Perspectives on Rebuilding Health System Governance in Opposition-Controlled Syria: A Qualitative Study
Perspectives on Rebuilding Health System Governance in Opposition-Controlled Syria: A Qualitative Study
复制标题
在反对派控制的叙利亚重建卫生系统治理的视角： 定性研究
DOI：
10.15171/ijhpm.2018.132
复制
发表时间：
2019-04-01
影响因子：
3.5
通讯作者：
Howard, Natasha
中科院分区：
文献类型：
--
作者：
Douedari, Yazan;Howard, Natasha
背景：持续不断的冲突和叙利亚政权在反对派控制区有计划地以卫生设施和人员为目标，导致卫生系统和治理机制崩溃。临时(反对派)卫生部于2014年在反对派控制的地区设立了卫生局，以满足新出现的需求。作为负责叙利亚反对派控制区卫生系统治理的地方卫生当局，他们面临许多挑战。这项研究探索了叙利亚5个反对派控制地区正在进行的卫生系统治理努力。方法：采用定性研究设计，采用深入的关键信息者访谈，20名参与者故意从HDS、非政府组织(NGO)、捐赠者和服务使用者中抽样。结果：卫生系统治理要素(即战略愿景、参与、透明度、响应性、公平性、有效性、问责制、信息)被认为是重要的，但在反对派控制的地区没有得到同等的解释或解决。与会者指出，人类发展机构主要负责反对派控制区的卫生系统治理。确定的主要卫生系统治理挑战是安全(例如，以卫生设施和人员为目标)、资金和能力。建议的解决方案包括支持HDS，解决卫生工作者的流失问题，以及改善协调。结论：叙利亚反对派控制区的卫生系统治理重建工作已经取得进展，尽管冲突仍在继续，当地卫生当局需要支持来克服已确定的挑战，建立可持续的卫生系统治理机制。
Background: Ongoing conflict and systematic targeting of health facilities and personnel by the Syrian regime in opposition-controlled areas have contributed to health system and governance mechanisms collapse. Health directorates (HDs) were established in opposition-held areas in 2014 by the interim (opposition) Ministry of Health (MoH), to meet emerging needs. As the local health authorities responsible for health system governance in opposition-controlled areas in Syria, they face many challenges. This study explores ongoing health system governance efforts in 5 opposition-controlled areas in Syria.Methods: A qualitative study design was selected, using in-depth key informant interviews with 20 participants purposely sampled from HDs, non-governmental organisations (NGOs), donors, and service-users. Data were analysed thematically.Results: Health system governance elements (ie, strategic vision, participation, transparency, responsiveness, equity, effectiveness, accountability, information) were considered important, but not interpreted or addressed equally in opposition-controlled areas. Participants identified HDs as primarily responsible for health system governance in opposition-controlled areas. Main health system governance challenges identified were security (eg, targeting of health facilities and personnel), funding, and capacity. Suggested solutions included supporting HDs, addressing health-worker loss, and improving coordination.Conclusion: Rebuilding health system governance in opposition-controlled areas in Syria is already progressing, despite ongoing conflict Local health authorities need support to overcome identified challenges and build sustainable health system governance mechanisms.