsistent linkages between facility and community due to poor documentation, lack of tiered referral, health system weaknesses, low utilization of primary level institutions, and inadequate post-natal home visits by Accredited Social Health Activists (ASHAs). Involvement of healthcare providers (HCPs) and frontline health workers (FHWs) was low and uneven in generating awareness across the districts with limited participation in supporting care in the community. Ensuring functionality of health centers and first-level care facilities; strengthening referral systems; adequate/trained human resources; strengthening routine health management systems, discharge processes and community-based care with adequate integration with facilities are necessary in closing access gaps.
尽管印度在新生儿护理项目方面做出了巨大努力并取得了显著进展，但在护理连续体中仍然存在实施差距。本案例研究对喜马偕尔邦的两个地区进行了分析，结果表明，由于文档记录不完善、缺乏分层转诊、卫生系统薄弱、基层医疗机构利用率低以及初级保健机构的产后家访不足，导致服务提供路径经常出现碎片化，医疗机构和社区之间的联系也不一致。医疗保健提供者（HCPs）和一线卫生工作者（FHWs）的参与度较低，且在整个地区的宣传工作中不均衡，对社区支持护理的参与度有限。确保卫生中心和一级保健设施的正常运转；加强转诊系统；提供充足/经过培训的人力资源；加强常规卫生管理系统、出院流程和以社区为基础的护理，并与设施充分整合，这些都是缩小服务可及性差距的必要条件。
