Strengthening Health Systems in Humanitarian Settings: Multi-Stakeholder Insights on Contraception and Postabortion Care Programs in the Democratic Republic of Congo and Somalia.
Strengthening Health Systems in Humanitarian Settings: Multi-Stakeholder Insights on Contraception and Postabortion Care Programs in the Democratic Republic of Congo and Somalia.
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DOI：
10.3389/fgwh.2021.671058
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Amsalu R
中科院分区：
文献类型：
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作者：
Tran NT;Meyers J;Malilo B;Chabo J;Muselemu JB;Riziki B;Libonga P;Shire A;Had H;Ali M;Arab MA;Da'ar JM;Kahow MH;Adive JE;Gebru B;Monaghan E;Morris CN;Gallagher M;Jouanicot V;Pougnier N;Amsalu R
背景资料：在人道主义背景下，加强卫生系统，同时满足受危机影响人口的卫生需求是一项挑战，而且存在证据缺口。从十年的计划生育和人工流产后护理方案在人道主义环境中绘制，本文旨在确定战略组成部分，有助于在这种情况下加强卫生系统。材料与方法：来自北基伍（刚果民主共和国）和邦特兰（索马里）的各种关键信息提供者，包括社区男女成员、青少年和成年人、医疗保健提供者、政府和社区领导人，参加了定性访谈，访谈采用了世界卫生组织卫生系统构件框架。根据这一框架对数据进行了专题分析。结果如下：焦点小组讨论的结果（刚果民主共和国11次，索马里7次）和关键线人访谈（刚果民主共和国7人，索马里4人）两国共有54名女性和72名男性参与者表明，人道主义环境中的健康计划，例如救助儿童会的计划生育和堕胎后护理倡议，通过积极影响国家政策和指导，加强地方协调机制，通过基于能力的培训和支持性监督，增强卫生保健工作人员的能力（受益于项目及其他项目支持的设施），发展卫生部工作人员有效管理供应链的能力，积极和创造性地动员社区提高认识和创造需求，并提供优质和负担得起的服务。在这两种人道主义情况下，医疗保健支出长期有限，这对财务可持续性构成挑战。结论：在人道主义背景下，精心设计的医疗保健干预措施，如解决受危机影响人口的计划生育和堕胎后护理需求的措施，不仅有可能增加获得基本服务的机会，而且有助于加强卫生系统的几个组成部分，同时提高政府的能力，所有权和问责制。
Background: In humanitarian settings, strengthening health systems while responding to the health needs of crisis-affected populations is challenging and marked with evidence gaps. Drawing from a decade of family planning and postabortion care programming in humanitarian settings, this paper aims to identify strategic components that contribute to health system strengthening in such contexts. Materials and Methods: A diverse range of key informants from North Kivu (Democratic Republic of Congo, DRC) and Puntland (Somalia), including female and male community members, adolescents and adults, healthcare providers, government and community leaders, participated in qualitative interviews, which applied the World Health Organization health system building blocks framework. Data were thematically analyzed according to this framework. Results: Findings from the focus group discussions (11 in DRC, 7 in Somalia) and key informant interviews (seven in DRC, four in Somalia) involving in total 54 female and 72 male participants across both countries indicate that health programs in humanitarian settings, such as Save the Children's initiative on family planning and postabortion care, could contribute to strengthening health systems by positively influencing national policies and guidance, strengthening local coordination mechanisms, capacitating the healthcare workforce with competency-based training and supportive supervision (benefiting facilities supported by the project and beyond), developing the capacity of Ministry of Health staff in the effective management of the supply chain, actively and creatively mobilizing the community to raise awareness and create demand, and providing quality and affordable services. Financial sustainability is challenged by the chronically limited healthcare expenditure experienced in both humanitarian contexts. Conclusions: In humanitarian settings, carefully designed healthcare interventions, such as those that address the family planning and postabortion care needs of crisis-affected populations, have the potential not only to increase access to essential services but also contribute to strengthening several components of the health system while increasing the government capacity, ownership, and accountability.