Implementing people-centred health systems governance in 3 provinces and 11 districts of Afghanistan: a case study.
Implementing people-centred health systems governance in 3 provinces and 11 districts of Afghanistan: a case study.
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DOI：
10.1186/1752-1505-9-2
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发表时间：
2015
影响因子：
3.6
通讯作者：
Trasi R
中科院分区：
文献类型：
--
作者：
Anwari Z;Shukla M;Maseed BA;Wardak GF;Sardar S;Matin J;Rashed GS;Hamedi SA;Sahak H;Aziz AH;Boyd-Boffa M;Trasi R
以往的研究表明，卫生系统的治理影响卫生系统的绩效和健康的结果。然而，如何在脆弱和受冲突影响的环境中实施和监测良好治理做法的例子很少。善政有可能使卫生系统以人为本。在这些环境中实施以人为本的治理方法需要进行更多的研究。我们试行了一项干预措施，将以人为本的卫生系统治理方法交给管理省和地区卫生系统的多方利益攸关方委员会。我们报告了在阿富汗三个省和十一个区六个月期间的干预结果。这种混合方法的探索性案例研究使用的治理自我评估分数，卫生管理信息系统的数据对卫生系统的性能，和焦点小组讨论的分析。感兴趣的结果是治理得分和卫生系统绩效指标。我们记录了以人为本的卫生系统治理概念模型的应用，该模型基于应用四种有效的治理实践：培养问责制，与利益相关者合作，制定共同的战略方向，负责任地管理资源。我们提出了一种参与性的方法，卫生系统的领导人确定并采取行动的机会，使自己和他们的卫生系统更负责任，更能满足他们所服务的社区的需求。我们发现，在脆弱和受冲突影响的环境中，卫生系统的治理是可以改善的，而有效的治理实践的一致应用是改善治理的关键。在试点省份，干预措施使产前保健就诊率提高了20%。焦点小组讨论显示，四种治理做法都有所改进，包括：设立新的小组委员会监督财务透明度和治理，与不同利益攸关方合作，更加注重社区卫生需求，更频繁地提供服务提供数据，以及更多地使用数据进行决策。我们的研究结果对阿富汗内外的政策和实践具有影响。治理是使卫生系统满足获得和提供服务的人的需要的核心。我们提供了一种切实可行的方法，以改善脆弱和受冲突影响的环境中的卫生系统治理。本文的在线版本（doi：10.1186/1752-1505-9-2）包含补充材料，可供授权用户使用。
Previous studies show that health systems governance influences health system performance and health outcomes. However, there are few examples of how to implement and monitor good governing practices in fragile and conflict affected environments. Good governance has the potential to make the health system people-centered. More research is needed on implementing a people-centered governance approach in these environments. We piloted an intervention that placed a people-centred health systems governance approach in the hands of multi-stakeholder committees that govern provincial and district health systems. We report the results of this intervention from three provinces and eleven districts in Afghanistan over a six month period. This mixed-methods exploratory case study uses analysis of governance self-assessment scores, health management information system data on health system performance, and focus group discussions. The outcomes of interest are governance scores and health system performance indicators. We document the application of a people-centred health systems governance conceptual model based on applying four effective governing practices: cultivating accountability, engaging with stakeholders, setting a shared strategic direction, and stewarding resources responsibly. We present a participatory approach where health system leaders identify and act on opportunities for making themselves and their health systems more accountable and responsive to the needs of the communities they serve. We found that health systems governance can be improved in fragile and conflict affected environments, and that consistent application of the effective governing practices is key to improving governance. Intervention was associated with a 20% increase in antenatal care visit rate in pilot provinces. Focus group discussions showed improvements across the four governing practices, including: establishment of new sub-committees that oversee financial transparency and governance, collaboration with diverse stakeholders, sharper focus on community health needs, more frequent presentation of service delivery data, and increased use of data for decision making. Our findings have implications for policy and practice within and beyond Afghanistan. Governance is central to making health systems responsive to the needs of people who access and provide services. We provide a practical approach to improving health systems governance in fragile and conflict affected environments. The online version of this article (doi:10.1186/1752-1505-9-2) contains supplementary material, which is available to authorized users.
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影响因子：
4.5
作者：
Olafsdottir AE;Reidpath DD;Pokhrel S;Allotey P
通讯作者：
Allotey P
影响因子：
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作者：
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影响因子：
3.3
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影响因子：
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通讯作者：
Jama, Mohamed A.
影响因子：
15.8
作者：
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通讯作者：
Peters, David H.