Rethinking health systems in the context of urbanisation: challenges from four rapidly urbanising low-income and middle-income countries
Rethinking health systems in the context of urbanisation: challenges from four rapidly urbanising low-income and middle-income countries
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DOI：
10.1136/bmjgh-2019-001501
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发表时间：
2019-05-01
影响因子：
8.1
通讯作者：
Mirzoev, Tolib
中科院分区：
文献类型：
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作者：
Elsey, Helen;Agyepong, Irene;Mirzoev, Tolib
当今世界主要是城市化;低收入和中等收入国家（LMICs）的快速和不受控制的城市化继续发展。卫生系统正在努力应对城市化带来的挑战。虽然富裕的城市居民可以从“城市生活”中获益，但最贫穷的人，特别是贫民窟居民和无家可归者的健康状况往往比农村居民差。在这份立场文件中，我们分析了城市化给卫生系统带来的挑战，借鉴了四个LMIC的例子：尼日利亚，加纳，尼泊尔和孟加拉国。主要挑战包括：应对非传染性疾病的上升趋势和更广泛的健康决定因素，加强城市卫生治理，以便能够采取多部门应对措施，由多个提供者提供可获得的优质初级保健和预防。我们认为这些挑战如何需要重新思考我们的卫生系统的概念。我们提出了一个城市卫生系统模式，重点是：多部门的方法，超越卫生部门采取行动的健康决定因素;问责制，并通过参与式决策与城市居民的参与;和响应，承认多元化的卫生服务提供者。在这个模型中，我们明确认识到数据和证据的作用，将这个复杂的系统粘合在一起，并允许在公平改善城市人口健康方面取得渐进式进展。
The world is now predominantly urban; rapid and uncontrolled urbanisation continues across low-income and middle-income countries (LMICs). Health systems are struggling to respond to the challenges that urbanisation brings. While better-off urbanites can reap the benefits from the ` urban advantage', the poorest, particularly slum dwellers and the homeless, frequently experience worse health outcomes than their rural counterparts. In this position paper, we analyse the challenges urbanisation presents to health systems by drawing on examples from four LMICs: Nigeria, Ghana, Nepal and Bangladesh. Key challenges include: responding to the rising tide of noncommunicable diseases and to the wider determinants of health, strengthening urban health governance to enable multisectoral responses, provision of accessible, quality primary healthcare and prevention from a plurality of providers. We consider how these challenges necessitate a rethink of our conceptualisation of health systems. We propose an urban health systems model that focuses on: multisectoral approaches that look beyond the health sector to act on the determinants of health; accountability to, and engagement with, urban residents through participatory decision making; and responses that recognise the plurality of health service providers. Within this model, we explicitly recognise the role of data and evidence to act as glue holding together this complex system and allowing incremental progress in equitable improvement in the health of urban populations.