Abstract
Objective: The Canada-China Yunnan Maternal and Child Health Project (1997–2003) sought to improve the quality of village life and promote development of productivity and social prosperity in Yunnan province, China.
Participants: The project targeted grassroots maternal and child health workers: new and in-service village doctors; traditional village midwives; doctors at township health centres; doctors at county maternal and child health hospitals; and provincial health staff.
Setting: Ten impoverished counties (population 2.2 million) in Yunnan province with high proportions of ethnic minority populations.
Intervention: There were three major innovations: training grassroots maternal and child health workers in participatory and community-based approaches and clinical skills; designing a model comprehensive referral system including provision of basic equipment; and introducing participatory monitoring and evaluation methods. Strategies to support sustainability were built into the project from the outset.
Outcomes: Over 4,000 village, township, and county health workers received training. Maternal, infant, and under-five mortality rates declined over 30% in project counties. Project innovations were disseminated throughout the province, into other donor-funded initiatives, and integrated into national health projects by local partners.
Conclusion: Maintaining the long-term benefits of international health interventions depends on sustaining innovations beyond short project timelines. Achieving sustainability poses a conundrum to implementing agencies. Three mechanisms influenced uptake in the Yunnan project: maintaining a good fit between core project elements and the existing health system; developing adequate organizational supports; and creating a handover plan from the outset. This project highlights some of the ways in which sustainability can be operationalized.
MeSH terms: China, public health, program sustainability, diffusion of innovation, community health planning, international cooperation
Résumé
Objectif: Le Programme sino-canadien de santé des mères et des enfants du Yunnan (1997–2003) visait à améliorer la qualité de vie dans les villages et à promouvoir le développement de la productivité et de la prospérité sociale dans la province chinoise du Yunnan.
Participants: Le programme s’adressait aux travailleuses et aux travailleurs locaux de la santé maternelle et infantile: les nouveaux médecins et les médecins en exercice dans les villages; les sages-femmes traditionnelles dans les villages; les médecins des centres sanitaires de district; les médecins des hôpitaux pour femmes et pour enfants des comtés; ainsi que le personnel de santé provincial.
Lieu: Dix comtés pauvres (2,2 millions d’habitants) de la province du Yunnan ayant de nombreuses populations issues de minorités ethniques.
Intervention: Il y en a eu trois principales: la formation des travailleuses et des travailleurs locaux de la santé maternelle et infantile aux approches participatives et communautaires et aux techniques de soins cliniques; la conception d’un modèle de système global d’aiguillage incluant la fourniture de l’équipement de base; et la présentation de méthodes de suivi-évaluation participatives. Des stratégies d’appui à la durabilité ont été intégrées dans le programme dès le début.
Résultats: Plus de 4 000 travailleuses et travailleurs de la santé dans les villages, les districts et les comtés ont reçu une formation. Les taux de mortalité chez les mères, les nourrissons et les enfants de moins de cinq ans ont baissé de plus de 30 % dans les comtés visés par le programme. Des partenaires locaux ont diffusé les innovations du programme dans toute la province; elles ont ensuite été intégrées dans les initiatives d’autres bailleurs de fonds et dans des projets de santé nationaux.
Conclusion: Le maintien à long terme des avantages d’interventions de santé internationale dépend de ce que l’on assure la continuité des innovations au-delà de la brève durée de vie des programmes. La durabilité présente un dilemme pour les organismes de mise en oeuvre. Trois mécanismes ont influencé l’acceptation du programme au Yunnan: le bon ajustement entre les éléments de base du programme et le système de santé existant; la mise au point de mesures de soutien organisationnel adéquates; et la création, dès le début, d’un plan de prise en charge. Ce programme met en évidence quelques-uns des moyens d’opérationaliser la durabilité.
Footnotes
Acknowledgements of sources of support: The China-Canada Yunnan Maternal and Child Health Project was funded by the Canadian International Development Agency. Nancy Edwards holds a Nursing Chair from the Canadian Health Services Research Foundation, the Canadian Institutes of Health Research and the Ontario Ministry of Health and Long-term Care. We thank our partners in Yunnan for the tremendous learning afforded to us and for their exemplary leadership in strengthening maternal and child health services for the poor.
Disclaimer: The opinions expressed in this publication are those of the authors. Publication does not imply any endorsement of these views by the Canadian International Development Agency or the Yunnan Provincial Public Health Bureau.
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