Community engagement for health system resilience: evidence from Liberia's Ebola epidemic
Community engagement for health system resilience: evidence from Liberia's Ebola epidemic
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DOI：
10.1093/heapol/czz174
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发表时间：
2020-05-01
影响因子：
3.2
通讯作者：
Kruk, Margaret E.
中科院分区：
文献类型：
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作者：
Barker, Kathryn M.;Ling, Emilia J.;Kruk, Margaret E.
社区参与（CE）的重要性，卫生系统的弹性建立在理论和实证文献。关于如何将理论付诸实施并执行其原则的实际问题，特别是在资源匮乏的危机环境中，探讨得较少。因此，尚不清楚如何利用CE，以及如何在卫生系统危机时促进卫生系统的复原力。为了解决这一关键差距，我们调整和应用现有的理论CE框架，以分析2014-15年埃博拉疫情爆发后与利比里亚卫生系统利益相关者收集的92次深入访谈和16次焦点小组讨论的定性数据。卫生系统利益攸关方表示，社区教育是应对利比里亚埃博拉疫情的一个关键因素。在疫情期间使用了多种形式的CE;然而，只有一些形式被认为是有意义的，例如成立以社区为基础的监测小组。为了实现有意义的社区教育，与会者建议，社区应被视为积极参与者，而不是被动的接受者，卫生应对工作，并在危机发生前建立社区教育的沟通平台。与会者的答复强调，有意义的CE导致改善与卫生当局和规划的沟通和增加信任。这促进了卫生系统的应对工作，导致了一个增加信任、改善沟通和持续有效的CE的偶然循环-所有这些都是卫生系统复原力的必要条件。这项研究完善了我们对CE的理解，并展示了有意义的CE和信任以相互促进和有益的方式共同工作的方式。这些研究结果提供了经验证据，可据以制定旨在提高卫生系统在资源匮乏环境中的复原力的政策和方案，以更有效地应对卫生系统危机。
The importance of community engagement (CE) for health system resilience is established in theoretical and empirical literature. The practical dimensions of how to operationalize theory and implement its principles have been less explored, especially within low-resource crisis settings. It is therefore unclear how CE is drawn upon and how, if at all, it facilitates health system resilience in times of health system crises. To address this critical gap, we adapt and apply existing theoretical CE frameworks to analyse qualitative data from 92 in-depth interviews and 16 focus group discussions collected with health system stakeholders in Liberia in the aftermath of the 2014-15 Ebola outbreak. Health system stakeholders indicated that CE was a crucial contributing factor in addressing the Ebola epidemic in Liberia. Multiple forms of CE were used during the outbreak; however, only some forms were perceived as meaningful, such as the formation of community-based surveillance teams. To achieve meaningful CE, participants recommended that communities be treated as active participants in-as opposed to passive recipients of-health response efforts and that communication platforms for CE be established ahead of a crisis. Participant responses highlight that meaningful CE led to improved communication with and increased trust in health authorities and programming. This facilitated health system response efforts, leading to a fortuitous cycle of increased trust, improved communication and continued meaningful CE-all necessary conditions for health system resilience. This study refines our understanding of CE and demonstrates the ways in which meaningful CE and trust work together in mutually reinforcing and beneficial ways. These findings provide empirical evidence on which to base policies and programmes aimed at improving health system resilience in low-resource settings to more effectively respond to health system crises.