Leaving no one behind: lessons on rebuilding health systems in conflict-and crisis-affected states
Leaving no one behind: lessons on rebuilding health systems in conflict-and crisis-affected states
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DOI：
10.1136/bmjgh-2017-000327
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发表时间：
2017-03-01
影响因子：
8.1
通讯作者：
Witter, Sophie
中科院分区：
文献类型：
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作者：
Martineau, Tim;McPake, Barbara;Witter, Sophie
世界许多地区的冲突和脆弱性正在增加。这种情况被称为“新常态”，影响着10亿人。脆弱和受冲突影响的国家的卫生指标最差，卫生系统最薄弱。这对实现全民医保构成了重大挑战。在这些情况下，加强卫生系统的证据基础非常薄弱，并受到研究能力有限、与不安全有关的挑战以及资助者对这一研究领域的优先程度明显较低的阻碍。本文报道了一个多国联盟的调查结果，该联盟研究了塞拉利昂、津巴布韦、乌干达北方和柬埔寨的冲突/危机后重建卫生系统。在ReBUILD联盟的跨学科研究计划中，通过我们的分析过程出现了三个交叉主题：社区，卫生人力资源和机构。了解冲突/危机对家庭和社区面临的相互交织的不平等的影响，对于制定应对性卫生政策至关重要。卫生工作者在冲突/危机中表现出复原力，但需要在冲突/危机后得到支持，制定适当的部署政策和奖励措施，确保各部门和地域分配的公平平衡。冲突后/危机局势的特点是多个行为体涌入，支持协调和建立反应迅速的国家和地方机构的努力至关重要。重建方案的证据库正在开始填补重要的知识空白，但需要进一步研究，以支持决策者和从业人员发展可持续的卫生系统，否则冲突后和危机后环境中的弱势社区将在促进全民健康覆盖的努力中落在后面。
Conflict and fragility are increasing in many areas of the world. This context has been referred to as the 'new normal' and affects a billion people. Fragile and conflict-affected states have the worst health indicators and the weakest health systems. This presents a major challenge to achieving universal health coverage. The evidence base for strengthening health systems in these contexts is very weak and hampered by limited research capacity, challenges relating to insecurity and apparent low prioritisation of this area of research by funders. This article reports on findings from a multicountry consortium examining health systems rebuilding post conflict/crisis in Sierra Leone, Zimbabwe, northern Uganda and Cambodia. Across the ReBUILD consortium's interdisciplinary research programme, three cross-cutting themes have emerged through our analytic process: communities, human resources for health and institutions. Understanding the impact of conflict/crisis on the intersecting inequalities faced by households and communities is essential for developing responsive health policies. Health workers demonstrate resilience in conflict/crisis, yet need to be supported post conflict/crisis with appropriate policies related to deployment and incentives that ensure a fair balance across sectors and geographical distribution. Postconflict/crisis contexts are characterised by an influx of multiple players and efforts to support coordination and build strong responsive national and local institutions are critical. The ReBUILD evidence base is starting to fill important knowledge gaps, but further research is needed to support policy makers and practitioners to develop sustainable health systems, without which disadvantaged communities in postconflict and postcrisis contexts will be left behind in efforts to promote universal health coverage.