Abstract
Background: Accessible, equitable, and efficient pediatric service is critical to achieve optimal child health. This study aimed to evaluate the effectiveness of a multi-component intervention on the pediatric health system over two different periods in Guangzhou.Methods: Based on the World Health Organization (WHO) “six building blocks” model and Donabedian's “Structure-Process-Outcomes” framework, an intervention package was developed to increase financial and human resouce investment to strengthen basic health care and strive for a better quality of pediatric care. This multi-component intervention package was conducted in Guangzhou to improve the pediatric service delivery during two stages (2011–2014 and 2016–2019). The main outcome indicators were the changes in the allocation of pediatricians and pediatric beds, pediatric service efficiency, and the impact of pediatricians on child mortality.Results: We found that pediatricians per 1,000 children (PPTC) and pediatric beds per 1,000 children (PBPTC) increased from 1.07 and 2.37 in 2010 to 1.37 and 2.39 in 2014, then to 1.47 and 2.93 in 2019, respectively. Infant mortality rate (IMR) and under-5 mortality rate (U5MR) dropped from 5.46‰ and 4.04‰ in 2010 to 4.35‰ and 3.30‰ in 2014 then to 3.26‰ and 2.37‰ in 2019. The Gini coefficients of PPTC and PBPTC decreased from 0.48 and 0.38 in 2010, to 0.35 and 0.28 in 2014, then to 0.35 and 0.22 in 2019, respectively, representing the improvement of pediatric resources distribution according to service population. However, equalities in the spatial distribution were not improved much. The average efficiency of pediatric service fluctuated from 2010 to 2019. A unit increase in PPTC was associated with an 11% reduction in IMR and a 16% reduction in U5MR.Conclusions: Findings suggest this multi-component intervention strategy is effective, particularly on the reduction of child mortality. In future, more rigorous and multi-faceted indicators should be integrated in a comprehensive evaluation of the intervention.
Highlights
Accessible, equitable, and efficient pediatric service is critical to achieve optimal child health
We aim to examine the effectiveness of a multi-component intervention that seeks to improve the quality and equity of pediatric service delivery in Guangzhou
We found that: [1] the numbers of pediatricians and pediatric beds per share of children and geographical area increased significantly coinciding with the implementation of the two-stage intervention; [2] the equity in the distribution of pediatricians and pediatric beds per served population was equal and improved over these years, while the distribution per geographical area remained inequitable; [3] the average efficiency of pediatric service fluctuated from 2010 to 2019, and the difference over time was small in most districts; [4] under-5 mortality rate (U5MR) and infant mortality rate (IMR) in Guangzhou decreased significantly and was inversely associated with the PPTC
Summary
Accessible, equitable, and efficient pediatric service is critical to achieve optimal child health. In Asian countries like Japan, the pediatric health care system is facing challenges of both shortage of pediatricians [9] and uneven geographic distribution [10]. These common challenges across countries call for joint efforts from governments and health care organizations, such as reforming medical education and strengthening training to increase the pediatric workforce [7, 11,12,13,14,15,16,17]
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