Early changes in intervention coverage and mortality rates following the implementation of an integrated health system intervention in Madagascar

Autor: Matthew H. Bonds, Ann C. Miller, Andriamihaja Randrianambinina, Megan Murray, Sidney Atwood, Mohammed Ali Ouenzar, Victor R Rabeza, Laura F Cordier, Justin Haruna, Josea Ratsirarson, Michael Rich, Djordje Gikic, Lara Hall, Hery-Tiana Rahaniraka Razanadrakato, Meg G. McCarty, Andres Garchitorena, Marius Randriamanambintsoa, Dana R. Thomson
Přispěvatelé: Health, Emergence, Adaptation and Transmission (MIVEGEC-HEAT), Processus Écologiques et Évolutifs au sein des Communautés (PEEC), Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle (MIVEGEC), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud])-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud])-Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle (MIVEGEC), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud])-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud]), Harvard Medical School [Boston] (HMS), Harvard School of Public Health
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Zdroj: BMJ Global Health
BMJ Global Health, BMJ Publishing Group Ltd, 2018, 3 (3), pp.e000762. ⟨10.1136/bmjgh-2018-000762⟩
BMJ Global Health, 2018, 3 (3), pp.e000762. ⟨10.1136/bmjgh-2018-000762⟩
ISSN: 2059-7908
Popis: IntroductionThe Sustainable Development Goals framed an unprecedented commitment to achieve global convergence in child and maternal mortality rates through 2030. To meet those targets, essential health services must be scaled via integration with strengthened health systems. This is especially urgent in Madagascar, the country with the lowest level of financing for health in the world. Here, we present an interim evaluation of the first 2 years of a district-level health system strengthening (HSS) initiative in rural Madagascar, using estimates of intervention coverage and mortality rates from a district-wide longitudinal cohort.MethodsWe carried out a district representative household survey at baseline of the HSS intervention in over 1500 households in Ifanadiana district. The first follow-up was after the first 2 years of the initiative. For each survey, we estimated maternal, newborn and child health (MNCH) coverage, healthcare inequalities and child mortality rates both in the initial intervention catchment area and in the rest of the district. We evaluated changes between the two areas through difference-in-differences analyses. We estimated annual changes in health centre per capita utilisation from 2013 to 2016.ResultsThe intervention was associated with 19.1% and 36.4% decreases in under-five and neonatal mortality, respectively, although these were not statistically significant. The composite coverage index (a summary measure of MNCH coverage) increased by 30.1%, with a notable 63% increase in deliveries in health facilities. Improvements in coverage were substantially larger in the HSS catchment area and led to an overall reduction in healthcare inequalities. Health centre utilisation rates in the catchment tripled for most types of care during the study period.ConclusionAt the earliest stages of an HSS intervention, the rapid improvements observed for Ifanadiana add to preliminary evidence supporting the untapped and poorly understood potential of integrated HSS interventions on population health.
Databáze: OpenAIRE
Externí odkaz: