Rethinking collaboration: developing a learning platform to address under-five mortality in Mpumalanga province, South Africa
Rethinking collaboration: developing a learning platform to address under-five mortality in Mpumalanga province, South Africa
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DOI：
10.1093/heapol/czz047
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发表时间：
2019-07-01
影响因子：
3.2
通讯作者：
Twine, Rhian
中科院分区：
文献类型：
--
作者：
D'Ambruoso, Lucia;van der Merwe, Maria;Twine, Rhian
经过50年的种族隔离，南非推出了有远见的卫生政策，承诺将健康权作为初级卫生保健办法的一部分。然而，在一个经常功能失调、资源稀缺、可避免的死亡率的复杂负担持续存在的卫生系统中，执行工作面临严重挑战。我们的目的是制定一个程序，为被排除在卫生系统之外的人提供执行进程的实际相关性证据。通过卫生政策和系统研究，我们开发了一个协作学习平台，在这个平台上，我们与一个农村省份的卫生当局合作。本文报告了卫生系统利益相关者带来的过程和见解。与一个省级管理局确定了五岁以下儿童死亡率方面的证据差距，之后我们收集了定量和定性数据。我们运用死因推断来量化死亡的水平、原因和情况，并运用参与性行动研究来获得社区对问题和行动优先事项的看法。然后，我们再次召集卫生系统利益攸关方分析和解释这些数据，通过这些数据确定了导致五岁以下儿童死亡的几个系统问题：工作人员的可用性和绩效;服务组织和基础设施;多个并行举措;以及解决社会决定因素的能力。提出的建议包括立即低成本或无成本地重新安排服务，以及需要系统内较高级别或外部作出反应的建议。这一过程被认为是可以接受的，对于在没有本地数据的情况下“在黑暗中”运行的负担过重的系统是相关的。许多卫生系统不存在循证决策的体制基础设施。我们制定了一个程序，将农村卫生优先事项的研究证据与行动手段联系起来，并使社区、当局和研究人员之间建立了新的伙伴关系。计划进一步发展，以了解农村初级保健审议进程的潜力。
Following 50 years of apartheid, South Africa introduced visionary health policy committing to the right to health as part of a primary health care (PHC) approach. Implementation is seriously challenged, however, in an often-dysfunctional health system with scarce resources and a complex burden of avoidable mortality persists. Our aim was to develop a process generating evidence of practical relevance on implementation processes among people excluded from access to health systems. Informed by health policy and systems research, we developed a collaborative learning platform in which we worked as co-researchers with health authorities in a rural province. This article reports on the process and insights brought by health systems stakeholders. Evidence gaps on under-five mortality were identified with a provincial Directorate after which we collected quantitative and qualitative data. We applied verbal autopsy to quantify levels, causes and circumstances of deaths and participatory action research to gain community perspectives on the problem and priorities for action. We then re-convened health systems stakeholders to analyse and interpret these data through which several systems issues were identified as contributory to under-five deaths: staff availability and performance; service organization and infrastructure; multiple parallel initiatives; and capacity to address social determinants. Recommendations were developed ranging from immediate low- and no-cost re-organization of services to those where responses from higher levels of the system or outside were required. The process was viewed as acceptable and relevant for an overburdened system operating 'in the dark' in the absence of local data. Institutional infrastructure for evidence-based decision-making does not exist in many health systems. We developed a process connecting research evidence on rural health priorities with the means for action and enabled new partnerships between communities, authorities and researchers. Further development is planned to understand potential in deliberative processes for rural PHC.