Building resilient health systems: lessons from international, national and local emergency responses to the Ebola epidemic in Sierra Leone.

建立有复原力的卫生系统：国际、国家和地方对塞拉利昂埃博拉疫情应急反应的经验教训。

• 批准号: MR/N015754/1
• 负责人: Susannah Mayhew
• 金额: $ 64.06万
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2016
• 资助国家: 英国
• 起止时间: 2016 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FN015754%2F1
• 关键词: Building; resilient; health; systems; lessons

The response to the Ebola virus has exposed major weaknesses in the health systems of the affected countries. In part this is because of institutional weaknesses at national and district level but the behaviour of global actors in the response has also attracted criticism. The situation has been particularly acute in Sierra Leone as many progressive reforms such as Free Health Care and other governance initiatives may have been undermined by the epidemic and the nature of the response.To date, the evidence on the impact of international Ebola-response assistance in Sierra Leone, and the way it has enabled or hampered local responses, is almost non-existent. For example, it is not known how, why and in what ways local health systems were used, or not used; and it is not at all clear whether international assistance has strengthened local health systems, or weakened them by building parallel structures and bypassing local institutions and relationships. The longer term implications of this kind of assistance, especially beyond the immediate crisis, are thus unclear. Documenting and understanding how and why national and international endeavours to care for the sick and interrupt the transmission of Ebola struggled to produce expected results, is paramount for improving future responses and ensuring health systems are not weakened by future emergencies.Our study will explore a range of factors including: the extent to which responses were informed by local concerns and perceptions of emergency-response systems; whether external interventions sought to work within or with local systems (and whether this resulted in the building of parallel response structures); whether external interventions ultimately weakened and made the health system less resilient by, for example, taking locally qualified staff away from public sector systems or by diverting resources from other ongoing health requirements (including routine maternal and child health and common preventable diseases).Specifically, we ask the following research questions:In what ways has the international Ebola-response affected Sierra Leone's health system and its ability to withstand future shocks? How can international, national and local emergency response mechanisms be utilised to build a resilient health system in Sierra Leone, and what lessons emerge?We bring together several different disciplinary and thematic perspectives, including health systems/systems strengthening, policy and implementation science; disaster risk reduction/emergency preparedness; and the anthropology of global health and medical humanitarianism. Explicitly bringing together these often separate bodies of learning will enable us to more fully and effectively answer our principal research questions, identify transferable lessons and contribute to generating substantive health systems research evidence relating to what promotes resilient health systems. Specific benefits of the project will include:* Identification of characteristics of resilient health systems that need to underpin health systems strengthening efforts, in Sierra Leone and other similar settings, and how these can be incorporated in national health systems development. * Identifying the key issues influencing village level responses to Ebola and reflecting on the implications of these issues for understanding and building more resilient health systems. * Suggestions for revising the existing guidelines for emergency responses, including those of the WHO drawing on the experiences of the recent Ebola epidemic in Sierra Leone.

对埃博拉病毒的应对暴露了受影响国家卫生系统的重大弱点。部分原因是国家和地区一级的体制薄弱，但全球行动者在防治工作中的行为也受到批评。塞拉利昂的情况尤其严重，因为许多渐进式改革，如免费医疗和其他治理举措可能因疫情和应对措施的性质而受到破坏，迄今为止，关于国际埃博拉应对援助在塞拉利昂的影响及其如何促进或阻碍当地应对措施的证据几乎不存在。例如，人们不知道如何、为什么和以何种方式利用或不利用当地保健系统;也根本不清楚国际援助是加强了当地保健系统，还是通过建立平行结构和绕过当地机构和关系而削弱了这些系统。因此，这种援助的长期影响，特别是在当前危机之后的影响，尚不清楚。记录和理解国家和国际社会如何以及为什么努力照顾病人和阻断埃博拉病毒的传播难以产生预期的结果，对于改善未来的反应和确保卫生系统不被未来的紧急情况削弱至关重要。我们的研究将探讨一系列因素，包括：反应在多大程度上受到当地关注和对紧急反应系统的看法的影响;外部干预是否寻求在当地系统内或与当地系统合作（以及这是否导致建立平行的反应结构）;外部干预是否最终削弱了卫生系统，使其弹性降低，例如，从公共部门系统抽调当地合格的工作人员，或从其他现有的保健需求中挪用资源具体而言，我们提出以下研究问题：国际埃博拉应对措施以何种方式影响了塞拉利昂的卫生系统及其抵御未来冲击的能力？如何利用国际、国家和地方应急机制在塞拉利昂建立一个有复原力的卫生系统，以及从中吸取了哪些经验教训？我们汇集了几个不同的学科和主题的观点，包括卫生系统/系统的加强，政策和实施科学;减少灾害风险/应急准备;和全球健康和医疗人道主义的人类学。明确地将这些往往独立的学习机构结合在一起，将使我们能够更充分和有效地回答我们的主要研究问题，确定可转移的经验教训，并有助于产生与促进弹性卫生系统有关的实质性卫生系统研究证据。该项目的具体效益将包括：* 确定塞拉利昂和其他类似情况下需要支持加强卫生系统努力的具有复原力的卫生系统的特点，以及如何将这些特点纳入国家卫生系统的发展。* 确定影响村庄一级应对埃博拉的关键问题，并反思这些问题对理解和建立更具复原力的卫生系统的影响。* 关于修订现有应急反应准则的建议，包括世卫组织借鉴塞拉利昂最近埃博拉疫情经验制定的准则。

项目成果

Towards Sustainable Community-Based Systems for Infectious Disease and Disaster Response; Lessons from Local Initiatives in Four African Countries

• DOI: 10.3390/su131810083
• 发表时间: 2021-09-01
• 期刊: SUSTAINABILITY
• 影响因子: 3.9
• 作者: Maat, Harro;Balabanova, Dina;Mayhew, Susannah
• 通讯作者: Mayhew, Susannah

Towards an understanding of resilience: responding to health systems shocks.

• DOI: 10.1093/heapol/czx183
• 发表时间: 2018-04-01
• 期刊: Health policy and planning
• 影响因子: 3.2
• 作者: Hanefeld J;Mayhew S;Legido-Quigley H;Martineau F;Karanikolos M;Blanchet K;Liverani M;Yei Mokuwa E;McKay G;Balabanova D
• 通讯作者: Balabanova D

(Re)arranging "systems of care" in the early Ebola response in Sierra Leone: An interdisciplinary analysis.

在塞拉利昂早期埃博拉应对中（重新）安排“护理系统”：跨学科分析。

• DOI: 10.1016/j.socscimed.2021.114209
• 发表时间: 2022-05
• 期刊: SOCIAL SCIENCE & MEDICINE
• 影响因子: 5.4
• 作者: Mayhew, Susannah H.;Balabanova, Dina;Vandi, Ahmed;Mokuwa, Gelejimah Alfred;Hanson, Tommy;Parker, Melissa;Richards, Paul
• 通讯作者: Richards, Paul

Responding to the 2018-2020 Ebola Virus Outbreak in the Democratic Republic of the Congo: Rethinking Humanitarian Approaches.

• DOI: 10.2147/rmhp.s219295
• 发表时间: 2021
• 期刊: Risk management and healthcare policy
• 影响因子: 3.5
• 作者: Mayhew SH;Kyamusugulwa PM;Kihangi Bindu K;Richards P;Kiyungu C;Balabanova D
• 通讯作者: Balabanova D

DISTRICT-CENTRED RESPONSES TO THE EVD OUTBREAK IN SIERRA LEONE

以地区为中心应对塞拉利昂埃博拉病毒病疫情

• 发表时间: 2021
• 作者: Ahmed Vandi