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是脆弱的、被动的、围绕应对特定疾病而组织起来的。这使得他们没有能力应对多种共存的疾病，如结核病、艾滋病毒和非传染性疾病，以及新出现的健康冲击，如COVID-19。建立有复原力和反应迅速的高质量卫生系统的必要性至关重要。为此目的，已确定以人为本的系统是撒哈拉以南非洲的前进之路，该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及其社区的健康负责。在2019冠状病毒病的背景下，这一需求被放大，这要求人们改变自己的行为，以防止病毒的传播。这需要加强社区子系统（历史上被忽视的卫生系统组成部分），包括家庭、民间团体、社区结构和其他部门，使其在卫生保健系统中发挥积极而不是被动的作用。南澳卫生部进行了政策改革，以加强这一制度，使其更加注重以人为本的社区导向，但在如何最好地实际实现这些改革方面存在知识空白。为了缩小这一差距，申请人与夸祖鲁-纳塔尔省卫生厅合作，调查如何最好地实施这些改革。为此目的，我们将对加强卫生系统支柱的障碍、需求和机会进行形成性调查，以实现以人为本的社区导向。这些信息将用于（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，使其更有利于以人为本的社区导向。测试和完善这些概念模型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.