Why do health systems matter? Exploring links between health systems and HIV response: a case study from Russia
Why do health systems matter? Exploring links between health systems and HIV response: a case study from Russia
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DOI：
10.1093/heapol/czq001
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发表时间：
2010-07-01
影响因子：
3.2
通讯作者：
Renton, Adrian
中科院分区：
文献类型：
--
作者：
Tkatchenko-Schmidt, Elena;Atun, Rifat;Renton, Adrian
方法这项研究是基于半结构化的定性访谈与政策制定者和高级卫生保健管理人员在两个俄罗斯地区，并审查已发表和未发表的来源卫生系统和艾滋病毒在Russian.Findings我们确定了一些因素与系统的失败，以解决流行病。我们认为，这些因素并不是艾滋病毒/艾滋病所独有的。艾滋病毒防治工作所处的更广泛的卫生系统的特点影响了该方案的结构和能力，特别是其监管和临床方向;正式承诺与执行之间的差距;对筛查服务的重视;以及扩大针对高危群体的干预措施方面的问题。先进的保健基础设施不能保护保健系统在提供纵向方案时避免可能的失败。如果更广泛的卫生系统不遵守同样的原则，艾滋病毒防治工作就不可能有效、高效和满足民众的需要。加强后苏联社会的艾滋病毒应对措施将需要改善其更广泛的卫生系统，即倡导对高危人群进行预防，将资源从治疗服务重新分配到预防服务，建设地方一级的决策能力，并为保健工作人员创造更好的工作环境。
Methods The study is based on semi-structured qualitative interviews with policy-makers and senior health care managers in two Russian regions, and a review of published and unpublished sources on health systems and HIV in Russia.Findings We identified a number of factors associated with the system's failure to address the epidemic. We argue that these factors are not unique to HIV/AIDS. The features of the wider health system within which the HIV response was set up influenced the structure and capacities of the programme, particularly its regulatory and clinical orientation; the discrepancy between formal commitments and implementation; the focus on screening services; and problems with scaling up interventions targeting high-risk groups.Discussion The system-programme interplay is as important in middle-income countries as in poorer settings. An advanced health care infrastructure cannot protect health systems from potential failures in the delivery of vertical programmes. The HIV response cannot be effective, efficient and responsive to the needs of the population if the broader health system does not adhere to the same principles. Strengthening HIV responses in post-Soviet societies will require improvements in their wider health systems, namely advocacy of prevention for high-risk populations, reallocation of resources from curative towards preventive services, building decision-making capacities at the local level, and developing better working environments for health care staff.