Health systems performance in sub-Saharan Africa: governance, outcome and equity.
Health systems performance in sub-Saharan Africa: governance, outcome and equity.
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DOI：
10.1186/1471-2458-11-237
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发表时间：
2011-04-16
影响因子：
4.5
通讯作者：
Allotey P
中科院分区：
文献类型：
--
作者：
Olafsdottir AE;Reidpath DD;Pokhrel S;Allotey P
关于卫生系统的文献主要侧重于围绕医院床位、产妇护理和免疫覆盖率等指标运作的卫生保健系统的绩效。然而，卫生系统的更广泛定义需要包括更广泛的卫生决定因素，可能包括治理及其与卫生和卫生公平的关系。这项研究的目的是审查卫生系统的成果和公平之间的关系，以及作为扩大用于评估卫生系统绩效的指标范围的过程的一部分的治理。利用来自世界卫生组织非洲区域46个国家的横截面数据，进行了生态分析，以研究治理与卫生系统绩效之间的关系。使用多元线性回归和标准渐进建模程序对数据进行分析。五岁以下儿童死亡率被用作健康成果的衡量标准，五岁以下儿童在最富有和最贫穷的五分之一人口中的比率被用作健康公平的衡量标准。治理是使用莫·易卜拉欣基金会制定的两个与背景相关的指数来衡量的。治理与五岁以下幼儿死亡率密切相关，与五岁以下幼儿死亡率五分位数比率中度相关。在控制了医疗保健、财政、教育、水和卫生等可能的混杂因素之后，治理仍然与五岁以下儿童死亡率有着显著的关联。然而，治理与五岁以下儿童死亡率结果的公平性没有显著联系。这项研究表明，治理质量可能是卫生系统绩效的一个重要结构性决定因素，也可能是一个监测指标。这种关联表明可能存在因果关系。然而，横截面设计，缺失数据的水平，以及小样本量，迫使暂时的结论。需要进一步的研究来评估因果关系、其作为健康结果指标超出五岁以下儿童死亡率的普遍性以及结果的地理普遍性。
The literature on health systems focuses largely on the performance of healthcare systems operationalised around indicators such as hospital beds, maternity care and immunisation coverage. A broader definition of health systems however, needs to include the wider determinants of health including, possibly, governance and its relationship to health and health equity. The aim of this study was to examine the relationship between health systems outcomes and equity, and governance as a part of a process to extend the range of indicators used to assess health systems performance. Using cross sectional data from 46 countries in the African region of the World Health Organization, an ecological analysis was conducted to examine the relationship between governance and health systems performance. The data were analysed using multiple linear regression and a standard progressive modelling procedure. The under-five mortality rate (U5MR) was used as the health outcome measure and the ratio of U5MR in the wealthiest and poorest quintiles was used as the measure of health equity. Governance was measured using two contextually relevant indices developed by the Mo Ibrahim Foundation. Governance was strongly associated with U5MR and moderately associated with the U5MR quintile ratio. After controlling for possible confounding by healthcare, finance, education, and water and sanitation, governance remained significantly associated with U5MR. Governance was not, however, significantly associated with equity in U5MR outcomes. This study suggests that the quality of governance may be an important structural determinant of health systems performance, and could be an indicator to be monitored. The association suggests there might be a causal relationship. However, the cross-sectional design, the level of missing data, and the small sample size, forces tentative conclusions. Further research will be needed to assess the causal relationship, and its generalizability beyond U5MR as a health outcome measure, as well as the geographical generalizability of the results.
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影响因子：
6.3
作者：
Braveman, P;Gruskin, S
通讯作者：
Gruskin, S
影响因子：
2.6
作者：
Arah, Onyebuchi A.;Westert, Gert P.;Klazinga, Niek S.
通讯作者：
Klazinga, Niek S.
DOI：
10.2471/blt.08.060137
发表时间：
2008-11-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Carrin, Guy;Xu, Ke;Evans, David B
通讯作者：
Evans, David B
DOI：
10.1016/s1701-2163(16)32294-0
发表时间：
2006-11-01
影响因子：
1.8
作者：
McAlister, Chryssa;Baskett, Thomas F.
通讯作者：
Baskett, Thomas F.
影响因子：
4.8
作者：
Kristiansson, Charlotte;Gotuzzo, Eduardo;Hartvig, Per
通讯作者：
Hartvig, Per