Strengthening the health system for a people-centred community orientation in South Africa. A formative study.

撒哈拉以南非洲的卫生系统通常很脆弱，反应迟钝，组织严密，以应对特定疾病为中心。这使得他们在应对结核病、艾滋病毒和非传染性疾病等多种并存疾病以及新冠肺炎等新出现的健康冲击方面装备不足。最重要的是需要建立有弹性和反应迅速的高质量卫生系统。为此，以人为本的系统被确定为撒哈拉以南非洲的前进方向，这些系统侧重于健康促进和预防干预措施，并使人们能够对自己和社区的健康负责。这种需求在新冠肺炎的背景下被放大了，微博要求人们改变自己的行为，以防止病毒的传播。这需要加强包括家庭、民间团体、社区结构和其他部门在内的社区子系统(历来是保健系统中被忽视的组成部分)，使其在保健系统中发挥积极而不是被动的作用。虽然南澳卫生部进行了政策改革，以加强该系统，使之更多地以人为本，但在如何切实实现这些改革方面还存在知识空白。为了缩小这一差距，申请者与夸祖鲁-纳塔尔(KZN)省卫生厅(DoH)合作，调查如何最好地实施这些改革。为此，我们将对加强卫生系统支柱的障碍、需要和机会进行深入调查，以实现以人为本的社区导向。这些信息将被用于(与KZN卫生部和其他部门)共同制定概念模型，说明如何加强卫生系统的支柱，以更好地支持以人为本的社区导向。对这些概念模型的测试和改进将构成完整阶段提案的基础。

Health systems in sub-Saharan Africa are typically fragile, reactive and organized around responding to specific diseases. This makes them ill-equipped to deal with multiple co-existing conditions such as tuberculosis, HIV and non-communicable diseases as well as emerging health shocks, such as COVID-19. The need to build resilient and responsive quality health systems is paramount. To this end, people-centred oriented systems which focus on health promotion and prevention interventions and empowering people to take responsibility for their health and that of their communities have been identified as the way forward for sub-Saharan Africa. This need is amplified in the context of COVID-19 which requires people to change their behavior to prevent the spread of the virus. This requires strengthening of the community sub-system (historically a neglected component of the health system) including households, civic groups, community structures and other sectors to play an active rather than passive role in the health care system. While the SA Dept of Health has engaged in policy reforms to strengthen the system to have a more people-centred community orientation, there are gaps in knowledge about how best to practically achieve these reforms. To narrow this gap, the applicants have partnered with the KwaZulu-Natal (KZN) provincial Department of Health (DoH), to investigate how best to implement these reforms. To this end, we will conduct a formative investigation of the barriers, needs and opportunities for strengthening of the pillars of the health system to be enabling of a people-centred community orientation. This information will be used to inform the co-development (with the KZN DoH and other sectors) of conceptual models of how the pillars of the health system could be strengthened to be more enabling of a people-centred community orientation. Testing and refining of these conceptual models will form the basis of a full stage proposal.