A cross-case comparative analysis of international security forces' impacts on health systems in conflict-affected and fragile states
A cross-case comparative analysis of international security forces' impacts on health systems in conflict-affected and fragile states
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DOI：
10.1186/s13031-015-0040-y
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发表时间：
2015-01-01
影响因子：
3.6
通讯作者：
Nickel, Karlheinz
中科院分区：
文献类型：
--
作者：
Bourdeaux, Margaret;Kerry, Vanessa;Nickel, Karlheinz
背景：脆弱和受冲突影响国家的卫生系统遭到破坏，平民死亡率增加。尽管国际安全部队在脆弱国家进行干预的规模、范围、规模和政治影响力很大，但除了对短期人道主义卫生援助的提供产生影响外，很少有人注意它们可能对卫生系统产生的各种影响。利用我们发表的关于国际安全部队对海地、科索沃、阿富汗和利比亚卫生系统影响的案例研究，我们进行了一项比较分析，研究了三个问题：安全部队在这些案件中影响了卫生系统的哪些方面或组成部分，这些影响的性质是什么？国际安全部队利用哪些论坛或机制与卫生系统行为者互动？哪些政策促进或阻碍安全部队支持卫生系统？结果：我们发现国际安全部队影响了卫生系统治理、信息系统和土著卫生服务组织。积极影响包括加强卫生系统领导的权威、透明度和能力。负面影响包括利用保健项目来实现安全目标，从而破坏了土著保健机构的公正性。安全和卫生行为体之间的互动主要是临时性的，往往不利于卫生系统的支助工作。当国际安全部队参与卫生系统支助活动时，管理其参与的最有帮助的沟通和协商机制是那些能够解决各种问题、足够灵活以适应迅速变化的情况、利用个人关系的力量并能够解决安全与卫生系统支助战略之间出现的紧张关系的机制。国际安全组织参与卫生系统支助的政策障碍包括缺乏授权、安全战略与维护卫生系统之间的冲突以及安全组织与当地卫生组织在后勤和信息共享方面缺乏互操作性。这些案件表明，国际安全组织参与保护卫生部门既有机会，也有风险，恢复和重建。我们讨论了两种潜在的方法，让这些组织参与卫生系统的支持，可能会增加实现这些机会的机会，同时降低风险。
Background: Destruction of health systems in fragile and conflict-affected states increases civilian mortality. Despite the size, scope, scale and political influence of international security forces intervening in fragile states, little attention has been paid to array of ways they may impact health systems beyond their effects on short-term humanitarian health aid delivery.Methods: Using case studies we published on international security forces' impacts on health systems in Haiti, Kosovo, Afghanistan and Libya, we conducted a comparative analysis that examined three questions: What aspects, or building blocks, of health systems did security forces impact across the cases and what was the nature of these impacts? What forums or mechanisms did international security forces use to interact with health system actors? What policies facilitated or hindered security forces from supporting health systems?Results: We found international security forces impacted health system governance, information systems and indigenous health delivery organizations. Positive impacts included bolstering the authority, transparency and capability of health system leadership. Negative impacts included undermining the impartial nature of indigenous health institutions by using health projects to achieve security objectives. Interactions between security and health actors were primarily ad hoc, often to the detriment of health system support efforts. When international security forces were engaged in health system support activities, the most helpful communication and consultative mechanisms to manage their involvement were ones that could address a wide array of problems, were nimble enough to accommodate rapidly changing circumstances, leveraged the power of personal relationships, and were able to address the tensions that arose between security and health system supporting strategies. Policy barriers to international security organizations participating in health system support included lack of mandate, conflicts between security strategies and health system preservation, and lack of interoperability between security and indigenous health organizations with respect to logistics and sharing information.Conclusions: The cases demonstrate both the opportunities and risks of international security organizations involvement in health sector protection, recovery and reconstruction. We discuss two potential approaches to engaging these organizations in health system support that may increase the chances of realizing these opportunities while mitigating risks.