라오스모자보건사업중간평가보고서 2012. 5. 31 한국국제보건의료재단 서울대학교의학연구원의료관리학연구소 - 1 -
< >
- 3 -
- 5 -
Ⅰ. 라오스모자보건사업중간평가의목적 - 1 -
Ⅱ. 사업배경및필요성 그림 1. 라오스전도 - 2 -
1) 모성사망률 (Maternal Mortality Rate): 모성사망은해당해에태어난 100,000 명당출산후 42 일이내에산모의사망으로정의됨. 출산시장소나출산시간과상관없이사고나우연적인원인이아닌출산으로인해발생하거나악화된원인으로사망한경우임. 2) 영아사망률 (Infant Mortality Rate): 해당해에태어난 1,000 명의출생수당 1 세미만에사망한아이의수 - 3 -
그림 2. 라오스모성사망률 (MMR) 과영아사망률 (IMR) 의목표 - 4 -
그림 3. 라오스국가모자보건전략 2009-2015 - 5 -
그림 4. 통합적인모자보건사업을모델로한라오스의모자보건사업의틀 - 6 -
Ⅲ. 라오스모자보건사업개관 3) Ministry of health, Consultative council on medical and allied services. Interim Report on the future provision of medical and allied services. 1920. - 7 -
- 8 -
- 9 -
- 10 -
- 11 -
그림 5. 라오스국가모자보건전략의틀 - 12 -
- 13 -
표 1. 라오스 MNCH 프로그램확산경과 도 군 시범사업 1 차 2 차 (Pro vince ) (D istrict) 대상지역사업확대사업확대 (Ja n 2 0 1 0 ) (A ug 2010) (A pril 2011) X ie n g K h o u n g P e k (8 D istricts) Kham N o n g h a t Pho ukhud P h a xa y M o k T h a to m K h o u n H u a p h a n E d d (8 D istricts) Sop hao X ie n g kh o r V ia n g th o n g H o u a m u a n g X a m n e u a X a m th a i V ie n xa i Saravan (1 D istrict) K ong sed on T o ta l 2 1 2 1 7-14 -
- 15 -
그림 6. 도차원의 MNCH 워크숍 그림 7. 군차원의 MNCH 워크숍 - 16 -
그림 8. 라오스 MNCH 사업의각실행단계 그림 9. 보건소의 micro planning 및마을지도 - 17 -
그림 10. 정기적인마을보건요원의보건소모임 그림 11. 마을기반모자보건정보수집체계 그림 12. 라오스보건소의모자보건관련현황판 - 18 -
그림 13. 보건요원에대한모자보건서비스의훈련 - 19 -
- 20 -
그림 14. 보건소에공급된모자보건서비스관련장비와물품 - 21 -
: 1 5 6-59 A 1-5 : A - 22 -
모자보건사업을위한개인 가정 지역사회의동원 그림 15. 마을보건요원메뉴얼 - 23 -
- 24 -
Ⅳ. 라오스모자보건사업의중간평가지표및평가결과 4) 콩세돈지역은물리적거리에대한부담으로인해중간사업평가에는포함되지않음 - 25 -
- 26 -
- 27 -
Indicators Baseline (Year) Target(2015) (100,000) 405(2005) 265 5 (1,000) 98(2005) 55 (1,000) 70(2005) 45 Impacts Outcome 1) KAP(knowledge-attitude -practice) 2) 1 3),, 1A) 2A) 3A) f 3B) Output a b c d e () g h i BEmONC CEmONC 4A) (Output) j k l - 28 -
Impact indicator Outcome indicator 3.1) 3.2) 3.3) Output indicator 3.1A) 3.2A) 1 (100,000) 2 5 (1,000) 3 (1,000) 1 2 3 1,, a b c d e () : (MDG 4, 5) 4.2) 3 4.2) 2 (, LCD,,,,,, ) 4.3) 1 4.3) 2 4.3) 3 4.3) 5 4.2) 3 4.3) 4 ( ) 3.3A) f 4.2) 1 3.3B) 3.4A) g h i BEmONC CEmONC i j k 4.2) 2 (, LCD,,,,,, ) 4.1) 1 (district) (provincial and district plans for MNCH) 4.1) 2 (micro planning) 4.1) 3 / 4.1) 4 :, 4.1) 5-29 -
[ 평가결과 ] ANC 〇 2009 2012 WHO KAP(knowledge-attitude practice) 2009 28.33% 그림 16. 산전진찰서비스의필요성에대한태도의변화 - 30 -
[ 평가결과 ] 1A) 사업환경및공동체적지원 (Output),, 100%, 표 4. 사업환경및공동체적지원의산출지표결과 (%) 1A) * a 100 b 100 c 100-31 -
[ 평가결과 ] o Xiengkhuang 8 district(pek, kham, Nonghet, Phuohud, Phaxay, Koun, Mork, Thatom) Huaphan 3 district(xiengkhor, Sopbao, Add) o Huaphan 5 district(xamneua, Viengthong, Viengxay, Huameuang, Xamtay) 1 산전산후진찰비율 (% of Antenatal Care/Postnatal Care) 1 (25.01% 56.7%) o 1, o (40.42% 44.03%) o,, (Counterfacutual analysis 5) ) 28.08% (56.7%- 28.62%) 5) 역사실적분석 (Counterfactual analysis): 현재의사실과같은대상이다른상황을맞은것을가정한분석으로본연구에서는사업시행지역과미시행지역에서사업이전 (baseline) ANC 및 SBA 의이용률이동일하다는가정으로본사업의효과를분석함 - 32 -
Counterfactural Analysis A N C 그림 17. 사업지역 / 사업미지역에서사업전후의 ANC 서비스이용율의차이 ( 단위 : %) 2 훈련된분만개조인력의도움을받은출산비율 (% of birth by SBA) (15.73% 46.65%) o, (19.51% 18.89%) o counterfactual analysis 31.54% (46.65%-15.11%), Counterfactural Analysis S B A 그림 18. 사업지역 / 사업미지역에서사업전후의 SBA 서비스이용율의차이 ( 단위 : %) - 33 -
3 1세미만아동중백신을접종한아동의비율 (% of children under age 1 with immunization) BCG DPT3, 50%, 35% 표 5. 1세미만아동중백신을접종한아동비율의결과지표결과 (%) BCG 51 DPT3 49 Measles(9-11 months) 35 [ 평가결과 ] 4 100% 55% o 50% 55%,, 1,348 4-34 -
표 6. 모자보건사업의접근성산출지표결과 (%) 2A) * d 55 e 100-35 -
[ 평가결과 ] 3AB) 서비스제공인력및시설및환경 81.5%, 51.9%, 23.1%, BEmONC CEmONC 25% o (,, ) 표 7. 서비스제공인력, 시설및환경에대한산출지표의결과 (%) 3A) f * 81.5 3B) g * 51.9 h * 23.1 i BEmONC CEmONC 25-36 -
4A) 국가관리능력 100% 0% 표 8. 국가관리능력의산출지표결과 (%) 4A) (Output) j * 100 k 0 l 100-37 -
- 38 -
- 39 -
#1 Division of Statistics & Planning : 2011 7 25, Division of Statistics & Planning Interviewer:? Interviewee A:... - 40 -
#2 Xiengkouang Province MCH Section : 2011 7 25, Xiengkouang Province MCH Section Interviewer: KOFIH UNFPA? Interviewee B: UNFPA 2.. KOFIH. Interviewer:? Interviewee B:., 20%. #3 Division of Statistics & Planning : 2011 7 25, Division of Statistics & Planning Interviewer: Interviewee A:.....,. #4 Xiengkouang Province MCH Section : 2011 7 25, Xiengkouang Province MCH Section Interviewer:? Interviewee B:. 2.. - 41 -
#5 : 2011 7 29, Minister of Health Interviewer: KOFIH/WHO? Interviewee C:. Interviewer:? Interviewee C:. KOFIH (capacity). (ownership & leadership).... (capacity building). Interviewer: (self sustainability). Interviewee C: KOFIH. Interviewer:. Interviewee C:. KOFIH. 2020.. - 42 -
#6 : 2012 4 4, Salavanne Provincial Hospital Interviewee D: 2 #7 : 2012 4 4, Salavanne Provincial Hospital Interviewee D:,., Toum Lane Ta Oy... #8 : 2011 7 26, Nonghet District Hospital Interviewer:? Interviewee D:.,,. Interviewer:? Interviewee D:.. 2. #9 : 2011 7 28, Khoun District hospital Interviewer: MCH? Interviewee E:.. Interviewer:? Interviewee E:. ( ) ( ). - 43 -
#10 : 2011 7 29, Khoun district Phai Village Interviewer: MNCH.? Interviewee F:.. Interviewer:??? Interviewee G:. Interviewee H:. #11 : 2011 7 26, Nonghet district Khang Pha Nian Health Center Interviewer:. Interviewee H: 낮에사람들이다들일을하러나가니까교육을주로밤에하러가게됩니다. #12 : 2011 7 27, Khoun District Ngang Health Center Interviewer:? Interviewee I:. Interviewee J:.. Interviewee I:. Interviewer:? Interviewee J:... - 44 -
#13 : 2011 7 26, Nonghet District Phou Hua Xang Health Center Interviewer:? Interviewee K:.. 2 1. Interviewer:??? Interviewee K:.,. Interviewee K:. Interviewer:? Interviewee L: 30km... #14 : 2011 7 28, Khoun District hospital Interviewee E:,.. #15 Division of Statistics & Planning : 2011 7 25, Division of Statistics & Planning office Interviewee A:..,. - 45 -
#16 : 2011 7 28, Khoun District hospital Interviewer:, KOFIH? Interviewee E:.... Interviewer:? Interviewee E:.. 4... #17 Nonghet District Hospital : 2011 7 26, Nonghet District Hospital Interviewer:? Interviewee M:, doppler,,,. Interviewer: kit, delivery kit? Interviewee M:. deliver kit.. Interviewer:? Interviewee E:.. #18 Division of Statistics & Planning : 2011 7 25, Division of Statistics & Planning office Interviewer:? Interviewer A:....,,. - 46 -
#19 : 2011 7 28, Nonghet District Hospital Interviewer:. Po Xeng: 70%. #20 : 2011 7 26, Nonghet District Hospital Interviewee E: 9. Interviewer:? Interviewee E:.. #21 : 2011 7 29, Khoun district Phai Village Interviewee N: - 47 -
#22 WHO : 2011 7 29, WHO Laos office Interviewee O: ( ). MDGs,,. #23 WHO : 2011 7 29, WHO Laos office Interviewee O:. ().. - 48 -
- 49 -
Ⅴ. 향후사업을위한제언 - 50 -
- 51 -
- 52 -
- 53 -
- 54 -
- 55 -
6) 1 개보건소지원액 (30 백만원 ): 벨기에보건소지원 (60 백만원 ) 의 1/2 수준임. 라오스에서다른보건소개보수사업을한 Lux-Development 의경우보건소개보수비용 $6000(1 개보건소 ) 를집행한것으로확인함. 본시범사업은단순보건소개보수가아닌주민참여에초점을맞추었기때문에마을주민의참여를통해예산을 Lux-development 의보건소개보수비용의 1/2 ~ 1/3 수준으로책정함 - 56 -
- 57 -
- 58 -
- 59 -
- 60 -
[ ] - 61 -
1. Delivery Kits - 62 -
2. Xiengkhouang H ouap hanh 소독기 2 5 1 3 혈압기 1 2 7 성인용청진기 1 6 6 휴대용태아심박측정기 3 6 1 3 성인용신장계 9 5 유아용체중계 1 9 1 1 체온계 4 9 2 2 분만키트 1 8 6 유아용청진기 1 2 3 흡입구 1 0 3 분만침대 3 5 7 환자처치용거즈 4 5 1 6 일회용장갑 4 5 1 6 의료용실세트 4 5 1 6 아웃리치용가방 4 5 1 6 3. 2010-2011 (: 2010.5-2011.4) E xp e n d itu re O rig ia n a l b u d g e t B a la n c e A ctivity 1 P lanning and m anag em ent 223,315 251,000 27,685 A ctivity 2 Training 200,248 144,000-56,248 A ctivity 3 M N C H service delivery 58,956 200,000 141,044 A ctivity 4 Supp ly for M N C H 289,708 270,000-19,708 A ctivity 5 A d m inistrative cost in Laos 77,693 40,000-37,693 A ctivity 6 C onting ency cost 21,332 18,009-3,323 * m in ib u d g e t fo r 5 n e w d istricts(stra te g y 1 ) 5 1,7 5 7 T o ta l 9 2 3,0 0 9 9 2 3,0 0 9-63 -
4. 2011-2012 (: 2011.5-2012.3) P la n n in g a n d m a n a g e m e n t (C ateg ory 1 ) T ra in in g (C ateg ory 2 ) M N C H se rv ic e d e liv e ry (C ateg ory 3 ) S u p p ly fo r M N C H (C ateg ory 4 ) U n it B u d g e t Exp endit A ctiv ity U n it c o st (U S D ) u re (U S D ) R eview w orkshop at p rovinces (2 p rovinces) 2 3,000 6,000 7,991 O rientation w orkshop at d istricts (5 d istricts) 5 1,300 6,500 6,992 Im p ro ve d su p e rvisio n a n d m o n ito rin g a t d istrict a n d health centers (15 D s 6 tim es) C e n tra l su p e rv isio n a n d m o n ito rin g (2 sta ffs x 1 0 tim es) Q u a rte rly m e e tin g s o f d istrict w ith h e a lth c e n te rs o n p rog ress & them atic training (15 D s 4 tim es) M ic ro p la n n in g b y h e a lth c e n te rs o n th e d e liv e ry o f M N C H p a c ka g e (3 6 H C s) R e g u la r m e e tin g w ith v illa g e v o lu n te e r/le a d e rs o n d a ta re p o rtin g & h e a lth e d u c a tio n (9 7 H C s 6 tim es) 9 0 4 0 0 3 6,0 0 0 5 2,7 9 2 2 0 3 0 0 6,0 0 0 1 2,0 7 9 6 0 5 0 0 3 0,0 0 0 3 8,6 4 2 3 6 1 5 0 5,4 0 0 5 8 2 3 0 0 1 7 4,6 0 0 1 5 2,7 8 3 P erfo rm ance assessm ent and incentives (97 H C s) 97 100 9,700 6,178 C o nduct case aud it on m aternal d eaths (15 d istricts) 15 800 12,000 8,595 Sub-total 286,200 25.6 286,052 T ra in in g o n h e a lth p la n n in g a n d m a n a g e m e n t fo r p rovincial and district m anag ers (2 p rovinces) T ra in in g fo r h e a lth ce n te r sta ff o n M N C H p a c k a g e services (36 H C s 2 p ersons 3 m od ules) T ra in in g fo r h e a lth ce n te r sta ff o n M N C H p a c k a g e services (97 H C s 2 p ersons 2 m od ules) T ra in in g fo r v illa g e h e a lth vo lu n te e rs/le a d e rs o n d a ta collectio n & rep orting (5 D s 2 tim es) T ra in in g fo r v illa g e h e a lth vo lu n te e rs/le a d e rs o n p ro m o tin g M N C H c a re (1 5 D s 2 tim e s) 2 1,0 0 0 4 1,6 4 0 3 2,7 0 0 2 1 6 1 5 0 3 2,4 0 0 6 2,6 1 4 3 8 8 1 5 0 5 8,2 0 0 7 5,7 4 1 1 0 8 0 0 8,0 0 0 3 0 8 0 0 2 4,0 0 0 3 8,5 8 8 Stud y tour (2 pro vincial officers, 5 d istrict o fficers) 7 2,500 17,500 25,275 Sub-total 181,740 16.3 234,918 S u p p o rt to o u tre a ch se rvice s o n M N C H p a rtic u la rly A N C, sa fe d e liv e ry & P N C (6 5 0 V illa g e s 4 tim e s) P ro m o tin g b irth s a t h e a lth fa c ilitie s o r a tte n d e d b y SBA (6,000 new b orns) 2,6 0 0 7 0 1 8 2,0 0 0 1 7 9,7 8 3 5,0 0 0 2 5 1 2 5,0 0 0 1 0 6,1 7 7 Sub-total 307,000 27.5 285,960 Essential eq uip m ent and sup plies (5 districts) 5 13,000 65,000 76,323 E sse n tia l e q u ip m e n t a n d su p p lie s (1 0 d istricts) 1 0 2,0 0 0 2 0,0 0 0 H e a lth e d u c a tio n m a te ria ls d isse m in a tio n & e v e n ts a t villag es (1240 villag es) 1,2 4 0 5 0 6 2,0 0 0 3 9,4 3 9 Sub-total 147,000 13.2 115,762 O p erational cost (Stationery, etc) 20,000 18,500 A d m in istra tiv e S a la ry fo r n a tio n a l sta ffs 2 5,0 0 0 2 5,3 4 6 c o st in Laos Travel fo r second ed staff 20,867 21,269 (C ateg ory 5 ) Sub-total 65,867 5.9 65,115 To tal for activities 987,807 88.5 987,807 P roject sup po rt co st (13% ) 128,625 11.5 G rand Total 1,116,432 100.0 1,2 2 8,0 7 5,2 0 0 K R W (if 1 U S D = 1,1 0 0 K R W ) - 64 -
5. (HMIS) HMIS 2009 (from Oct 2008 to Sep 2009) Prov. Demoninator Service Hospital Xamneua Xiengkhor Viengthong Viengxay Huameuang Xamtay Sopbao Add Total Coverage(%) (census estimation) ANC1 677 0 259 371 751 292 605 186 31 3,172 9,336 34 ANC1+ 1,908 0 1,113 942 1,137 365 1,091 464 65 7,085 9,336 76 PNC 587 0 323 127 140 70 156 156 7 1,566 8,891 18 SBA 508 0 237 190 125 206 256 68 11 1,601 8,891 18 HMIS 2010 (from Oct 2009 to Sep 2010) Prov. Demoninator Service Xamneua Xiengkhor Viengthong Viengxay Huameuang Xamtay Sopbao Add Total Coverage(%) Hospital (census estimation) ANC1 577 70 325 333 173 385 543 224 182 2,812 9,472 30 ANC1+ 1,857 175 1,085 681 442 921 1,001 491 436 7,089 9,472 75 PNC 118 19 80 128 267 145 188 120 148 1,213 9,021 13 SBA 585 21 272 185 113 65 132 111 73 1,557 9,021 17 HMIS 2011 (from Oct 2010 to Sep 2011) Prov. Demoninator(censu Service Xamneua Xiengkhor Viengthong Viengxay Huameuang Xamtay Sopbao Add Total Coverage(%) Hospital s estimation) ANC1 924 111 277 627 696 622 863 459 632 5,211 9,611 54 ANC1+ 2,704 292 937 1,426 1,335 1,116 1,531 947 1,241 11,529 9,611 120 PNC 364 7 74 168 722 100 209 119 164 1,927 9,153 21 SBA 591 24 114 186 164 97 186 157 92 1,611 9,153 18 HMIS 2012 (from Oct 2011 to Mar 2012) Prov. Demoninator(censu Service Xamneua Xiengkhor Viengthong Viengxay Huameuang Xamtay Sopbao Add Total Coverage(%) Hospital s estimation) ANC1 521 121 362 144 348 199 213 313 206 2,427 9,752 50 ANC1+ 1,235 275 1,088 508 642 472 433 802 459 5,914 9,752 121 PNC 230 51 110 114 274 88 51 51 149 1,118 9,288 24 SBA 316 11 122 110 85 61 57 110 48 920 9,288 20-65 -
<> Central Intelligence Agency. (2012). The World Factbook: Laos Retrieved 30. Sep. 2011, from https://www.cia.gov/library/publications/the-world-factbook/geos/la.html Department of Statistics and UNICEF. (2008) Lao PDR Multiple Indicator Cluster Survey 2006, Final report. Vientiane: Department of Statistics and UNICEF. EA Goodburn, M Chowdhury, R Gazi, T Marshall, W Graham. Training traditional birth attendants in clean delivery does not prevent postpartum infection. Health Policy Plan, 15 (2000), pp. 394 399) Laos National Statistic Centre. (2005). Results from the Population and Housing Census 2005. Vientien, Lao PDR: Laos National Statistic Centre. Maine D. Detour and shortcuts on the road to maternal mortality reduction. Lancet. 2007 Oct 13;370(9595):1380-2 Ministry of Health, Lao PDR. (2009). Strategy and Planning Framework for the Intergreated Package of Maternal Neonatal and Child Health Services 2009-2015. Vientien, Lao PDR tn United Nations Development Programme. (2010). Human Development Report 2010 World Health Organization. (2010). World Health Statistics 2010 http://www.who.int/whosis/whostat/2010/en/index.html Retrieved from World Health Organization Western Pacific Region. (2009). Maternal, Newborn, and Child Health at the Margins. Vientien, Lao PDR Bossyns, P., Abache, R., Abdoulaye, M. S., & Lerberghe, W. V. (2005). Unaffordable or cost effective?: introducing an emergency referral system in rural Niger. Tropical Medicine & International Health, 10(9), 879-887. Fournier, P., Dumont, A., Tourigny, C., Dunkley, G., & Dramé, S. (2009). Improved access to comprehensive emergency obstetric care and its effect on institutional maternal mortality in rural Mali. Bulletin of the World Health Organization, 87(1), 30-38. - 66 -