Policy challenges facing integrated community case management in Sub-Saharan Africa
Policy challenges facing integrated community case management in Sub-Saharan Africa
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DOI：
10.1111/tmi.12319
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发表时间：
2014-07-01
影响因子：
3.3
通讯作者：
Cliff, Julie
中科院分区：
文献类型：
--
作者：
Bennett, Sara;George, Asha;Cliff, Julie
目的深入分析6个撒哈拉以南非洲国家儿童疾病综合社区病例管理(ICCM)政策变化。我们分析了ICCM政策是如何制定的，以及政策变化的障碍和促进者。方法通过文献审查、半结构化访谈和国内验证研讨会，在布基纳法索、肯尼亚、马拉维、马里、莫桑比克和尼日尔进行了定性的回溯性案例研究。选择这些国家是为了最大化ICCM政策地位、社区卫生工作者(CHW)模式和不同非洲地区的差异。结果各国ICCM政策是以临时方式演变的，但受到初级卫生保健历史和CHW项目性质的很大影响。卫生部内的技术官员在国际捐助者的支持下领导了ICCM政策的变化，但社区和政治领导都没有动员起来。对实现千年发展目标的关切，以及对现有儿童保健方案缺点的认识，导致采取了国际儿童保健中心的政策。外部资金的可获得性在促进政策变化方面发挥了关键作用。结论ICCM政策变化得到了国际机构的推动，但各国政府一直在努力使ICCM与国家卫生系统保持一致。在调整全球政策举措以适应各国需求方面，需要加大投资。对国际货币基金组织政策的高级别政治所有权可以促进政策变化，也可以为确保这些政策的长期可持续性制定更明确的战略。
OBJECTIVE To report an in-depth analysis of policy change for integrated community case management of childhood illness (iCCM) in six sub-Saharan African countries. We analysed how iCCM policies developed and the barriers and facilitators to policy change.METHODS Qualitative retrospective case studies drawing from document reviews, semi-structured interviews and in-country validation workshops were conducted in Burkina Faso, Kenya, Malawi, Mali, Mozambique and Niger. These countries were selected to maximise variation in iCCM policy status, community health worker (CHW) models and different African regions.RESULTS Country iCCM policies evolved in an ad hoc fashion, but were substantially influenced by the history of primary health care and the nature of CHW programmes. Technical officers within Ministries of Health led iCCM policy change with support from international donors, but neither communities nor political leadership was mobilised. Concerns about achieving the Millennium Development Goals, together with recognition of the shortcomings of existing child health programmes, led to the adoption of iCCM policies. Availability of external financing played a critical role in facilitating policy change.CONCLUSIONS iCCM policy change has been promoted by international agencies, but national governments have struggled to align iCCM with country health systems. Greater investment is needed in tailoring global policy initiatives to match country needs. High-level, political ownership of iCCM policies could facilitate policy change, as could clearer strategies for ensuring the long-term sustainability of such policies.