怀孕期间寻求护理：测试肯尼亚农村孕产妇和新生儿健康服务提供改革背后的假设。
Health Policy and Planning
(
IF
2.9
)
Pub Date : 2024-09-20
, DOI:
10.1093/heapol/czae088
Kevin Croke,David Kapaon,Kennedy Opondo,Jan Cooper,Jacinta Nzinga,Easter Olwande,Nicholas Rahim,Margaret E Kruk
一项名为“孕产妇和新生儿健康服务提供重新设计”的卫生系统改革旨在通过加强医院级护理并使医院分娩成为孕妇的默认选择，安保顺家政13825404095在肯尼亚西部卡卡梅加县普及高质量的分娩护理。通过对卡卡梅加县新妈妈进行的一项大型前瞻性调查，我们研究了支撑服务提供重新设计政策变革理论的几个关键假设。我们分析了 19,127 名预期参加产前护理并在产后进行了两次调查的女性的分娩地点、旅行时间和距离、自付费用以及自我报告的护理质量等数据。我们评估了女性在怀孕期间的分娩地点偏好，并与之前的怀孕进行了比较，并比较了在公立医院与初级保健中心分娩的女性的出行时间、自付费用和患者满意度。我们发现，随着时间的推移，人口层面的分娩地点以及个别女性在怀孕期间的分娩地点发生了巨大变化：设施分娩从 2010 年的 50.4% 增加到 2019 年的 89.5%； 70% 的受访者在与他们所报告的产前护理意愿不同的设施中分娩。医院的自付费用平均为 1351 肯尼亚先令 (Ksh)，而初级卫生保健中心的自付费用为 964 肯尼亚先令 (p<0.01)。初级卫生保健交付的交通支出为 337 肯尼亚先令，而医院的交通支出为 422 肯尼亚先令 (p<0.01)。自我报告的平均出行时间为 51 分钟（初级保健中心分娩）与 47 分钟（医院分娩）（p=0.78）。初级保健中心分娩到分娩地点的平均距离为 15.1 公里，而医院为 15.2 公里 (p=0.99)。 患者报告的总体质量评分没有差异，但质量的一些子组成部分对医院有利。这些发现总体上支持卡卡梅加县 SDR 变革理论的关键假设，同时也强调了为提高成功实施的可能性而应解决的挑战。
Care seeking during pregnancy: testing the assumptions behind Service Delivery Reform for Maternal and Newborn Health in rural Kenya.
A health systems reform known as Service Delivery Redesign for Maternal and Newborn Health seeks to make high-quality delivery care universal in Kakamega County, in western Kenya, by strengthening hospital-level care and making hospital deliveries the default option for pregnant women. Using a large prospective survey of new mothers in Kakamega County, we examine several key assumptions which underpin the Service Delivery Redesign policy's theory of change. We analyze data on place of delivery, travel time and distance, out-of-pocket spending, and self-reported quality of care for 19,127 women prospectively enrolled at antenatal care and surveyed two times after their delivery. We assess womens' delivery location preferences over the course of pregnancy and compared to previous pregnancies, and compare travel time, out of pocket expenditures, and patient satisfaction for women who deliver in public hospitals versus primary health centers. We find substantial changes in delivery location at population level over time, and for individual women over the course of pregnancy: Facility delivery has increased from 50.4% in 2010 to 89.5% in 2019; and 70% of respondents deliver at a different facility than their reported intention at antenatal care. Out of pocket delivery expenditures are on average 1351 Kenyan shillings (Ksh) in hospitals compared to 964 Ksh in PHCs (p
