Understanding pathways for scaling up health services through the lens of complex adaptive systems
Understanding pathways for scaling up health services through the lens of complex adaptive systems
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DOI：
10.1093/heapol/czr054
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发表时间：
2012-08-01
影响因子：
3.2
通讯作者：
Peters, David H.
中科院分区：
文献类型：
--
作者：
Paina, Ligia;Peters, David H.
尽管全球卫生倡议日益突出并获得更多资金，但发展中国家扩大卫生服务的努力仍达不到千年发展目标的期望。基于对复杂适应系统(CAS)行为的理解，我们描述了路径依赖、反馈环、无标度网络、突发行为和相变等现象如何在扩展卫生服务的背景下为卫生政策和计划的设计和实施提供相关的经验教训。其影响包括更多地关注地方背景、激励和机构，以及预测某些类型的意外后果，这些后果可能会破坏扩大工作，以及制定和实施通过透明使用数据进行持续问题解决和适应来吸引关键行为者参与的方案。我们建议，未来扩大规模的努力应适应和应用已在研究CAS的其他领域使用但在公共卫生中未得到充分利用的模型和方法。这可以帮助政策制定者、规划者、实施者和研究人员探索不同的创新方法，为有需要的人口提供有效、公平和高效的卫生服务。旧的假设导致人们对如何扩大卫生服务的期望失望，也没有提供关于未来如何扩大有效干预措施的洞察力。CAS提供的替代视角可能更好地反映卫生系统的复杂和不断变化的性质，并为理解和扩大卫生服务创造新的机会。
Despite increased prominence and funding of global health initiatives, efforts to scale up health services in developing countries are falling short of the expectations of the Millennium Development Goals. Arguing that the dominant assumptions for scaling up are inadequate, we propose that interpreting change in health systems through the lens of complex adaptive systems (CAS) provides better models of pathways for scaling up.Based on an understanding of CAS behaviours, we describe how phenomena such as path dependence, feedback loops, scale-free networks, emergent behaviour and phase transitions can uncover relevant lessons for the design and implementation of health policy and programmes in the context of scaling up health services. The implications include paying more attention to local context, incentives and institutions, as well as anticipating certain types of unintended consequences that can undermine scaling up efforts, and developing and implementing programmes that engage key actors through transparent use of data for ongoing problem-solving and adaptation.We propose that future efforts to scale up should adapt and apply the models and methodologies which have been used in other fields that study CAS, yet are underused in public health. This can help policy makers, planners, implementers and researchers to explore different and innovative approaches for reaching populations in need with effective, equitable and efficient health services.The old assumptions have led to disappointed expectations about how to scale up health services, and offer little insight on how to scale up effective interventions in the future. The alternative perspectives offered by CAS may better reflect the complex and changing nature of health systems, and create new opportunities for understanding and scaling up health services.