Comparison of FIMR Programs with Other Perinatal Systems Initiatives

OBJECTIVES: While the goals of fetal and infant mortality review (FIMR) programs and other perinatal systems initiatives (PSI) are similar, our knowledge of the processes they use to meet their goals is limited. This article compares a nationwide sample of FIMR programs and PSIs with regard to their roles and involvement in performance of eight essential maternal and child health services (EMCHS) as part of a national evaluation of FIMR. METHODS: The evaluation was a cross-sectional observational study in which geographic units were sampled based on the presence or absence of a FIMR or other PSI using FIMRs as the sampling frame of reference. Telephone interviews were conducted with 74 FIMR and 62 PSI directors in the sampled communities. RESULTS: Both programs performed several of the essential MCH services. FIMRs were significantly more likely to be located in a local health department than were PSIs. The results of multiple logistic regression analyses indicate that the performance of the essential MCH services by the programs was increased when both a FIMR and a PSI were in the community. FIMR programs alone had reduced odds of performing several essential MCH services than did PSIs alone. The findings also indicate that performance of some essential MCH services was reduced for FIMR programs and PSIs located in a local health department. CONCLUSIONS: Comparisons between FIMR and other PSIs suggest that both programs are currently engaged in diverse efforts to attain their goal of improving the health and health care delivery system for pregnant women, infants, and their families. FIMR programs appear to be more circumscribed in their activities than PSIs, but the presence of both programs in a community appears to enhance the programs' performance of the essential MCH services.     

The Nationwide Evaluation of Fetal and Infant Mortality Review (FIMR) Programs: Development and Implementation of Recommendations and Conduct of Essential Maternal and Child Health Services by FIMR Programs

OBJECTIVE: An evaluation of fetal and infant mortality review (FIMR) programs nationwide was conducted to characterize their unique role in improving the system of perinatal health care. The aim of this paper is to examine intermediate outcomes of the FIMR, in particular the development and implementation of recommendations produced by the FIMRs and the conduct of essential MCH services by the FIMRs. METHODS: We report on 74 FIMRs whose communities were selected for the nationwide evaluation and for whom we had data from the FIMR director or comparable respondent. We focus on the recommendations of the FIMRs and the essential maternal and child health (MCH) services conducted by the FIMRs as intermediate outcomes (or outputs) and then examine how selected characteristics of the FIMR may influence these. RESULTS: FIMRs developed recommendations on a broad range of topics but there were some areas for which nearly all programs had developed recommendations. The FIMRs relied primarily on strategies related to programs and practices, with few FIMRs reporting attention to policy-oriented approaches. Implementation of recommendations was high. Factors that influenced likelihood of implementing recommendations and conduct of essential MCH services included structure of the FIMR and training received by FIMR directors and staff. CONCLUSIONS: The focus of FIMR recommendations and the likelihood of implementation vary across FIMRs as does the conduct of essential MCH services. FIMR team structure and training of the director and staff are important areas to consider in efforts to maximize the impact of FIMR.     

Perspectives on State Title V Programs' Involvement in FIMR Programs

OBJECTIVES: The aim of this paper is to explore the involvement of state Title V programs in fetal and infant mortality review (FIMR) programs. METHODS: On the basis of information from four data sources, this article explores interactions among state Title V and FIMR programs, and considers recommendations regarding how these connections can be fostered for their mutual benefit. RESULTS: A brief history of state Title V engagement with FIMR programs is reviewed. Examples of state Title V-FIMR interactions are provided as suggestions for consideration by other states. CONCLUSIONS: Fetal and infant mortality review programs are, by design, local interventions, but there are many instances in which state Title V agencies can play roles in individual local, regional, or statewide FIMRs.     

The FIMR Evaluation: Objectives,Concepts, Frameworks,and Methods

FIMR is now a widespread strategy that has been adopted by more than 200 communities nationwide. Examining the impact of FIMR programs in a rigorous fashion presented a formidable challenge. A complex multiphase study design and innovative outcome measures were developed for the nationwide evaluation of FIMR. Data were collected from multiple respondents in nearly 200 communities across the United States. The results of this evaluation are an important contribution to the literature on the value of FIMR. However, while our study represents a substantial improvement over past research, limitations persist. Future work in this area will need to creatively address these limitations in order to better understand the effect of FIMR programs in communities.     

世界银行—云南省妇幼卫生扶贫资金服务的利用

分析,比较了世界银行－云南省妇幼夫贫资金项目实施前后1年间,3个经济水平组常规孕产妇保健服务的利用情况,结果显示：妇幼卫生扶贫资金促进了特困,次贫困家庭（南润）的孕产妇对常规孕产妇保健服务的利用,提高了其对服务的利用率。     

MCH Functions Framework: A Guide to the Role of Government in Maternal and Child Health in the 21st Century

Objectives: At the close of the 20th century, the government's role in maternal and child health is in a state of transition. What is needed is a framework defining roles and responsibilities and guidance on how to operationalize these functions. This article presents the Maternal and Child Health (MCH) Functions Framework and discusses its value as an advocacy, planning, evaluation, and educational tool. Methods: The Johns Hopkins Child and Adolescent Health Policy Center developed the Framework in collaboration with leading public health organizations. The process entailed formulating a conceptual approach and facilitating consensus among the relevant organizations. Results: The Framework consists of three main components: (a) a list of ten essential public health services to promote maternal and child health, (b) an outline detailing program functions specific to MCH that apply to all levels of government and to all MCH populations, and (c) selected examples of local, state, and federal activities for implementing MCH program functions. Conclusions: The MCH Functions Framework can be used in advocacy, policy development, program planning, organizational assessment, education, and training. To date, it has been used by several state and local MCH agencies and in MCH education and training programs.     

广州市社区卫生服务机构妇幼保健工作现状及资源配置公平性研究

目的 探讨广州市社区卫生服务机构妇幼保健工作开展现状、资源配置情况及其公平性.方法 2010年12月至2011年2月,广州市妇幼保健院采用自行设计的<社区卫生服务机构及镇医院妇幼保健工作基本情况调查表>对广州市提供社区卫生服务机构进行普查,并运用Lorenz 曲线和Gini系数分析法,进行社区妇幼保健服务人力资源配置及其公平性进行评价.结果 广州市10个区及2个县级市,共计195家社区卫生服务机构接受调查,从业妇幼保健的人员共计735位.按照服务人口测算,社区卫生妇幼机构及妇幼保健人力资源配置的Gini系数分别为0.107,0.114;按照辖域面积测算,社区卫生妇幼机构及妇幼保健人力资源配置的Gini系数分别为0.509,0.598.按照辖域面积测算的Gini系数处于公平性配置警戒区域.结论 广州市社区卫生服务机构总体布局基本合理,达到国家覆盖人口设置标准,但公平性尚待改善,社区卫生服务人员结构仍尚待改善.     

城市社区妇幼保健服务现状研究

目的掌握当前社区妇幼保健服务基本情况和发展中面临的主要问题,并提出相应的发展建议。方法在武汉市随机抽取4个城区,将所属的41家社区卫生服务中心作为调查对象,采用定量调查和定性访谈方法,了解其妇幼保健部门设置、服务内容、方式及人员情况。结果社区妇幼保健服务现状为经费补偿机制不明确,保健人员年龄结构老化、技术能力薄弱,保健服务项目发展不均衡。计划免疫、产后访视、育儿指导项目开展得最充分,而妇幼心理咨询、营养指导、妇女病普查、婚后卫生指导、更年期保健等项目开展率低。结论政府需进一步明确社区妇幼保健服务经费补偿方式,完善服务项目,提高专业人员技术水平,取得社会的配合,提升妇幼保健服务水平。     

The Role of State Maternal and Child Health Programs in the Issue of Newborn Discharge

Objectives: Since dramatically shortened newborn hospitalization has shifted the focus of care from the hospital, a central policy question has become how to assure a system of care that extends into the home and community. The objective of this study was to examine the role of the state Maternal and Child Health Title V programs in the assessment of the issue of newborn discharge, the development of policies, and the assurance of appropriate care. Method: The director or their designee in all 50 states and the District of Columbia participated in a structured telephone interview lasting 30–60 minutes. Results: Twenty-eight states reported new or previously implemented mandates for 48 hours of private insurance coverage for postpartum hospitalization. Only 6 states reported mandates concerning private insurance coverage of inpatient services, but 20 states reported mandates for postdischarge services. In the assessment function, only 18 maternal and child health (MCH) programs reported that they had undertaken specific studies on the effects of discharge timing in their states. In policy development, 18 of the 51 respondents reported that the MCH program initiated newborn discharge discussions, 23 reported that the agency participated in discussions, and 10 indicated that they did not participate. In assurance, 29 programs reported that they had taken action to provide technical assistance to local communities in developing follow-up systems. The relationship between the performance of core functions and the development of specific discharge policies in the state was minimal. Conclusions: The MCH programs appear to have played varied, but often limited, roles in the development of discharge policies. It is essential for MCH programs to engage actively in the policy-making process. But in the political environment surrounding newborn discharge policy, where laws and regulations consistent with the well-being of infants and mothers were being enacted, the limited MCH program roles may have been appropriate. Arguing against this conclusion, however, is that only 15 programs believed they had been effective and only 19 were satisfied with the discharge policies in their states, which suggests that a more proactive role may be necessary.     

Client Satisfaction on Maternal and Child Health Services in Rural Bengal

Background:

Services are being provided by health functionaries to the community with the objective of fulfilling their satisfaction but sometimes this is not working for the target population.

Objectives:

The study was conducted to assess the satisfaction of clients′ receiving maternal and child health services and to elicit clients′ suggestion for improving the services.

Materials and Methods:

Anexit interview was employed to collect data using a predesigned and pretested schedule.

Results:

Most of the populations were adult clients. In respect of satisfaction, responses of the clients were either satisfactory (54.31%) or good (23.56%) on maternal and child health services; ‘poor or very poor around 20% and it was significantly worse in respect of satisfaction’. Most of the clients (63.06 to 73.94%) expressed their responses as satisfactory and good regarding the assessment of doctors and it was significant. Most of them (73.31%) expressed satisfactory “response” on the quality of services given by nursing staffs. Suggestions of clients for improving the level of satisfactionwere sought and in this respect, response was little.

Conclusions:

Mostly satisfactory observations on maternal and child health services were found in respect of clients'' satisfaction and there was scope to improve the quality and quantity of services, and accordingly actions may be taken in the working field.     

Assessing Capacity and Measuring Performance in Maternal and Child Health

Objectives: To understand the similarities, differences, and relationships between three tools for performance and capacity assessment currently available for Maternal and Child Health (MCH) programs and for state and local health agencies. Methods: Three tools for performance and capacity assessment currently available for Maternal and Child Health (MCH) programs and for state and local health agencies, the Title V MCH Block Grant Performance and Outcome Measures (Title V 24), CAST-5, and the National Public Health Performance Standards Program (NPHPSP) were compared using two metrics, a conceptual model of the public health system, and a set of attributes related to the use of the instruments. Results: Both CAST-5 and the NPHPSP are focused on the capacity and key processes (10 Essential Public Health Services) of the public health system, although CAST-5 is intended for capacity assessment and the NPHPSP is intended for performance measurement. The Title V 24 tool is also intended for performance measurement; however, its focus is on the outputs and outcomes of the health system. The Title V 24 tool is the only one of the three that is mandatory, and the only one whose results at the current time can be used to compare across entities. In addition, both the Title V 24 and the NPHPSP include explicit standards, while CAST-5 does not specify explicit standards against which to compare findings. Conclusions: While there are various tools available to MCH practitioners for capacity assessment and performance measurement, knowing how the tools relate to each other, and their defining characteristics, should lead to more effective and productive use.     

参与式培训在世界银行—云南省妇幼卫生扶贫资金项目中的应用

给出了参与式培训的定义，并简要介绍了在世界银行-云南省妇连续剧卫生扶贫资金项目培训中所采取的7种具体方法的定义及其具体步骤，最后对培训的效果评估及组织参与式培训的注意事项进行的阐述。     

乡级妇幼保健服务成本及效果案例分析

妇幼保健服务的成本及效果是妇幼卫生服务的一个基本问题。作为一个较深入的乡级案例分析,本文对云南省双柏县2个典型农业乡进行了不同生育健康模式下妇幼保健服务的成本及效果的对比分析。     

Measures of Strength for Maternal Health Programs in 55 Developing Countries: The MNPI Study

Objectives: To measure levels and types of effort for national maternal and neonatal health programs in 55 developing countries, in 2002, as a replication of a 1999 study. Methods: Thirteen components of program effort were covered, based on 81 items in questionnaires completed by 10–25 expert respondents in each country. Results: With 100% representing maximum effort, the international average was 58–60%, and the 13 component averages varied from 48 to 72%. The components included health center and district hospital capacities, services provided, proportion of the rural and urban populations with actual access to the services, together with the support functions of policy, training, education, resources, and evaluation. Scores are high for policies but low for access, resources, training, and public education. Conclusions: National programs to improve maternal health are far from satisfactory, as assessed here, with negligible improvement from 1999–2002. Efforts fall short in general, but considerably more so for some program features than others. Literal access to basic services is poor, and is especially lacking in rural areas. Regions differ much more in the access they provide to services than in other respects.     

A Formative Evaluation in Maternal and Child Health Practice: The Partners for Life Nutrition Education Program for Pregnant Women

Objectives: This paper describes the formative evaluation of the Partners For Life Program that was developed to change dietary behavior of low income pregnant women in the Mississippi Delta region. Methods: A diverse group of nutrition/health professionals, adapted the Expanded Food and Nutrition Education Program's (EFNEP) methodology for pregnant patients in the local Women, Infants, and Children program who were receiving maternity care at the county health department. Formative evaluation activities included gathering data to determine 1) whether a new nutrition curriculum, modeled after EFNEP could be created, 2) whether peer educators could be recruited and trained to deliver the intervention, 3) whether pregnant women could be recruited to participate in the new program, 4) whether a pilot test of the new intervention would produce short-term impact in nutrition knowledge and dietary behavior, and 5) reactions of pregnant women on the usability of the new program. Data were gathered through use of the Program Implementation Index, focus groups, and a retrospective record review. Pilot test assessments included tests of nutrition knowledge and self-reported changes in dietary behavior. Results: The formative evaluation demonstrated both positive and negative outcomes. Positive data included 1) successful recruitment and training of the peer educators to deliver the intervention; 2) successful recruitment of the targeted population for the pilot study; 3) complete information on project questionnaires and measuring forms; and 4) among those who completed the program, a statistically significant improvement in nutrition knowledge and dietary behavior. Two negative aspects in this formative study were 1) the Program Implementation Index quantitatively showed that the program experienced problems retaining participants it recruited and 2) deviation of the timeframe for intervention delivery. Program length was identified as the primary reason for participant attrition. Conclusions: It is important for program developers to use results from formative evaluations to make changes in problem areas prior to implementation of a full-scale impact evaluation.     

我国台湾地区妇幼健康服务体系建设现状及启示

我国台湾地区妇幼健康服务体系相对完善,不同类型妇幼健康服务机构提供各有侧重的医疗与保健服务内容,全民健保和多样化筹资水平能够为妇幼健康水平的提升提供资金保障,同时高门槛的资格准入和培养机制实现了专科医生、全科医生、家庭医生的同质化要求,文章从妇幼健康服务机构设置、妇幼健康服务提供、妇幼健康服务筹资渠道及水平、妇幼健康人...     

The Evolution of Fetal and Infant Mortality Review as a Public Health Strategy

Infant mortality review (IMR), the forerunner of fetal and infant mortality review (FIMR), emerged at the national level in the mid-1980s as a promising method to improve understanding of local factors contributing to infant mortality and to motivate community response. Building on federal efforts to enhance data capacity and early state and local infant mortality case review studies, the federal Maternal and Child Health Bureau (MCHB) initiated its IMR Program in 1988. Key actions taken to refine and diffuse the IMR/FIMR method include forging a public-private partnership between MCHB and the American College of Obstetricians and Gynecologists in 1990 to develop the National Fetal and Infant Mortality Review Program, recruiting prominent leaders to advocate for FIMR, seeding community projects in geographically dispersed states and localities, and routinely reporting best practices information to the field. In concert with the articulation of core public health functions and a growing emphasis on accountability, attention at the national level has turned to promoting and institutionalizing FIMR in state systems. Efforts are underway in states to build on the FIMR model and coordinate multiple maternal and child health-related review programs. Increasingly, FIMR is recognized as a strategy for contributing to implementation of the core public health functions of assessment, policy development, and quality assurance. The recent national evaluation of FIMR sheds new light on the role of FIMR in community and state maternal and child health systems and marks a new phase in the evolution of FIMR.     

基于集中指数的妇幼健康服务和妇幼健康公平性分析

目的 对妇幼健康公平性进行分析,为促进妇幼保健服务和提高妇幼健康公平程度提供借鉴和参考.方法 利用《中国卫生统计年鉴》《中国卫生和计划生育统计年鉴》《中国统计年鉴》中的相关资料,计算反映妇幼保健服务和妇幼健康水平的各项指标的集中指数.结果 孕产妇系统管理、产前检查、产后访视、儿童保健管理的集中指数均为正值,反映出其主要集中在社会经济发展水平相对富裕的省份,围产儿死亡、孕产妇死亡的集中指数均为负值,反映出其主要集中于社会经济发展水平相对落后的省份.2008-2013年我国妇幼保健服务及妇幼健康的不公平性在各省(市、区)间的差距有所改善.结论 不同省(市、区)的妇幼保健服务和妇幼健康状况的不公平程度有所改善,应发展贫困地区经济,缩小贫富差距,注重对中部地区的支持,提高妇幼保健服务的效率和质量,从而改善妇幼健康.     

安徽省妇幼卫生费用研究报告

妇幼卫生费用是指妇女儿童为获得妇幼卫生服务所消费的各种费用的总和。为了体现卫生总费用的政策服务的目的,中国卫生总费用核算小组采用服务量法,测算了1997－1999年安徽省妇幼卫生费用。介绍了妇幼卫生费有的测算目的,指标体系及测算方法与结果,并从妇幼卫生费用总量及其构成,妇幼卫生业务收入及其构成,住院分娩费用因素分析等角度对测算结果进行初步分析,并与全国相关指标进行了对比,根据测算结果提出了有关的建议。     

西部妇幼卫生对口支援模式探索

目的：通过对长沙市妇幼保健院参与西部地区妇幼卫生能力提升项目的分析,从理论上初步探索适合妇幼保健院之间的对口支援模式,为上级行政部门更好地开展对口支援工作提供依据。方法采用实地调查法、文献法,对对口支援工作的情况进行调研和分析,解析西部地区妇幼卫生能力提升项目的对口支援现状与模式创新之间的关系。结果对口支援的成效与对口支援的模式密切相关。结论对口支援工作必须采取切实可行的具体模式、方法,认真落实各项工作,才能真正起到推动对口支援工作上台阶、上水平的效果。