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Policies and actions to reduce maternal mortality in Nepal: perspectives of key informants
Sexual and Reproductive Health Matters ( IF 5.732 ) Pub Date : 2021-04-06 , DOI: 10.1080/26410397.2021.1907026
Rajendra Karkee, Kirti Man Tumbahanghe, Alison Morgan, Nashna Maharjan, Bharat Budhathoki, Dharma S. Manandhar

Abstract

Nepal made impressive progress in reducing maternal mortality until 2015. Since then, progress has stagnated, coinciding with Nepal’s transition to a federation with significant devolution in health management. In this context, we conducted key informant interviews (KII) to solicit perspectives on policies responsible for the reduction in maternal mortality, reasons for the stagnation in maternal mortality, and interventions needed for a faster decline in maternal mortality. We conducted 36 KIIs and analysed transcripts using standard framework analysis methods. The key informants identified three policies as the most important for maternal mortality reduction in Nepal: the Safe Motherhood Policy, Skilled Birth Attendant Policy, and Safe Abortion Policy. They opined that policies were adequate, but implementation was weak and ineffective, and strategies needed to be tailored to the local context. A range of health system factors, including poor quality of care, were identified by key informants as underlying the stagnation in Nepal’s maternal mortality ratio, as well as a few demand-side aspects. According to key informants, to reduce maternal deaths further Nepal needs to ensure that the current family planning, birth preparedness, financial incentives, free delivery services, abortion care, and community post-partum care programmes reach marginalised and vulnerable communities. Facilities offering comprehensive emergency obstetric care need to be accessible, and in hill and mountain areas, access could be supported by establishing maternity waiting homes. Social accountability can be strengthened through social audits, role models, and empowerment of health and management committees.



中文翻译:

降低尼泊尔孕产妇死亡率的政策和行动:主要知情人的观点

摘要

直到 2015 年,尼泊尔在降低孕产妇死亡率方面取得了令人瞩目的进展。从那时起,进展停滞不前,恰逢尼泊尔过渡到一个在卫生管理方面有重大权力下放的联邦。在此背景下,我们进行了关键知情人访谈 (KII),以征求对降低孕产妇死亡率的政策、孕产妇死亡率停滞的原因以及更快降低孕产妇死亡率所需的干预措施的看法。我们使用标准框架分析方法进行了 36 次 KII 并分析了转录本。主要信息提供者确定了尼泊尔降低孕产妇死亡率最重要的三项政策:安全孕产政策、熟练助产士政策和安全堕胎政策。他们认为政策是充分的,但实施薄弱和无效,战略需要根据当地情况进行调整。主要信息提供者确定了一系列卫生系统因素,包括护理质量差,是尼泊尔孕产妇死亡率停滞不前的原因,以及一些需求方面的因素。据主要知情人称,为了进一步减少孕产妇死亡,尼泊尔需要确保目前的计划生育、生育准备、经济激励、免费接生服务、堕胎护理和社区产后护理计划能够惠及边缘化和弱势社区。提供综合紧急产科护理的设施需要无障碍,并且在山区和山区,可以通过建立产科候诊院来支持访问。社会责任可以通过社会审计、榜样、

更新日期:2021-04-06
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