The emergence of global attention to health systems strengthening
The emergence of global attention to health systems strengthening
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DOI：
10.1093/heapol/czs023
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发表时间：
2013-01-01
影响因子：
3.2
通讯作者：
Shiffman, Jeremy
中科院分区：
文献类型：
--
作者：
Hafner, Tamara;Shiffman, Jeremy
在针对具体疾病的举措大量涌现之后，过去十年，特别是自2005年以来，参与全球卫生工作的许多组织开始将注意力和资源转向加强卫生系统的问题。我们将探讨这种关注是如何以及为什么出现的。采用了一种定性方法-过程跟踪法，以建立一个个案历史，并分析影响和阻碍全球政治关注加强卫生系统的因素。我们发现，最近引起关注的关键因素包括：全球卫生行动者担心卫生系统问题会威胁到与卫生有关的千年发展目标的实现，担心全球卫生举措对国家卫生系统的不利影响，以及全球卫生举措认识到薄弱的卫生系统是实现其组织目标的瓶颈。虽然各种行为体现在都支持加强卫生系统，但它们并不构成一个有凝聚力的政策群体。此外，加强卫生系统的概念仍然模糊，为加强卫生系统的政策和方案提供信息的证据基础薄弱。有几个理由质疑该议程的可持续性。其中包括全球金融危机、全球卫生的钟摆式摆动历史以及一些行为体对这一问题的工具性接受。
After a period of proliferation of disease-specific initiatives, over the past decade and especially since 2005 many organizations involved in global health have come to direct attention and resources to the issue of health systems strengthening. We explore how and why such attention emerged. A qualitative methodology, process-tracing, was used to construct a case history and analyse the factors shaping and inhibiting global political attention for health systems strengthening. We find that the critical factors behind the recent burst of attention include fears among global health actors that health systems problems threaten the achievement of the health-related Millennium Development Goals, concern about the adverse effects of global health initiatives on national health systems, and the realization among global health initiatives that weak health systems present bottlenecks to the achievement of their organizational objectives. While a variety of actors now embrace health systems strengthening, they do not constitute a cohesive policy community. Moreover, the concept of health systems strengthening remains vague and there is a weak evidence base for informing policies and programmes for strengthening health systems. There are several reasons to question the sustainability of the agenda. Among these are the global financial crisis, the history of pendulum swings in global health and the instrumental embrace of the issue by some actors.