Towards an understanding of resilience: responding to health systems shocks.
Towards an understanding of resilience: responding to health systems shocks.
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DOI：
10.1093/heapol/czx183
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发表时间：
2018-04-01
影响因子：
3.2
通讯作者：
Balabanova D
中科院分区：
文献类型：
--
作者：
Hanefeld J;Mayhew S;Legido-Quigley H;Martineau F;Karanikolos M;Blanchet K;Liverani M;Yei Mokuwa E;McKay G;Balabanova D
最近在西非爆发的埃博拉病毒病引起了人们对卫生系统在面对冲击时的作用和反应能力的关注。它使人们清楚地认识到，卫生系统不仅需要变得更强大，而且还需要更“有弹性”。在这篇文章中，我们认为应对冲击是复原力的一个重要方面，考察了卫生系统在面对四种当代冲击时的行为：2008年以后的欧洲金融危机；气候变化灾难；2013-16年西非埃博拉疫情；以及最近欧洲的难民和移民危机。根据这一分析，我们确定了与卫生系统适应和应对冲击的能力特别相关的‘3+2’关键方面；在所有这些方面采取的行动将决定反应的成功程度。这是与卫生系统的三项职能相对应的三个核心方面：“卫生信息系统”(拥有就需要做什么作出决定的信息和知识)；“筹资/筹资机制”(投资或调动资源以资助应对)；以及“卫生工作人员”(谁应该规划和实施以及如何规划和实施)。这些与两个交叉方面相交：“治理”，作为影响所有其他系统层面的基本职能；主导“价值观”，影响回应，以及在个人和社区层面如何经历。此外，在这里审查的所有危机中，保健系统内的整合有助于提高复原力，与当地社区的联系也是如此，社区成功应对埃博拉病毒和应对金融危机的社会运动证明了这一点。在所有危机中，不平等都在加剧，但我们的证据也突显出，冲击的影响是可以由政府采取行动的。所有这些因素都是由环境决定的。我们认为，“3加2”维度可以为寻求提高卫生系统复原力的务实政策提供依据。
The recent outbreak of Ebola Virus Disease (EVD) in West Africa has drawn attention to the role and responsiveness of health systems in the face of shock. It brought into sharp focus the idea that health systems need not only to be stronger but also more ‘resilient’. In this article, we argue that responding to shocks is an important aspect of resilience, examining the health system behaviour in the face of four types of contemporary shocks: the financial crisis in Europe from 2008 onwards; climate change disasters; the EVD outbreak in West Africa 2013–16; and the recent refugee and migration crisis in Europe. Based on this analysis, we identify ‘3 plus 2’ critical dimensions of particular relevance to health systems’ ability to adapt and respond to shocks; actions in all of these will determine the extent to which a response is successful. These are three core dimensions corresponding to three health systems functions: ‘health information systems’ (having the information and the knowledge to make a decision on what needs to be done); ‘funding/financing mechanisms’ (investing or mobilising resources to fund a response); and ‘health workforce’ (who should plan and implement it and how). These intersect with two cross-cutting aspects: ‘governance’, as a fundamental function affecting all other system dimensions; and predominant ‘values’ shaping the response, and how it is experienced at individual and community levels. Moreover, across the crises examined here, integration within the health system contributed to resilience, as does connecting with local communities, evidenced by successful community responses to Ebola and social movements responding to the financial crisis. In all crises, inequalities grew, yet our evidence also highlights that the impact of shocks is amenable to government action. All these factors are shaped by context. We argue that the ‘3 plus 2’ dimensions can inform pragmatic policies seeking to increase health systems resilience.
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影响因子：
3.7
作者：
Akl EA;El-Jardali F;Bou Karroum L;El-Eid J;Brax H;Akik C;Osman M;Hassan G;Itani M;Farha A;Pottie K;Oliver S
通讯作者：
Oliver S
影响因子：
7.4
作者：
Connor, KM;Davidson, JRT
通讯作者：
Davidson, JRT
影响因子：
4.8
作者：
Doocy, Shannon;Lyles, Emily;Burnham, Gilbert
通讯作者：
Burnham, Gilbert
影响因子：
3.6
作者：
Bourdeaux, Margaret;Kerry, Vanessa;Nickel, Karlheinz
通讯作者：
Nickel, Karlheinz
影响因子：
5.4
作者：
Gilson, L;Palmer, N;Schneider, H
通讯作者：
Schneider, H