A systems approach to examining health sector responses to cholera epidemics in Kenya

简单概述由于霍乱疫情在加里萨和图尔卡纳难民营持续传播，以及在内罗毕和蒙巴萨等城市零星传播，肯尼亚的疾病负担增加。然而，尽管人们询问卫生部门如何应对霍乱等流行病以及人口如何受到霍乱等流行病的影响，但对卫生系统独特组成部分之间的因果关系没有给予足够的重视，导致对卫生系统的组成部分在疾病监测和流行病应对中如何相互作用的了解不足。因此，这项研究工作的重点是检查卫生部门对这些流行病的反应，制定基于系统理论的对上述反应的描述，并根据结果提出可能有助于打破疫情的连续性和周期性的建议。这项研究将在肯尼亚的图尔卡纳和加里萨以及内罗毕进行。这些县拥有不同程度的卫生系统复杂程度和最近的霍乱流行经历。此外，该研究借鉴了几个系统分析框架，以确定行为者及其决定，以及它们的相互关系、联系和依赖关系。因此，这项研究采用了面向系统的研究技术，并以一种新颖的方式将其应用于卫生服务提供的评估。这项研究的结果预计将指导旨在改善疾病监测和流行病应对的干预措施。这项研究还将作为研究界的入门读物，评估系统思维方法在这种情况下的效用，并随后开启相关的研究议程。

Simple SummaryKenya has experienced an increased disease burden due to cholera outbreaks characterized by continuous transmission in the refugee camp settings of Garissa and Turkana, and sporadic transmission in cities such as Nairobi and Mombasa. However, while inquiry has been made regarding how the health sector has responded to and how populations have been impacted by epidemics such as cholera, not enough attention has been paid to causal relationships between the unique components of the health systems leading to an inadequate understanding of how the building blocks of the health systems interact in disease surveillance and epidemic response. Consequently, this research effort focuses on examining the health sector responses to these epidemics, developing a systems-theory-based description of the said responses, and based on the results, provide recommendations that may help break the epidemic's continuous and cyclical nature. The study will be conducted in Turkana and Garissa in Kenya, as well as in Nairobi. These are counties that have diverse levels of health system sophistication and recent experiences of cholera epidemics. Moreover, the study draws on several systems analytic frameworks to determine the actors and their decisions, as well as their inter-relationships, linkages and dependencies. Thus, the study appropriates systems-oriented research techniques and applies them in a novel fashion to the assessment of health service delivery. The findings of this study are expected to guide interventions aimed at improving disease surveillance and epidemic response. The study will also act as a primer for the research community by assessing the utility of systems-thinking approaches in such settings, and subsequently opening a related research agenda.