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Study on Evaluation for Safe Motherhood Policy of Guangxi

Author: LiJian
Tutor: QianXu;ChenLiLi;ChenYingYao;ZhaoNaiQing
School: Fudan University
Course: Epidemiology and Biostatistics,
Keywords: Safe Motherhood Policy Hospital delivery Maternal health services utilization Maternal mortality Formative Evaluation Evaluation of TOPSIS method ARIMA model
CLC: R173
Type: PhD thesis
Year: 2008
Downloads: 300
Quote: 1
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Abstract


I. Background While the 1987 launched the global Safe Motherhood Action, but there are still some of the country's maternal mortality rate did not significantly decrease the world each year about 529,000 maternal deaths, almost 99% of maternal deaths occur in developing countries. Maternal health policy development and sustainability depends on whether the science policy process, and this process in many developing countries lack. In order to reduce the maternal mortality rate, Guangxi since 1998 as the core of safe motherhood policies to promote hospital delivery. The scientific basis for determining the focus of policies at different stages of intervention as well as to determine the future of the policy to the very important. Policy stakeholders want to know the policy development process and the effect of the implementation of information acquired by virtue of scientific theory and analysis. Guangxi Safe Motherhood policy process and implementation of the policy effect for the lack of a system, a comprehensive, in-depth evaluation of the failure of the policy interests of stakeholders are concerned about the problem to give a satisfactory answer, and failed to put forward convincing policy further development of evidence-based. The study is dedicated to fill this gap, and to promote the smooth development of the policy, and to improve the level of maternity care in Guangxi. Second, the research purpose of this study is to learn from the policy point of view, the Guangxi Safe Motherhood policy development process, formation evaluation, to explore the role and influence of the main determinants of the policy in the policy process: from maternal health services utilization side get pregnant the improvement of the production of health services and characteristics change from maternal mortality to evaluate the effect of policy implementation, and evaluation of the direction of policy development; discover new demand for policy makers and implementers, to promote the further development of policies to provide evidence-based decision-making basis for policy recommendations. Research content and research methods. Convenience sample method to choose the mother of eight people in Nandan County, Guangxi, of Rongshui with Sanjiang County, 2 mother-in-law, the village women's director, village MCH member and former home deliveries members of five people personal narrative interviews; select government officials, policy-makers, health managers, doctors, members of the civil society, international organizations and officials of 13 key informant semi-structured in-depth interviews, document analysis method used in combination, using policy Formative evaluation model affect the main aspects of the policy from the policy environment, policy process, policy content and policy actors formative evaluation of the the Guangxi safe motherhood policy development process, focusing on health systems, human resources, service providers and civil society the main determinants of the policy impact of the policy. 2 to the 2003 national health services survey Guangxi database for baseline information, the use of multi-stage stratified random sampling method in Yongning County, Guangxi, Yangshuo County, Rongshui, Pingguo County, Nandan County in 2007, Yung County and other counties each survey and 99 of the last 3 years, mother of the live production history of 594 application Andersen behavioral model of health service utilization data as a result of policy interventions, evaluation Guangxi rural maternal hospital delivery services to take advantage of the improvement and analysis of influence factors. 3. Characteristic changes in maternal mortality in Guangxi, Guangxi maternal mortality maternal mortality monitoring points using 1998-2006 monitoring data evaluation and analysis of the main influence of maternal mortality and maternal mortality location factors. 4 of the annual reports of the maternal and child health in 1998-2006, Guangxi, Guangxi Safe Motherhood policy implementation effect evaluation system decision analysis methods, using time series analysis methods fitting Guangxi maternal mortality prediction model and carried out recently The external to predict, to evaluate the development of the Guangxi Safe Motherhood policy direction to promote policies to further the effective implementation of evidence-based policy recommendations. Four major findings. Guangxi Safe Motherhood policy since its implementation in the Government attaches importance to social support, the concerted efforts of all policy actors, by taking into family midwives functions, to establish sound township a basic obstetric service center and county level emergency obstetric care center, NCMS decreasing items effective combination of subsidies hospital delivery, free shuttle and free hospitalization to be produced, safe motherhood stretcher action, civil society organizations actively promote such as distinctive and effective measures of maternal health systems management , the main determinants of health human resources, service providers and public and social policy actively interact promote policy development, the region's hospital delivery rate rose from 45.67 percent in 1998 to 93.75% in 2007, the maternal mortality rate and infant mortality rates were reduced from 86/10, 000 in 1998 and 23 ‰ to the 24.06/10 million in 2007 and 12.64 per thousand, and four years ahead to achieve the objectives and requirements of the Guangxi two \Delivery place to give birth at home in the baseline survey mainly accounted for 58.72 percent, 39.80 percent hospital delivery only: after the intervention hospital delivery rate was 92.09%, 66.67% the proportion of births in the township hospitals. The proportion of home births declining, the proportion of births in the township and county hospitals showed an increasing trend (P <0.001), especially in township hospitals in the proportion of births to rise significantly. Mainly due to give birth at home, in the baseline survey of the economic difficulties (46.03%) (21.34 percent), the concept behind the radical production (17.57%) and transportation difficulties (9.62%), and post-intervention surveys give birth at home mainly due to economic difficulties ( 37.78%), acute production (35.75%), transportation difficulties (17.78%) and the concept behind (6.67%). Policy interventions for improving minorities, senior citizens, farmers, non-high-risk, and I husband low level of education, poor family economic status, living far from the hospital, fewer prenatal check first prenatal late maternal and better maternal hospital delivery rate effect. Possible influencing factors by multivariate analysis adjusted baseline survey affect the the hospitalized delivery service utilization factors childbirth history, ethnicity, maternal education status, family type of drinking water, the fastest way to go to the nearest hospital, whether mobilizing hospital delivery and prenatal conditions, in accordance with the size arranged to promote the role of hospital delivery, the OR value were: antenatal care more than 5 times 25.579 mobilization hospital delivery by 7.865, the high school culture by 4.479 The home drinking tap water by 2.735, the time to go to the hospital less than 10min by 185.6 primiparous 1.71 Han 1.508. Post-intervention survey of hospital delivery service utilization factors nation subsidize hospitalized childbirth know obstetric emergency calls, pregnant women, school can drop eliminate or new rural cooperative grants husband educational status, establish Guangxi maternal health manual, prenatal check you think should take the initiative to obtain the health services, in accordance with the role in promoting hospital delivery size arranged OR values ??were: to get the new rural cooperative grants 482.758, Reducing and Eliminating subsidies 137.912,5 antenatal care 18.673, know emergency calls by 17.880, husband, high school culture by 12.672, hospitalization subsidy 10.554, Han 7.769 that should take the initiative to obtain services by 7.431, the establishment of maternal health handbook 4.555, pregnant women, school by 4.049 . Through policy interventions, basically eliminating labor history, economic and transportation for hospital delivery services use, but still ethnic, cultural level, the quality of prenatal care services, maternal health awareness and social mobilization situation important factors affecting hospital delivery. 4. Policy interventions to improve antenatal coverage (P <0.05), the average number of prenatal check (P <0.05) and the average number of postpartum visits (P <0.05), and ahead of the average first prenatal time ( P <0.05). Pregnant women, school enrollment rate of 48.31% after the intervention, should strengthen the education of prenatal screening and neonatal screening. The prenatal check the quality of higher average prenatal check the number of items of 8.27, 72.14% of the objects do all nine prenatal check: The average number of items of post-natal visits 5.65 accept more than 8 postpartum visits project accounted received postpartum visits, as by 20.85%, and postpartum visits improve the quality. Maternal policy intervention for hospital services and the overall level of satisfaction is high, people are not satisfied with the hospital services without increased from 50% of the baseline to 78.98% after the intervention. Higher overall level of awareness of maternal health, access to maternal health knowledge of the most important sources of medical personnel, accounting for 75.87%, followed by propaganda slogans and pregnant women, school, accounting for 22.30% and 22.12% respectively. 5 intervention after deducting drop eliminate the project NRCMS the grants, the median in the township hospitals eutocia actual costs 60 yuan lower than the baseline survey, county hospitals eutocia the actual cost of the median is lower than the baseline survey 150 yuan, greatly reduced in township health centers and county hospitals eutocia actual fees paid to improve the economic and sexual Maternal access to hospital delivery services. Proportion of maternal deaths maternal living in mountainous areas, illiteracy, families with per capita annual income of the lowest, did not make a prenatal examination showed a declining trend (P <0.05): maternal death at home, the proportion of yearly The downward trend in the proportion died in hospitals above the county level showed an increasing trend (P <0.001). The main reasons of maternal mortality for obstetric hemorrhage (44.25%), amniotic fluid embolism (9.95%), pregnant women with heart disease (9.51%) with pregnancy-induced hypertension (9.29%). Obstetric hemorrhage causes of death than was declining trend, the causes of death of the amniotic fluid embolism showed an increasing trend (P <0.05); retained placenta (31.75%) and uterine inertia (27.50%), postpartum bleeding to death the first two reasons causes of death, and retained placenta than declining trend (P <0.001). 8 deaths maternal avoid to create the conditions to avoid death constitute a declining trend the inevitable death constituent ratio showed an increasing trend (P <0.001); can be avoided and to create the conditions to avoid the death of an individual family the main problem with the knowledge and skills of the health care system, knowledge of personal family problems accounted for 68.03%, and accounted for 21.58% of the knowledge and skills of the health care system. 9 possible influencing factors by multivariate analysis adjusted, ethnic, educational status, birth history, family planning situation, place of residence, annual household per capita income, and prenatal situation factors affecting maternal place. Compared to maternal death in the home, high school education (OR = 11.78), living in the plains who (OR = 2.726), early maternal (OR = 2.036), the annual per capita income 4000-8000 $ (OR = 1.917) Han maternal (OR = 1.904) greater likelihood of death: regional hospitals in the county, compared with the maternal death at home, high school education (OR = 3.594), prenatal check more than 5 times ( OR = 2.879), Han maternal (OR = 2.383) the planned fertility (OR = 1.647), primipara (OR = 1.396) as likely to die in the township hospitals, research results above maternal access to hospital delivery services or medical emergency services can better also prompted the minorities, unplanned births, low level of education, family economic status, living in the mountains, prenatal examinations fewer maternal and access to hospital delivery after maternal poor availability of services or access to emergency medical services in the event of a fatal obstetric risk, the risk of death at home, should be the focus of the next policy interventions crowd. 10. TOPSIS method, Guangxi Safe Motherhood policy implementation of the combined effect of increasing year by year in the past nine years: ARIMA time series model to forecast 2008 Guangxi maternal mortality rate 17.695/10 million. Policy recommendations. Maintenance of a good external environment of the health system, strengthen the dominant position of the Government in Guangxi Safe Motherhood policy development and public responsibility; 2. Further strengthen cooperation with civil society, the establishment of the Guangxi Safe Motherhood policy with other social policies coordination and support mechanisms: to continue to increase the funds for the cause of maternal health, the establishment of maternal health institutionalized mechanism to ensure funding and investment growth mechanism; 4. established to cover the whole population, fully functional, rational division of labor maternal health service system: (1) to strengthen rural grassroots obstetric construction, improve service capacity and quality of service, to establish and perfect the virtuous cycle between all levels of the service network referral mechanism: (2) strengthen the obstetrics human resources team building, develop Guangxi long-term development strategy for maternal health human resources: (3) to establish coordination mechanisms of maternal and child health and family planning system, the unplanned pregnancy maternal fully integrated into the maternity care system management; 5. establishment of maternal expectant further remote rural maternal hospital delivery services geographic and sex; the person should be taken from place to place health promotion strategies focus on minority and low culture women, maternal health knowledge into compulsory education to improve hospital delivery sustainability.

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CLC: > Medicine, health > Preventive Medicine,Health > Maternal and child health > Women 's health and hygiene
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