Spreading the Integrated District Evidence-to-Action Program for Neonatal Mortality Reduction (IDEAs) in Mozambique

在莫桑比克推广降低新生儿死亡率综合地区证据行动计划（IDEA）

• 批准号: 10394863
• 负责人: Quinhas Fernandes
• 金额: $ 49.78万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-05-07 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10394863
• 关键词: Address; Adopted; Adoption; Adrenal Cortex Hormones; Affect; Africa South of the Sahara; Area; Birth; Budgets; Cessation of life; Child; Child Mortality; Clinical; Consolidated Framework for Implementation Research; Country; Data; Development; Effectiveness; Evaluation; Evidence based intervention; Feedback; Foundations; Frequencies; Funding; Future; Goals; Guidelines; Health; Health Professional; Health Services; Health care facility; Health system; Human Resources; Intervention; Investments; Knowledge; Lead; Life; Magnesium Sulfate; Maintenance; Measures; Methods; Modeling; Modification; Mozambique; National Institute of Child Health and Human Development; Neonatal Mortality; Newborn Infant; Outcome; Performance; Policies; Population; Premature Birth; Process; Protocols documentation; Provider; Province; Public Health; Quasi-experiment; Reach Effectiveness Adoption Implementation and Maintenance; Readiness; Research; Research Priority; Resource-limited setting; Resources; Services; Subgroup; Supervision; System; Time; Translations; Woman; antenatal; base; cost; cost effective intervention; cost estimate; cost outcomes; design; dissemination strategy; efficacious intervention; evidence base; evidence based guidelines; flexibility; global health; health care delivery; implementation intervention; implementation process; implementation research; implementation strategy; improved; innovation; low and middle-income countries; microcosting; mortality; neonatal death; organizational readiness; population health; prevent; programs; prospective; scale up; standard of care; tool

Significant increases in global health investment to deliver low-cost, efficacious interventions contributed to an over 50% reduction in under-five mortality in the 25 years leading up to the end of the Millennium Development Goals in 2015. The rate of decline in child mortality has slowed due to high neonatal mortality (mortality in the first 28 days of life), especially in low resource settings in sub-Saharan Africa. In countries with high neonatal mortality, improving the quality and coverage of implementation of Ministry of Health guidelines that include available, evidence-based interventions delivered at or around the time of birth has the potential to jump start stalled population-level child mortality reductions. Audit and feedback approaches systematically assess and provide feedback to health professionals on their performance to guide adjustments to practice, and have the potential to improve the routine implementation of evidence-based guidelines for clinical interventions that prevent neonatal deaths. The Integrated District Evidence to Action (IDEAs) program is a multifaceted, enhanced audit and feedback implementation intervention that aims to improve the coverage and quality of a package of existing, evidence-based clinical interventions targeting major causes of neonatal mortality. IDEAs modifies audit and feedback by engaging health managers across the tiers of facility, district and province (rather than front line health workers in isolation). Furthermore, it is enhanced with systematically collected health service readiness data and routine district to facility supportive supervision to provide ongoing support to facility personnel who deliver clinical interventions that prevent neonatal deaths The overall goal of this application is to gather evidence on spreading the IDEAs audit and feedback intervention that is led by district management teams (rather than research teams), to serve as a foundation for national scale-up. We propose to implement IDEAs in 12 high population districts in central Mozambique using district management teams as disseminating agents, who will implement IDEAs in subordinate health facilities. Using a 4.5-year quasi-experimental design, a mixed- methods evaluation will be used to assess the impact of the intervention on health system responsiveness, as well as quality and coverage of interventions to prevent neonatal deaths. Our specific aims are to: Aim 1: Evaluate a funded district-based dissemination and implementation strategy for the IDEAs intervention, using the RE-AIM model to assess the program’s Reach, Effectiveness, Adoption, Implementation, and Maintenance; and Aim 2: Via activity based micro-costing and health outcomes modeling, estimate the potential budget and program impact from the payer perspective to scale-up IDEAs compared to the standard of care. The results of this implementation research are expected to generate knowledge of global significance, and by providing a real- world implementation model for the IDEAs intervention and programmatically relevant information, is designed to lead to rapid policy translation for future scale-up in Mozambique, and more broadly in countries with high neonatal mortality and weak delivery systems.

全球健康投资的大幅增加，以提供低成本，高效的干预措施，导致 在千年发展结束之前的25年中，五岁以上的死亡率降低了50％以上 2015年的目标。由于新生儿死亡率高，儿童死亡率下降速度已减慢（死亡率 生命的前28天），尤其是在撒哈拉以南非洲的低资源环境中。在新生儿高的国家 死亡率，提高卫生部指南的实施质量和涵盖，包括 可用的，在出生时或出生时提供的基于证据的干预措施有可能开始 停滞的人口级儿童死亡率降低。审核和反馈方法系统地评估和 向卫生专业人员提供有关其表现的反馈，以指导调整以进行练习，并拥有 提高常规实施基于证据的临床干预指南的潜力 预防新生儿死亡。行动（思想）计划的综合地区证据是一个多方面的，增强的 审计和反馈实施干预措施，旨在提高一包包装的覆盖范围和质量 现有的，基于证据的临床干预措施，旨在新生儿死亡率的主要原因。想法修饰符审核 和通过在设施，地区和省份跨越层次的卫生经理参与的反馈（而不是前线 卫生工作者孤立）。此外，通过系统收集的卫生服务准备就绪增强 数据和常规区，以提供支持监督的设施，以向设施人员提供持续的支持 提供防止新生儿死亡的临床干预措施，该应用程序的总体目标是收集 有关传播由地区管理团队领导的想法审核和反馈干预措施的证据 （而不是研究团队），作为国家规模扩大的基础。我们建议在 莫桑比克中部的12个高度人口地区使用地区管理团队作为传播代理商， 谁将在下属卫生设施中实施想法。使用4。5年的准实验设计，一种混合 方法评估将用于评估干预对卫生系统响应能力的影响，因为 以及预防新生儿死亡的干预措施的质量和覆盖范围。我们的具体目的是：目标1： 评估基于地区的基于地区的传播和实施策略，用于思想干预，使用 评估该计划的影响，有效性，采用，实施和维护的重新模型； 和目标2：通过基于活动的微观成本和健康成果建模，估算潜在预算和 与护理标准相比，计划从付款人角度到扩展想法的影响。结果 预计这项实施研究将产生有关全球意义的知识，并通过提供一个现实 设计了思想干预和编程相关信息的世界实施模型 导致莫桑比克未来扩大规模的快速政策翻译，并且更广泛地 新生儿死亡率和较弱的输送系统。