摘要
Improved child, newborn, and maternal health(CNM) is a top priority in developing countries. Many factors must be addressed simultaneously to improve clinical outcomes for CNM. A public-private project in Haiti that will deploy the World Health Organization(WHO) evidence-based medicine(EBM) and essential interventions utilizing CNM healthcare technologies(HT), is expected to be a model for improving national health systems. The CNM mortality rates in Haiti are the highest in the western hemisphere with rates similar to those found in Afghanistan and several African countries. Several factors perpetuating this crisis are noted, as well as the most cost-effective interventions proven to decrease CNM mortality rates in low-and middle-income countries. To create major change in health system infrastructure, two strategies are presented, requiring appropriate and leading-edge health technologies(HT), e.g., wireless cellular-network-based Telemedicine(TM):(1) Development of a countrywide network of geographical "Community Care Grids" to facilitate implementation of frontline interventions;(2) The construction of a central hospital(called Bethesda Referral and Teaching Hospital-BRTH NGO) that will provide secondary and tertiary care for communities throughout the country, including helping local hospitals and clinics practice EBM care. We believe that these strategies-supported by HT will fast track improvement in CNM mortality rates throughout the country and that in a relatively short period of time Haiti's health care system will be among the leaders in the region. Primary factors contributing to the CNM crisis, all addressed by TM:(1) Limited access: demographics, geography, cost, transportation;(2) Inadequate health care facilities: less than 20 NICU beds for 10 million population; BRTH to provide 80 bed NICU and 40 bed PICU in 225 bed hospital;(3) Health care practitioners: inadequate numbers and training;(4) Low % of skilled attendants now at deliveries;(5) Low % of prenatal and postnatal visits; and(6) High risk deliveries in qualified health facilities: only 25% now. BRTH NGO guiding principles:(1) Partnerships: Internal: Public-Ministry of Health and Private hospitals; External: collaboration with USA-based CNM specialists(on-site at BRTH and via TM);(2) Philanthropic donor model for both capital and operating funds: a leading WHO CNM physician expert says BRTH to provide EBM care for "pennies on the dollar comparatively";(3) Public-Private Partnership plan for national/regional HT Management Projects and Maintenance Centers; BTRH at new Port;(4) Care processes: to meet Joint Commission International(JCI)Standards;(5) Safety and Security design: addressing seismic issues;(6) Countrywide: hospitals in Haiti's 10 internal regions/provinces enabled for EBM; and(7) Financial: patient remuneration based on sliding scale for no charge care as needed. EBM and Essential Interventionsutilize HT at every stage of CNM care:(1) Pregnancy;(2) Delivery;(3) Post-Delivery: Mother and Baby; and(4) Infancy and Childhood up to age 5.
Improved child, newborn, and maternal health（CNM） is a top priority in developing countries. Many factors must be addressed simultaneously to improve clinical outcomes for CNM. A public-private project in Haiti that will deploy the World Health Organization（WHO） evidence-based medicine（EBM） and essential interventions utilizing CNM healthcare technologies（HT）, is expected to be a model for improving national health systems. The CNM mortality rates in Haiti are the highest in the western hemisphere with rates similar to those found in Afghanistan and several African countries. Several factors perpetuating this crisis are noted, as well as the most cost-effective interventions proven to decrease CNM mortality rates in low-and middle-income countries. To create major change in health system infrastructure, two strategies are presented, requiring appropriate and leading-edge health technologies（HT）, e.g., wireless cellular-network-based Telemedicine（TM）：（1） Development of a countrywide network of geographical ＂Community Care Grids＂ to facilitate implementation of frontline interventions;（2） The construction of a central hospital（called Bethesda Referral and Teaching Hospital-BRTH NGO） that will provide secondary and tertiary care for communities throughout the country, including helping local hospitals and clinics practice EBM care. We believe that these strategies-supported by HT will fast track improvement in CNM mortality rates throughout the country and that in a relatively short period of time Haiti＇s health care system will be among the leaders in the region. Primary factors contributing to the CNM crisis, all addressed by TM：（1） Limited access： demographics, geography, cost, transportation;（2） Inadequate health care facilities： less than 20 NICU beds for 10 million population; BRTH to provide 80 bed NICU and 40 bed PICU in 225 bed hospital;（3） Health care practitioners： inadequate numbers and training;（4） Low % of skilled attendants now at deliveries;（5） Low % of prenatal and postnatal visits; and（6） High risk deliveries in qualified health facilities： only 25% now. BRTH NGO guiding principles：（1） Partnerships： Internal： Public-Ministry of Health and Private hospitals; External： collaboration with USA-based CNM specialists（on-site at BRTH and via TM）;（2） Philanthropic donor model for both capital and operating funds： a leading WHO CNM physician expert says BRTH to provide EBM care for ＂pennies on the dollar comparatively＂;（3） Public-Private Partnership plan for national/regional HT Management Projects and Maintenance Centers; BTRH at new Port;（4） Care processes： to meet Joint Commission International（JCI）Standards;（5） Safety and Security design： addressing seismic issues;（6） Countrywide： hospitals in Haiti＇s 10 internal regions/provinces enabled for EBM; and（7） Financial： patient remuneration based on sliding scale for no charge care as needed. EBM and Essential Interventionsutilize HT at every stage of CNM care：（1） Pregnancy;（2） Delivery;（3） Post-Delivery： Mother and Baby; and（4） Infancy and Childhood up to age 5.
出处
《中国医疗设备》
2016年第1期1-5,共5页
China Medical Devices
