Good Health at Low Cost 25 years on: lessons for the future of health systems strengthening
Good Health at Low Cost 25 years on: lessons for the future of health systems strengthening
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DOI：
10.1016/s0140-6736(12)62000-5
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发表时间：
2013-06-15
期刊：
影响因子：
168.9
通讯作者：
McKee, Martin
中科院分区：
文献类型：
--
作者：
Balabanova, Dina;Mills, Anne;McKee, Martin
1985年，洛克菲勒基金会出版了《低成本的良好健康》，讨论了为什么一些国家或地区在收入水平相似的情况下比其他国家或地区取得了更好的健康和社会成果，并显示了政治意愿和社会进步政策的作用。25年后，“低成本健康”项目重新审视了这些地方，但重新审视了孟加拉国、埃塞俄比亚、吉尔吉斯斯坦、泰国和印度泰米尔纳德邦，这些国家要么在健康或服务获取方面取得了实质性改善，要么实施了相对于邻国的创新卫生政策。一系列比较案例研究（2009- 2011年）考察了每个地区如何以及为什么实现了这些变化。成功的要素包括善治和政治承诺、保持机构记忆并能从经验中学习的有效官僚机构，以及创新和适应资源限制的能力。此外，在面临政治动荡、经济危机和自然灾害时，应对人口需求和建立卫生系统复原力的能力也很重要。交通基础设施、妇女赋权和教育也发挥了作用。卫生系统是复杂的，没有简单的成功秘诀。然而，在所研究的国家和地区，制度稳定有助于取得进展，尽管政治和经济动荡，但改革仍在继续，从经验中吸取教训，抓住机会之窗，并确保对背景的敏感性。这些经验表明，在资源相对较少的国家，仍然可以改善健康状况，尽管需要进行战略投资，以应对复杂的慢性病和日益增长的人口期望等新挑战。
In 1985, the Rockefeller Foundation published Good health at low cost to discuss why some countries or regions achieve better health and social outcomes than do others at a similar level of income and to show the role of political will and socially progressive policies. 25 years on, the Good Health at Low Cost project revisited these places but looked anew at Bangladesh, Ethiopia, Kyrgyzstan, Thailand, and the Indian state of Tamil Nadu, which have all either achieved substantial improvements in health or access to services or implemented innovative health policies relative to their neighbours. A series of comparative case studies (2009-11) looked at how and why each region accomplished these changes. Attributes of success included good governance and political commitment, effective bureaucracies that preserve institutional memory and can learn from experience, and the ability to innovate and adapt to resource limitations. Furthermore, the capacity to respond to population needs and build resilience into health systems in the face of political unrest, economic crises, and natural disasters was important. Transport infrastructure, female empowerment, and education also played a part. Health systems are complex and no simple recipe exists for success. Yet in the countries and regions studied, progress has been assisted by institutional stability, with continuity of reforms despite political and economic turmoil, learning lessons from experience, seizing windows of opportunity, and ensuring sensitivity to context. These experiences show that improvements in health can still be achieved in countries with relatively few resources, though strategic investment is necessary to address new challenges such as complex chronic diseases and growing population expectations.