An analysis of Liberia's 2007 national health policy: lessons for health systems strengthening and chronic disease care in poor, post-conflict countries
An analysis of Liberia's 2007 national health policy: lessons for health systems strengthening and chronic disease care in poor, post-conflict countries
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DOI：
10.1186/1744-8603-7-37
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发表时间：
2011-10-10
影响因子：
10.8
通讯作者：
Gwenigale, Walter T.
中科院分区：
文献类型：
--
作者：
Lee, Patrick T.;Kruse, Gina R.;Gwenigale, Walter T.
背景：在全球范围内，慢性病造成死亡、残疾和经济损失的巨大负担，但人们对贫穷、冲突后国家卫生部门对慢性病的最佳反应知之甚少。利比里亚在全面加强卫生系统和卫生筹资，特别是解决艾滋病毒/艾滋病和精神健康问题方面的经验，为其他贫穷、冲突后国家的国际利益攸关方和决策者提供了一个相关的案例研究，以期了解和优先考虑全球对慢性病的反应。主要资料来源包括利比里亚卫生和社会福利部的主要文件、出版的灰色文献以及参与利比里亚卫生部门改革的主要利益攸关方的个人通信。在这个案例研究中，我们考察了从2003年冲突结束到现在利比里亚卫生保健系统的早期重建，强调了从这一初步经验中吸取的挑战和教训，并描述了利比里亚加强卫生系统和慢性病护理和治疗的未来方向。结果：从这一分析中得出六个关键教训：(I)2007年国家卫生政策的‘一刀切’方法达到了总体规划目标，但导致整个系统存在重大缺口和效率低下；(Ii)创新的卫生部门集合基金被证明是一种有效的筹资机制，可以招募卫生行为者并使其与2007年国家卫生政策保持一致；(3)农村保健服务仍有很大差距，但可以通过将一支强大的社区卫生工作者队伍纳入初级保健系统加以弥补；(4)应在利比里亚验证其他环境中艾滋病毒/艾滋病护理的有效战略，并将其用于其他慢性病；(5)心理健康障碍在利比里亚极为普遍，应继续作为慢性病的首要优先事项；结论：利比里亚慢性病的前进道路将更加注重质量而不是数量，需要更好的数据管理以指导合理的卫生部门规划，纠正机制以更有效地将卫生基础设施和人员与现有需求相结合，以及创新方法以改善长期护理和弥合农村卫生服务的差距。
Background: Globally, chronic diseases are responsible for an enormous burden of deaths, disability, and economic loss, yet little is known about the optimal health sector response to chronic diseases in poor, post-conflict countries. Liberia's experience in strengthening health systems and health financing overall, and addressing HIV/AIDS and mental health in particular, provides a relevant case study for international stakeholders and policymakers in other poor, post-conflict countries seeking to understand and prioritize the global response to chronic diseases.Methods: We conducted a historical review of Liberia's post-conflict policies and their impact on general economic and health indicators, as well as on health systems strengthening and chronic disease care and treatment. Key sources included primary documents from Liberia's Ministry of Health and Social Welfare, published and gray literature, and personal communications from key stakeholders engaged in Liberia's Health Sector Reform. In this case study, we examine the early reconstruction of Liberia's health care system from the end of conflict in 2003 to the present time, highlight challenges and lessons learned from this initial experience, and describe future directions for health systems strengthening and chronic disease care and treatment in Liberia.Results: Six key lessons emerge from this analysis: (i) the 2007 National Health Policy's 'one size fits all' approach met aggregate planning targets but resulted in significant gaps and inefficiencies throughout the system; (ii) the innovative Health Sector Pool Fund proved to be an effective financing mechanism to recruit and align health actors with the 2007 National Health Policy; (iii) a substantial rural health delivery gap remains, but it could be bridged with a robust cadre of community health workers integrated into the primary health care system; (iv) effective strategies for HIV/AIDS care in other settings should be validated in Liberia and adapted for use in other chronic diseases; (v) mental health disorders are extremely prevalent in Liberia and should remain a top chronic disease priority; and (vi) better information systems and data management are needed at all levels of the health system.Conclusions: The way forward for chronic diseases in Liberia will require an increased emphasis on quality over quantity, better data management to inform rational health sector planning, corrective mechanisms to more efficiently align health infrastructure and personnel with existing needs, and innovative methods to improve long-term retention in care and bridge the rural health delivery gap.