A Comprehensive Systems Analysis of Community Based Primary Health Care

基于社区的初级卫生保健的综合系统分析

• 批准号: 9019699
• 负责人: James Franklin Phillips
• 金额: $ 20万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-03 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9019699
• 关键词: Address; Africa South of the Sahara; Age; Age-Years; Behavior; Child; Child Mortality; Childhood; Communities; Community Health; Complex; Data; Demographic Survey; Development; Environmental Risk Factor; Evaluation; Evaluation Research; Exposure to; Fathers; Ghana; Goals; Health; Health Planning; Health Policy; Health Services; Health Services Accessibility; Health Status; Health behavior; Health care facility; Health system; Healthcare; Household; Individual; Influentials; Interview; Investments; Life; Link; Measures; Methodology; Methods; Modeling; Monitor; National Institute of Child Health and Human Development; Pattern; Policies; Primary Health Care; Procedures; Process; Public Health; Research; Resources; Rural; Science; Services; Social Environment; Social Interaction; Surveys; System; Systems Analysis; Time; United States Public Health Service; Woman; Work; advanced system; base; clinical care; contextual factors; dynamic system; geographic inaccessibility; health care service; health seeking behavior; interest; mathematical model; meetings; mortality; multilevel analysis; novel; programs; public health relevance; response; scale up; social; social health determinants; surveillance data; theories

 DESCRIPTION (provided by applicant): In sub-Saharan Africa, intense investment in community-based primary health care is aimed at reducing the high level of child mortality. Programs and policies currently promote the hiring and deployment of community health workers to village health posts. Such policies lack adequate grounding in statistically rigorous analyses of the interaction of social contextual factors with the programmatic strategies that are employed. In this setting, social systemic determinants of health behavior are highly influential i determining child survival, yet the link between health systems determinants and social system influences is often poorly understood. Moreover, socio-demographic studies fail to provide direct evidence of system strengthening effects, or to indicate which investments are most productive, because survey evaluation procedures are unconnected with service strengthening inputs. The means of optimizing health systems inputs are unassessed or only crudely elucidated by evaluation research. Therefore, the goal of our proposed research is to successfully model the complex relationships between the context of health services at the community and higher levels and the health seeking behavior of individuals and communities on child survival. The model we propose to develop will identify which health system strategies are responsible for improvements in health, given social contextual effects. We will develop and estimate a complex multilevel model of child survival and life years gained that represents a theory of health systems strengthening and health seeking behavior based on extant data from northern Ghana. This model will assess the relationship between mortality among children under five and the addition of community-engaged primary health care services during the development and scale-up of Ghana's national primary health care policy, known as the Community-based Health Planning and Services Initiative (CHPS), from 1994 to 2003. We will use existing multilevel, longitudinal data on health systems strengthening in conjunction with a decade of yearly socio-demographic survey data and demographic surveillance of over 6,000 children under five years of age in 257 communities zoned for primary health care scale-up in Ghana's Kassena-Nankana District. The proposed work will demonstrate practical means of combining survey research with programmatic monitoring data to study the impact of health systems strengthening inputs on health behavior. It will also bridge the gap between individual level behavior and service system dynamics. Using demographic methods, parameters measured through this analysis will be used to calculate child life years gained through health system investments at the community level. These data will allow us to elucidate the relationship between health system strengthening that addresses geographic inaccessibility, as well as social barriers to health care, individual and community level health behavior, and their effect on child mortality. We expect our results to provide keenly needed guidance to strategies for health systems strengthening in sub-Saharan Africa.

 描述（由申请人提供）：在撒哈拉以南非洲地区，对社区初级卫生保健的大量投资旨在降低高水平的儿童死亡率，目前的计划和政策促进了社区卫生工作者的雇用和部署到乡村卫生站。此类政策缺乏对社会背景因素与所采用的规划策略之间相互作用的严格分析的充分基础。在这种情况下，健康行为的社会系统决定因素对决定儿童生存具有很大影响，但卫生系统决定因素之间的联系也很大。和社会制度影响此外，社会人口统计研究无法提供系统强化效果的直接证据，也无法表明哪些投资最有成效，因为调查评估程序与强化服务投入无关。优化卫生系统投入的手段未经评估或未评估。因此，我们提出的研究的目标是成功地模拟社区和更高级别的卫生服务背景与个人和社区的健康寻求行为之间的复杂关系。提议开发考虑到社会背景影响，我们将确定哪些卫生系统战略有助于改善健康状况。我们将开发和估计一个复杂的儿童生存和寿命年数的多层次模型，该模型代表了基于现有数据的卫生系统强化和寻求健康行为的理论。该模型将评估在加纳国家初级卫生保健政策（称​​为基于社区的卫生规划）的制定和扩大过程中，五岁以下儿童死亡率与增加社区参与的初级卫生保健服务之间的关系。和服务倡议 (CHPS)，来自1994 年至 2003 年。我们将利用现有的关于加强卫生系统的多层次、纵向数据，结合十年来的年度社会人口调查数据以及对 257 个社区划分为初级卫生保健规模的 6,000 多名五岁以下儿童进行的人口监测。拟议的工作将展示将调查研究与规划监测数据相结合的实用方法，以研究卫生系统加强投入对健康行为的影响。弥合个人层面行为和服务系统动态之间的差距。通过此分析测量的参数将用于计算通过社区层面的卫生系统投资获得的儿童寿命。这些数据将使我们能够阐明健康之间的关系。加强系统，解决地理上的不便以及医疗保健、个人和社区层面的健康行为及其影响的社会障碍 我们希望我们的研究结果能够为加强撒哈拉以南非洲卫生系统的战略提供急需的指导。