Beyond the building blocks: integrating community roles into health systems frameworks to achieve health for all
Beyond the building blocks: integrating community roles into health systems frameworks to achieve health for all
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DOI：
10.1136/bmjgh-2018-001384
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发表时间：
2018-05-01
影响因子：
8.1
通讯作者：
Sarriot, Eric
中科院分区：
文献类型：
--
作者：
Sacks, Emma;Morrow, Melanie;Sarriot, Eric
实现雄心勃勃的卫生目标----从“每个妇女每个儿童”战略到可持续发展目标的卫生目标，再到阿拉木图“人人享有健康”的新承诺----需要有强大、有效和包容的卫生系统。改善和维持社区健康是加强整个卫生系统努力的组成部分。然而，虽然卫生系统和社区卫生在概念上和业务上都是相关的，但为卫生系统决策者和供资者提供信息的指导-特别是众所周知的世卫组织“积木”框架-只是间接地涉及有效的社区卫生所必需的基本要素。虽然社区包容性和社区主导的战略可能比基于设施的战略更困难、更复杂，需要更广泛的资源，但将其排除在卫生系统框架之外，导致对需要事先努力和投资以在系统内有效地建立社区卫生的要素关注不够。本文件建议扩大世卫组织的组成部分，首先是承认健康生产的基本决定因素。它提出了一个扩大的框架，阐明了在社区一级需要专门的人力资源和优质服务;它将组织和调动社区社会资源的战略置于卫生系统的背景下;它将卫生信息定位为专门用于信息、学习和问责制的更大模块的一个组成部分;它承认社会伙伴关系是公共卫生部门的重要联系。这一框架明确了经常被忽视的社区卫生投资需求，旨在为在国家卫生系统内加强社区卫生的努力提供信息，并为实现人人享有健康提供全球指导。
Achieving ambitious health goals-from the Every Woman Every Child strategy to the health targets of the sustainable development goals to the renewed promise of Alma-Ata of `health for all'-necessitates strong, functional and inclusive health systems. Improving and sustaining community health is integral to overall health systems strengthening efforts. However, while health systems and community health are conceptually and operationally related, the guidance informing health systems policymakers and financiers-particularly the well-known WHO `building blocks' framework-only indirectly addresses the foundational elements necessary for effective community health. Although communityinclusive and community-led strategies may be more difficult, complex, and require more widespread resources than facility-based strategies, their exclusion from health systems frameworks leads to insufficient attention to elements that need ex-ante efforts and investments to set community health effectively within systems. This paper suggests an expansion of the WHO building blocks, starting with the recognition of the essential determinants of the production of health. It presents an expanded framework that articulates the need for dedicated human resources and quality services at the community level; it places strategies for organising and mobilising social resources in communities in the context of systems for health; it situates health information as one ingredient of a larger block dedicated to information, learning and accountability; and it recognises societal partnerships as critical links to the public health sector. This framework makes explicit the oft-neglected investment needs for community health and aims to inform efforts to situate community health within national health systems and global guidance to achieve health for all.