Implementation strategies and outcomes.

The COVID-19 pandemic posed unprecedented challenges and threats to health systems, particularly affecting delivery of evidence-based interventions (EBIs) to reduce under-5 mortality (U5M) in resource-limited settings such as Bangladesh. We explored the level of disruption of these EBIs, strategies and contextual factors associated with preventing or mitigating service disruptions, and how previous efforts supported the work to maintain EBIs during the pandemic. We utilized a mixed methods implementation science approach, with data from: 1) desk review of available literature; 2) existing District Health Information System 2 (DHIS2) in Bangladesh; and 3) key informant interviews (KIIs), exploring evidence on changes in coverage, implementation strategies, and contextual factors influencing primary healthcare EBI coverage during March–December 2020. We used interrupted time series analysis (timeframe January 2019 to December 2020) using a Poisson regression model to estimate the impact of COVID-19 on DHIS2 indicators. We audio recorded, transcribed, and translated the qualitative data from KIIs. We used thematic analysis of coded interviews to identify emerging patterns and themes using the implementation research framework. Bangladesh had an initial drop in U5M-oriented EBIs during the early phase of the pandemic, which began recovering in June 2020. Barriers such as lockdown and movement restrictions, difficulties accessing medical care, and redirection of the health system’s focus to the COVID-19 pandemic, resulted in reduced health-seeking behavior and service utilization. Strategies to prevent and respond to disruptions included data use for decision-making, use of digital platforms, and leveraging community-based healthcare delivery. Transferable lessons included collaboration and coordination of activities and community and civil society engagement, and investing in health system quality. Countries working to increase EBI implementation can learn from the barriers, strategies, and transferable lessons identified in this work in an effort to reduce and respond to health system disruptions in anticipation of future health system shocks.

新冠疫情（COVID-19 pandemic）对全球卫生系统造成了前所未有的挑战与威胁，尤其对孟加拉国等资源受限地区落实以证据为基础的干预措施（evidence-based interventions, EBIs）以降低5岁以下儿童死亡率（under-5 mortality, U5M）的工作产生了不利影响。本研究旨在明确此类干预措施的受干扰程度，探究与预防或缓解服务中断相关的策略及背景因素，同时梳理疫情期间既往工作对维持EBIs落实的支撑作用。本研究采用混合方法实施科学研究框架，数据来源包括：1）现有文献案头综述；2）孟加拉国现有地区卫生信息系统2（District Health Information System 2, DHIS2）数据库；3）关键知情人访谈（key informant interviews, KIIs）。研究聚焦2020年3月至12月期间，初级卫生保健EBIs覆盖率的变化、落实策略及影响覆盖率的背景因素相关证据。本研究采用泊松回归模型，对2019年1月至2020年12月的间断时间序列数据开展分析，以评估新冠疫情对DHIS2指标的影响。研究人员对关键知情人访谈获取的质性数据进行录音、转录与翻译，并基于实施研究框架，对编码后的访谈资料开展主题分析，以识别新兴的模式与主题。疫情早期，孟加拉国旨在降低5岁以下儿童死亡率的EBIs落实率出现初始下滑，于2020年6月起逐步恢复。诸如封锁与出行限制、就医困难、卫生系统工作重心转向新冠疫情防控等障碍因素，导致民众就医行为与服务利用率下降。用于预防及应对服务中断的策略包括：依托数据辅助决策、采用数字化平台、依托基层社区卫生服务网络开展服务。可推广的经验包括：加强活动的协作与统筹、动员社区与民间社会参与，以及加大卫生系统质量建设投入。各国若致力于提升EBIs的落实覆盖率，可借鉴本研究识别的障碍因素、应对策略及可推广经验，从而为未来可能出现的卫生系统冲击做好准备，降低并应对卫生系统中断风险。