SSM - Health Systems最新文献_第4页

Corrigendum to “Strengths and challenges for implementing non-clinical safe spaces for people experiencing emotional distress and/or suicidal crisis: A mixed-methods study from Australia” [SSM Health Syst. 5 (2025) 100100] “为经历情绪困扰和/或自杀危机的人实施非临床安全空间的优势和挑战：来自澳大利亚的混合方法研究”的勘误表[SSM卫生系统5 (2025)100100]

SSM - Health Systems

Pub Date : 2025-10-29 DOI: 10.1016/j.ssmhs.2025.100114

Scott J. Fitzpatrick , Grenville Rose , Melanie Giugni , Louise A. Ellis , Alyssa R. Morse , Cassandra Chakouch , Erin Oldman , Benn Miller , Helen T. Oni , Michelle Banfield

引用次数: 0

Protective factors and stressors that influence the mental wellbeing of community health workers in South Asia and Sub-Saharan Africa: A scoping review 影响南亚和撒哈拉以南非洲社区卫生工作者心理健康的保护因素和压力源：范围审查

SSM - Health Systems

Pub Date : 2025-10-28 DOI: 10.1016/j.ssmhs.2025.100147

Robinson Njoroge Karuga , Obaida Karim , Semonty Jahan , Anne Ngunjiri , Caroline Kabaria , Clement Oduor , Eunice Omanga , Judy Wairiuko , Maaike Seekles , Laura Dean , Lilian Otiso , Linet Okoth , Nahitun Naher , Patricia Okoth , Ranjan Koiri , Robbinson Nduati , Sabina Rashid , Sammy Gachigua , Selima Kabir , Stella Gitia , Blessing Mberu

Background

Community health workers (CHWs) are crucial to the achievement of Universal Health Coverage. In their roles, CHWs often experience a range of stressors that can affect their wellbeing. This scoping review aims to understand the stressors and protective factors that influence the mental wellbeing of CHWs in sub-Saharan Africa and South Asia.

Methods

We reviewed English literature that we searched in MEDLINE and Scopus databases. We also conducted an online search for grey literature in Google Scholar. Our search returned 11,135 articles. After screening out duplicates and ineligible articles, we included 97 articles that met the inclusion criteria.

Results

We categorized findings into interrelated domains: protective factors and stressors, which are mediated by individual characteristics. Protective factors that promote mental wellbeing of CHWs include altruism, social recognition, incentives, psychosocial support, flexibility of their work, and, training. Stressors that create anxiety and hinder mental wellbeing include: gender-based violence, harassment, delayed payment of incentives, unclear career pathways, heavy workload, unrealistic performance targets, stigma, and inadequate supervision. In the review, we developed a conceptual framework for programs and research on the mental wellbeing of CHWs in low and middle-income countries (LMICs).

Conclusion

Strengthening mental wellbeing requires policy interventions such as fair remuneration, clear career pathways, capacity building, and psychosocial support. Future research may need to prioritize CHW wellbeing and advocacy for their formal integration into the health workforce to advance universal health coverage and ensure no one is left behind.

背景：社区卫生工作者对实现全民健康覆盖至关重要。在他们的角色中，chw经常会经历一系列影响他们健康的压力源。本综述旨在了解影响撒哈拉以南非洲和南亚chw心理健康的压力源和保护因素。方法在MEDLINE和Scopus数据库中检索英文文献。我们还在b谷歌Scholar上进行了灰色文献的在线搜索。我们的搜索返回了11135篇文章。在筛选了重复和不符合条件的文章后，我们纳入了97篇符合纳入标准的文章。结果我们将研究结果划分为相互关联的领域：保护因素和应激因素，它们是由个体特征介导的。促进chw心理健康的保护因素包括利他主义、社会认可、激励、社会心理支持、工作灵活性和培训。造成焦虑和阻碍心理健康的压力源包括：基于性别的暴力、骚扰、奖励延迟支付、不明确的职业道路、繁重的工作量、不切实际的绩效目标、耻辱和监督不足。在这篇综述中，我们为低收入和中等收入国家（LMICs）的卫生工作者的心理健康项目和研究制定了一个概念性框架。结论加强心理健康需要政策干预，如公平薪酬、清晰的职业道路、能力建设和社会心理支持。未来的研究可能需要优先考虑老龄妇女的福祉，并倡导将其正式纳入卫生工作队伍，以推进全民健康覆盖，确保不让任何人掉队。

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引用次数: 0

The power to prioritize the health system resilience agenda: A review of global strategies and guidelines 确定卫生系统复原力议程优先次序的权力：对全球战略和准则的审查

SSM - Health Systems

Pub Date : 2025-10-28 DOI: 10.1016/j.ssmhs.2025.100148

Celia Blaas , Mariano Salazar , Dell D. Saulnier

Power is infrequently explored in health system resilience, yet is integral to understand the choices made that shape what is prioritized and funded for resilience, which actors are given responsibility for resilience, and which health system capacities are emphasized. This review aimed to explore how power is reflected in strategies and guidelines for health system resilience in grey literature from global governance actors. We included 22 health system resilience strategies and guidelines and adapted a power-sensitive framework to extract data related to power in resilience literature. We found that documents prioritized the health system functions of service delivery and resource generation over governance and financing for resilience, and external shocks were a focus over chronic, internal health system stressors, with a lack of strategies to shift power and authority to actors evenly across community, national and global levels. Governance actors framed resilience as a positive adaptation and an intermediary to other health system goals without acknowledgement of negative outcomes of adaptations for resilience. This review draws attention to explicit and implicit reflections of power in the framing of health system resilience and the lack of clear recommendations to address structural, systemic issues or empower actors across all health system levels.

在卫生系统复原力方面很少探讨权力，但权力对于理解所做的选择是不可或缺的，这些选择决定了复原力的优先事项和资助，哪些行为体被赋予复原力的责任，以及哪些卫生系统能力得到强调。本综述旨在探讨权力如何反映在全球治理行为体灰色文献中的卫生系统弹性战略和指南中。我们纳入了22个卫生系统弹性策略和指南，并采用了一个权力敏感框架来提取弹性文献中与权力相关的数据。我们发现，文件将卫生系统的服务提供和资源产生功能置于韧性的治理和融资之上，外部冲击是对慢性、内部卫生系统压力源的关注，缺乏在社区、国家和全球层面将权力和权威均匀转移给行动者的战略。治理行为体将恢复力定义为积极的适应和实现其他卫生系统目标的中介，而不承认适应恢复力的负面结果。本次审查提请注意卫生系统复原力框架中明确和隐含的权力反映，以及缺乏解决结构性和系统性问题或增强卫生系统各级行为体权能的明确建议。

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引用次数: 0

Nurses' perspectives on barriers to family-centered cardiac care in Pakistan 护士对巴基斯坦以家庭为中心的心脏护理障碍的看法

SSM - Health Systems

Pub Date : 2025-10-25 DOI: 10.1016/j.ssmhs.2025.100146

Umbreen Dildar , Saba Khurshid , Shagufta Perveen

Background

Family involvement is a critical component of person-centered cardiac care, contributing to improved patient outcomes and continuity of care. However, integrating family members into hospital-based cardiac care presents various challenges, particularly for frontline nurses. Understanding these barriers from the perspective of nursing staff is vital for informing health system reforms. Therefore, this study aimed to explore the barriers faced by nurses when involving families in cardiac patient care.

Methods

An exploratory qualitative study design was conducted with 10 cardiac care nurses (7 females and 6 males; age range 26–46 years) from public and private tertiary hospitals in the twin cities of Pakistan between February 2024 to September, 2024. Participants were selected using purposive sampling. Semi structure interview ewer conducted and thematic analysis was used to identify key themes reflecting nurses’ insights into the challenges of involving families in patient care.

Results

Five major themes emerged: (1) lack of institutional guidelines and structured protocols for family involvement; (2) emotional burden and role strain experienced by nurses during family interactions; (3) systemic constraints such as understaffing and time pressure; and (4) communication challenges due to sociocultural differences and unclear role expectations (5) cultural and ethical barriers in nurse-family dynamics. Nurses expressed a desire for clearer policy direction, more training, and institutional support.

Conclusion

The study underscores the need for health system-level interventions to strengthen the role of families in cardiac care. Addressing the identified barriers can promote more inclusive, equitable, and effective care delivery models that support both patients and health professionals.

家庭参与是以人为本的心脏护理的重要组成部分，有助于改善患者的预后和护理的连续性。然而，将家庭成员纳入医院心脏护理提出了各种挑战，特别是对一线护士。从护理人员的角度了解这些障碍对于卫生系统改革至关重要。因此，本研究旨在探讨护士在涉及心脏病患者家属护理时所面临的障碍。方法对2024年2月至2024年9月在巴基斯坦双城公立和私立三级医院工作的10名心内科护理护士（女7名，男6名，年龄26-46岁）进行探索性定性研究。参与者的选择采用有目的的抽样。我们进行了半结构访谈，并使用主题分析来确定反映护士对涉及患者护理家庭的挑战的见解的关键主题。结果：(1)缺乏家庭参与的制度性指导和结构化协议；(2)护士在家庭互动中的情绪负担和角色紧张；(3)人员不足和时间压力等系统性约束；(4)社会文化差异和角色期望不明确导致的沟通挑战(5)护士-家庭动态中的文化和伦理障碍。护士们表示希望得到更明确的政策指导、更多的培训和机构支持。结论本研究强调了卫生系统层面干预的必要性，以加强家庭在心脏护理中的作用。解决已确定的障碍可以促进更加包容、公平和有效的护理提供模式，从而同时支持患者和卫生专业人员。

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引用次数: 0

Rural digital social innovation for health and social care: A systematic review 农村数字社会创新促进卫生和社会保健：系统回顾

SSM - Health Systems

Pub Date : 2025-10-24 DOI: 10.1016/j.ssmhs.2025.100143

Eric Ping Hung Li , Trina Kushnerik , Cherisse L. Seaton , Kathy L. Rush , Puneet Aulakh , Mike Zajko , Khalad Hasan , Rajeev Manhas , Vida Nyagre Yakong , Robert Janke

Digitalization in the health sector has created numerous opportunities for social innovators and change-makers. However, there is a lack of integrated knowledge of how the latest technological changes have impacted social innovators from marginalized populations living in rural contexts who are often considered the “left-behind” segment in the age of digitalization. The purpose of this systematic review was to synthesize evidence for rural digital social innovations for health and social care. Drawing on searches from multiple databases we adopted a Context-Process-Outcomes Model to evaluate 25 empirical studies focused on innovations within the healthcare sector (18 studies) and general community level innovations (7 studies). Geographical distance between providers and rural patients was often the context for healthcare innovations, necessitating processes with multiple levels of collaboration, whereas diverse community-specific challenges were usually addressed through grassroots initiatives. Most healthcare and community level innovations had evidence of positive outcomes (e.g., positive impacts on health service utilization or community health). Although digitalization accelerated the scope and reach of social innovations, substantial human investment and rural community engagement remained crucial for success. In conclusion, our application of the Context-Process-Outcomes framework enabled us to aggregate diverse findings and unpack the role of digitalization in rural social innovations.

卫生部门的数字化为社会创新者和变革者创造了许多机会。然而，对于最新的技术变革如何影响生活在农村的边缘化人群的社会创新者，人们缺乏综合的认识，这些人群通常被认为是数字化时代的“落后者”。本系统综述的目的是综合农村卫生和社会保健数字社会创新的证据。通过对多个数据库的检索，我们采用了情境-过程-结果模型来评估25项实证研究，这些研究主要关注医疗保健部门的创新（18项研究）和一般社区层面的创新（7项研究）。提供者和农村患者之间的地理距离往往是医疗保健创新的背景，这就需要进行多层次的合作，而各种社区特有的挑战通常是通过基层倡议来解决的。大多数卫生保健和社区一级的创新都有积极成果的证据（例如，对卫生服务利用或社区卫生产生积极影响）。尽管数字化加速了社会创新的范围和范围，但大量人力投资和农村社区参与仍然是成功的关键。总之，我们对“背景-过程-结果”框架的应用使我们能够汇总各种发现，并揭示数字化在农村社会创新中的作用。

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引用次数: 0

Who gets funded? Global analysis of research funding for newborn health and stillbirth in fragile and non-English speaking countries, 2016–2020 谁会得到资助？2016-2020年脆弱和非英语国家新生儿健康和死产研究经费全球分析

SSM - Health Systems

Pub Date : 2025-10-23 DOI: 10.1016/j.ssmhs.2025.100144

Lauren E. Allison , Harriet Ruysen , María J. Sánchez Alva , Priyesh Agravat , Eva M. Loucaides , Meghan Bruce Kumar , Alexandra Molina-García , Ismail Sebina , Elizabeth J.A. Fitchett , Neal Russell , Joy E. Lawn

Context

Despite global progress toward the Sustainable Development Goals (SDGs), 2.3 million newborn deaths and 1.9 million stillbirths occur each year, with a disproportionate burden in humanitarian and fragile contexts. We investigated how funding for newborn health research during the SDG period (2016–2020) varied according to country fragility and language.

Methods

We conducted a systematic analysis of research grants using the Dimensions database, classifying grants by research theme, stage of the research process, type of funding agency, and classification of donor and recipient countries according to the World Bank's income ranking. The grants were then analyzed according to the Fragile States Index and the official languages of the recipient countries.

Results

Between 2016 and 2020, USD 308.2 million was awarded across 1,372 grants involving at least one low- or middle-income recipient country (LMIC). Of this amount, 35% (USD 108.0 million) funded grants involving both an LMIC and a recipient from one of the 30 most fragile countries, while only 19% (USD 57.3 million) was awarded directly to organizations based in the 30 most fragile countries. Among these recipients from fragile states, most funding supported intervention research (USD 33.6 million), with minimal investment in implementation (USD 5.0 million) or basic science (USD 2.8 million). Linguistic disparities were evident: of all grants, recipients from English-speaking countries received the largest amount (USD 115.5 million).

Interpretation

Significant inequalities persist in the allocation of funding for research on newborn health and stillbirths. Despite bearing a disproportionate burden of neonatal mortality, organizations in non-English-speaking countries and the 30 most fragile countries have received limited research funding. These disparities contribute to gaps in evidence regarding impact in humanitarian settings, hinder implementation, and exacerbate global inequalities in research and health.

尽管全球在实现可持续发展目标方面取得了进展，但每年仍有230万新生儿死亡和190万死产，这在人道主义和脆弱环境中造成了不成比例的负担。我们调查了可持续发展目标期间（2016-2020年）新生儿健康研究的资助如何因国家脆弱性和语言而异。方法我们使用Dimensions数据库对研究资助进行了系统分析，根据研究主题、研究过程的阶段、资助机构的类型以及根据世界银行收入排名的捐助国和受援国分类对资助进行分类。然后根据脆弱国家指数和受援国的官方语言对赠款进行分析。2016年至2020年期间，共有1372笔赠款发放了3.082亿美元，涉及至少一个低收入或中等收入受援国。其中，35%（1.08亿美元）资助的赠款既涉及低收入和中等收入国家，也涉及来自30个最脆弱国家之一的受援国，而只有19%（5730万美元）直接提供给30个最脆弱国家的组织。在这些来自脆弱国家的受援国中，大多数资金支持干预研究（3360万美元），实施投资（500万美元）或基础科学投资（280万美元）最少。语言差异很明显：在所有赠款中，英语国家的受助人获得的金额最大（1.155亿美元）。解释在新生儿健康和死产研究的资金分配方面仍然存在显著的不平等。尽管承担着不成比例的新生儿死亡率负担，非英语国家和30个最脆弱国家的组织得到的研究经费有限。这些差异造成了关于人道主义环境影响的证据差距，阻碍了实施，并加剧了研究和卫生方面的全球不平等。

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引用次数: 0

Sustaining gains in laboratory systems, HIV, malaria, tuberculosis programs amidst declining international funding: Key considerations for health integration 在国际资金减少的情况下，实验室系统、艾滋病毒、疟疾和结核病规划持续取得进展：卫生一体化的关键考虑因素

SSM - Health Systems

Pub Date : 2025-10-23 DOI: 10.1016/j.ssmhs.2025.100145

Augustine Onyeaghala , Theophilus Faruna

The efforts to eradicate HIV/AIDS, and other diseases of poverty- Malaria and Tuberculosis have consumed a significant proportion of financial allocation for healthcare. For over two decades, Nigeria has received support from international funding such as the President's Emergency Plan for AIDS Relief (PEPFAR) and other donor agencies. These funds have been used to strengthen Nigeria’s clinical laboratory system, combat the HIV/AIDS epidemic, improve HIV testing and treatment, and reduce HIV-related mortality and morbidity. Declining external funding poses a significant challenge to sustaining these hard-won gains, especially in a nation where budgetary allocation for healthcare is below the projected average. This paper examines the critical challenges that may arise from the reduction or withdrawal of donor funding for HIV and other programs, and provides suggestions on alternative sources of financing. The tips, when integrated into the national health system and implemented, could help to sustain the gains made so far in clinical laboratory systems, the fight against HIV/AIDS, Malaria, and Tuberculosis.

根除艾滋病毒/艾滋病和其他贫穷疾病————疟疾和结核病————的努力消耗了用于保健的很大一部分财政拨款。二十多年来，尼日利亚得到了诸如总统艾滋病紧急救援计划（PEPFAR）和其他捐助机构等国际资金的支持。这些资金已用于加强尼日利亚的临床实验室系统，防治艾滋病毒/艾滋病流行，改善艾滋病毒检测和治疗，并降低与艾滋病毒有关的死亡率和发病率。外部资金的减少对维持这些来之不易的成果构成了重大挑战，特别是在一个医疗保健预算分配低于预计平均水平的国家。本文探讨了减少或撤回对艾滋病毒和其他项目的捐助资金可能带来的重大挑战，并就其他融资来源提出了建议。如果将这些提示纳入国家卫生系统并加以实施，将有助于维持迄今在临床实验室系统、抗击艾滋病毒/艾滋病、疟疾和结核病方面取得的成果。

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引用次数: 0

The development of private health insurance in Malaysia: A case study analysis exploring its influence on financial risk protection 马来西亚私人医疗保险的发展：个案分析，探讨其对金融风险保护的影响

SSM - Health Systems

Pub Date : 2025-10-08 DOI: 10.1016/j.ssmhs.2025.100142

Rui Jie Ng, Wan Yuen Choo, Noran Naqiah Hairi, Chiu-Wan Ng

Since the 1980s, private health insurance (PHI) in Malaysia has undergone significant changes, closely linked to the increased healthcare privatisation driven by government policies. Given the rising number of insured individuals and ongoing government encouragement efforts, this study aims to assess how the development of PHI has influenced financial risk protection. This research adopts a case study approach, combining document analysis and key informant interviews to gain a comprehensive understanding of PHI development. A total of 210 documents detailing PHI development from 1980 to 2023 were analysed. Additionally, stakeholder mapping using the Mendelow matrix identified ten key informants, focusing on those within the high-power, high-interest quadrant. Framework analysis was applied, using an adapted model encompassing five key themes: public policy, demand, market structure, market conduct, and performance. Under "public policy", the study examined government plans, industry governance, and relevant legislation. Analysis of "demand" identified a complex interplay of factors driving PHI uptake. The "market structure" revealed characteristics of an oligopolistic market, with a small number of insurers dominating. Under "market conduct," the evolution of benefit designs largely strengthened financial risk protection. Finally, the "performance" analysis focused on PHI coverage, claims inflation, equity, and financial risk protection. This study revealed the dual effect of PHI development in Malaysia, with certain aspects enhancing financial risk protection while others undermine it. Assessing PHI’s financial protective effect is vital as Malaysia embarks on health system reforms and offers valuable insights for other countries exploring PHI as an alternative financing strategy.

自20世纪80年代以来，马来西亚的私人健康保险（PHI）发生了重大变化，与政府政策推动的医疗保健私有化密切相关。鉴于参保人数的不断增加和政府持续的鼓励措施，本研究旨在评估PHI的发展如何影响金融风险保护。本研究采用个案研究的方法，结合文献分析和关键线人访谈，全面了解PHI的发展。共分析了210份详细描述1980年至2023年PHI发展的文件。此外，使用Mendelow矩阵的利益相关者映射确定了十个关键线人，重点关注那些处于高权力、高利益象限的人。应用框架分析，使用一个包含五个关键主题的调整模型：公共政策、需求、市场结构、市场行为和绩效。在“公共政策”方面，该研究考察了政府计划、行业治理和相关立法。对“需求”的分析确定了驱动PHI吸收的因素之间复杂的相互作用。“市场结构”显示出少数保险公司主导的寡头垄断市场特征。在“市场行为”下，利益设计的演变在很大程度上加强了金融风险保护。最后，“绩效”分析侧重于PHI覆盖范围、索赔膨胀、权益和金融风险保护。这项研究揭示了马来西亚PHI发展的双重影响，在某些方面加强了金融风险保护，而在其他方面则破坏了它。随着马来西亚开始卫生系统改革，评估PHI的财务保护作用至关重要，并为其他国家探索PHI作为替代融资战略提供了宝贵的见解。

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引用次数: 0

Can Indonesia achieve universal health coverage? Organisational and financing challenges in implementing the national health insurance system 印度尼西亚能否实现全民健康覆盖？实施国家健康保险制度的组织和资金挑战

SSM - Health Systems

Pub Date : 2025-10-07 DOI: 10.1016/j.ssmhs.2025.100138

Dwidjo Susilo , Luh Putu Lila Wulandari , Evi Sukmayeti , Augustine Asante , Stephen Jan , Hasbullah Thabrany , Viroj Tangcharoensathien , Virginia Wiseman , Marco Liverani

Indonesia's National Health Insurance system - the Jaminan Kesehatan Nasional (JKN) - is one of the largest single-payer health insurance schemes in the world, aiming to provide equitable and affordable healthcare to a population of over 280 million. Since its launch in 2014, the JKN has achieved near-universal enrolment, covering 98 % of Indonesians in 2024. However, progress towards universal health coverage – understood as access to the health services people need, when and where they need them, without financial hardship - has been hindered by financing deficits and operational hurdles faced by healthcare providers. In this paper, we examine critical issues affecting the implementation of JKN through the analysis of 20 in-depth interviews and a focus group discussion with government officers and health sector managers at the national and provincial level. Data analysis was guided by a framework combining health systems building blocks and dimensions of access to services. The findings highlight persistent challenges despite the JKN's wide coverage, including difficulties among informal sector workers in paying premiums, regional disparities in service access and health workforce distribution, inefficiencies in provider payment mechanisms, and weak information systems for tracking subsidised members. Interviews also revealed a growing financial and administrative strain on hospitals linked to frequent regulatory changes. To address these issues, we recommend three priority reforms: (1) implement sliding-scale subsidies for informal sector workers; (2) improve provider payment models by introducing cost-sharing for elective services; and (3) adopt participatory policymaking processes to ensure reforms are sustainable and inclusive.

印度尼西亚的国民健康保险系统——Jaminan Kesehatan Nasional （JKN）——是世界上最大的单一付款人健康保险计划之一，旨在为超过2.8亿人口提供公平和负担得起的医疗保健。自2014年启动以来，JKN几乎实现了全民注册，到2024年覆盖了98% %的印度尼西亚人。然而，由于卫生保健提供者面临的资金赤字和业务障碍，在实现全民健康覆盖方面取得的进展受到阻碍。全民健康覆盖被理解为在人们需要的时间和地点获得所需的卫生服务，而不会出现经济困难。在本文中，我们通过对20次深度访谈的分析以及与国家和省级政府官员和卫生部门管理人员的焦点小组讨论，研究了影响JKN实施的关键问题。数据分析是在一个框架的指导下进行的，该框架结合了卫生系统的组成部分和获得服务的各个方面。尽管JKN覆盖范围很广，但调查结果强调了持续存在的挑战，包括非正规部门工人在支付保费方面的困难、服务获取和卫生人力分布方面的地区差异、提供者支付机制的效率低下以及跟踪补贴成员的信息系统薄弱。采访还显示，与频繁的监管变化有关，医院的财务和行政压力越来越大。为了解决这些问题，我们建议三项优先改革：(1)对非正规部门工人实行滑动补贴；(2)通过引入可选服务的成本分担机制，改善医疗服务提供者的付费模式；(3)采用参与式决策过程，确保改革具有可持续性和包容性。

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引用次数: 0

Public health facility quality and place of delivery in India: A decomposition analysis across wealth groups 印度公共卫生设施质量和交付地点：跨财富群体的分解分析

SSM - Health Systems

Pub Date : 2025-10-06 DOI: 10.1016/j.ssmhs.2025.100140

Amit Summan , Arindam Nandi , Deepshikha Batheja , Abhik Banerji , Ramanan Laxminarayan

Institutional delivery rates in India remain low, with significant interstate disparities. There is limited research on how supply-side factors influence maternal delivery choices. This study examined whether improvements in the quality of delivery services can impact maternal delivery location decisions using the Integrated Child Health and Immunization Survey (2015–2016). The national survey covered 1510 public planning units (PU) and 44,571 households. We constructed three indices of quality: physical infrastructure, health staff availability, and equipment and vaccine availability. Using multinomial probit regression, we analyzed the relationship between place of delivery for the household’s youngest child under age two and PU quality. Additionally, we conducted Fairlie decomposition analysis to examine factors contributing to differences in delivery location by income group. Mothers living near higher-quality public health facilities, as assessed by all three indices, were more likely to deliver in public facilities and less likely to choose private facilities or home births. The effects of the equipment and vaccine availability index were the strongest and most consistent across terciles, followed by the health staff index in urban areas and the infrastructure index in rural areas. Households in the bottom two wealth quintiles had access to lower-quality public health facilities. Limited access to quality facilities was linked to lower institutional delivery rates when compared to households in the top three wealth quintiles. Improving the quality of health facilities, particularly in low-income areas, can improve institutional delivery rates in public facilities.

印度的机构交付率仍然很低，州际差异很大。关于供给侧因素如何影响产妇分娩选择的研究有限。本研究利用儿童健康和免疫综合调查（2015-2016年）考察了分娩服务质量的改善是否会影响产妇分娩地点的决定。这项全国调查覆盖了1510个公共规划单位和44571户家庭。我们构建了三个质量指标：物质基础设施、卫生人员可用性、设备和疫苗可用性。使用多项probit回归，我们分析了两岁以下最小孩子的出生地点与PU质量之间的关系。此外，我们进行了费尔利分解分析，以检查影响不同收入群体的送货地点差异的因素。根据所有三项指数的评估，居住在质量较高的公共卫生设施附近的母亲更有可能在公共设施分娩，而不太可能选择私人设施或在家分娩。设备和疫苗可得性指数的影响在各个地区是最强和最一致的，其次是城市地区的保健人员指数和农村地区的基础设施指数。收入最低的两个五分之一家庭只能获得质量较低的公共卫生设施。与财富前五分之三的家庭相比，获得优质设施的机会有限与较低的机构交付率有关。提高保健设施的质量，特别是在低收入地区，可以提高公共设施的机构交付率。

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引用次数: 0