MNCHN assets of interest.

Inequitable coverage of evidence-based MNCHN interventions is particularly pronounced in low and middle income countries where access and delivery of these interventions can vary dramatically at the subnational level. We conducted health system assessments in nine subnational geographies in five countries (Burkina Faso, Ethiopia, India, Kenya and Nigeria) to explore progress toward scale of 14 evidence-based MNCHN interventions (iron-folic acid, oxytocin, magnesium sulfate, misoprostol; 7.1% chlorhexidine for umbilical cord care, neonatal resuscitation, kangaroo mother care, community regimen for the treatment of possible severe bacterial infection; amoxicillin dispersible tablets, multiple micronutrient supplements, balanced energy protein supplementation, early and exclusive breastfeeding, feeding of small and sick newborns, and management of severe and moderate acute malnutrition in children less than five years old). Between March and October 2021, we conducted key informant interviews with a purposive sample of 275 healthcare providers and 94 district health management (DHMT) staff to better understand bottlenecks, facilitators and uptake of the interventions across varied subnational settings. Across all interventions and geographies, providers and DHMT staff perceived lack of robust HMIS data as the most significant barrier to scale followed by weak facility infrastructure. DHMT staff viewed limited budget allocation and training as a much larger barrier than healthcare providers, most likely given their purview as subnational managers. Healthcare providers were focused on supply chain and staffing, which affect workflows and service provision. Understanding provider and health facility management views of why interventions do or do not advance towards effective coverage can assist in creating enabling environments for the scale of best practices. These types of data are most helpful when collected at the subnational level, which allows for comparisons both within and between countries to show health disparities. Importantly, this strategic data collection can provide a starting point for improvement efforts to address existing health system gaps.

循证孕产妇、新生儿、儿童健康与营养（MNCHN）干预措施的覆盖公平性缺失问题在中低收入国家尤为突出，此类国家的干预措施可及性与落地实施情况在次国家层面存在显著差异。我们在五个国家（布基纳法索、埃塞俄比亚、印度、肯尼亚及尼日利亚）的九个次国家地理区域开展了卫生系统评估，旨在探索14项循证MNCHN干预措施的规模化推广进展。这14项措施具体包括：叶酸铁剂、催产素、硫酸镁、米索前列醇；7.1%浓度氯己定脐带护理、新生儿复苏、袋鼠式护理、疑似重症细菌感染社区治疗方案；分散式阿莫西林片剂、多种微量营养素补充剂、均衡能量蛋白质补充、早发型纯母乳喂养、低体重与患病新生儿喂养，以及5岁以下儿童中重度急性营养不良管理。2021年3月至10月期间，我们采用目的性抽样方法，对275名医疗服务提供者与94名地区卫生管理团队（DHMT）成员开展关键知情人访谈，以深入了解不同次国家场景下，各项干预措施的实施瓶颈、促进因素与推广采用情况。在所有干预措施及所有地理区域中，医疗服务提供者与DHMT成员均认为，缺乏完善的卫生管理信息系统（HMIS）数据是阻碍干预规模化的最主要障碍，其次是薄弱的机构基础设施。DHMT成员认为，预算拨款有限与培训不足是比医疗服务提供者感知到的更为严重的障碍，这大概率源于其作为次国家卫生管理者的职责范畴。医疗服务提供者则更关注供应链与人员配置问题，此类因素会直接影响工作流程与服务供给。了解医疗服务提供者与卫生机构管理者对干预措施能否实现有效覆盖的看法，有助于为最佳实践的规模化推广营造有利环境。此类数据在次国家层面收集时最具应用价值，因为这可实现国家内部及国家之间的对比分析，以清晰展现健康公平差距。值得注意的是，此类战略性数据收集可为解决现有卫生系统短板的改进工作提供初始起点。