Developing Strategies to coordinate HEalthcare provision between The GAmbia and Senegal (SHEGAS)

尽管世界上大约有10亿移民，人们越来越认识到医疗保健的使用并不局限于国界，但关于卫生系统适应人口流动的文献仍然很少。现有的研究大多调查了不同国家和世界区域的模式和趋势、旅行的原因以及人口流动和医疗保健使用的好处和挑战。大多数文献的注意力集中在北到南和南到北旅行，而大多数跨国医疗保健使用实际上发生在区域内。当关于跨境医疗保健使用的研究以区域为重点时，这些研究主要集中在高收入和中等收入国家，而不是低收入国家。关于移徙与卫生的全球研究议程迫切要求对卫生系统适应人口流动进行研究。据我们所知，之前还没有研究这样做过。该项目的目的是制定一项卫生系统战略，以协调冈比亚和塞内加尔之间的跨境卫生保健使用。冈比亚和塞内加尔为这项研究提供了一个理想的环境，因为它们有共同的前殖民历史、相同的种族群体和密切的政治联系，同时有不同的殖民历史，导致不同的后殖民政治和卫生系统。我们最近对冈比亚和塞内加尔之间的跨国医疗保健使用进行了一项研究，发现了很大程度上的跨境医疗保健使用，但两个卫生系统之间明显缺乏协调，导致重复护理，失去随访和患者之间的歧视感。当我们向冈比亚和塞内加尔的决策者展示我们的发现时，他们要求研究小组制定一项战略来协调这两个国家的卫生系统。这项研究将致力于做到这一点，并将对其他低收入和中等收入国家的政策制定者有用，这些国家正在经历大量的跨境医疗保健使用。本研究将分为六个目标：1。评估塞内加尔和冈比亚之间跨境医疗保健使用的当前水平2。检查塞内加尔和冈比亚之间的跨境流动和医疗保健使用的历史。分析冈比亚和塞内加尔不同地区现有的不同安排审查西非不同国家之间的卫生系统协议5。审查Covid-19对人口流动和跨境医疗保健的影响，并确定适应人口流动的卫生系统战略如何提高国家对大流行的抵御能力。采用参与式方法设计一套卫生系统战略，以协调冈比亚和塞内加尔的卫生系统。我们将研究卫生系统，将其分为六个组成部分：人力资源、药物和技术、治理、融资、服务提供和信息。我们将使用定量和定性相结合的方法来解决研究目标。我们将对边境地区以及冈比亚和塞内加尔首都的所有主要保健中心进行调查。这项调查的目的是评估过去三年中跨境患者设施的数量和类型。我们将进行文件和文献综述，以评估冈比亚和塞内加尔边境地区之间以及西非其他国家之间的跨境医疗保健安排。我们还将与政策制定者、医疗保健提供者和跨境患者进行130次访谈和36次焦点小组讨论，以探讨冈比亚和塞内加尔之间目前和过去的跨境医疗保健做法。最后，我们将与冈比亚和塞内加尔的决策者举行一次研讨会，共同设计一项战略，以协调两国的卫生系统。

Despite the fact that there are approximately one billion migrants in the world, and an increasing recognition that healthcare use is not confined to national borders, the literature on health systems adaptation to population movement remains scant. Available studies have mostly investigated patterns and trends, reasons for travel, as well as benefits and challenges of population movement and healthcare use in different countries and world regions. Most of the literature attention has focused on North-to-South and South-to-North travel, whilst most transnational healthcare use actually takes place within regions. When studies on cross-border healthcare use have taken a regional focus, these are mostly focused on high- and middle-, rather than low-income countries. A global research agenda on migration and health urgently called for research on health systems adaptation to population mobility. To our knowledge, no previous study has done this yet. The aim of this project is to develop a health systems strategy to coordinate cross-border healthcare use between The Gambia and Senegal. The Gambia and Senegal provide an ideal setting for this research because they have a common pre-colonial history, the same ethnic groups and close political ties, whilst having different colonial histories leading to differing post-colonial political and health systems. We recently undertook a study of transnational healthcare use between The Gambia and Senegal, and found a large degree of cross-border healthcare use, but a clear lack of coordination between the two health systems, resulting in duplication of care, loss to follow up and feelings of discrimination amongst patients. When we presented our findings to Gambian and Senegalese policymakers, they asked the research team to develop a strategy to coordinate the health systems of the two countries. This study will aim to do that, and will be of use to policymakers in other low- and middle-income countries experiencing a high volume of cross-border healthcare use. The study will be divided into six objectives:1. Assess current levels of cross-border healthcare use between Senegal and The Gambia2. Examine the history of cross-border movement and healthcare use between Senegal and The Gambia3. Analyse different existing arrangements in different regions of The Gambia and Senegal 4. Review health system agreements between different countries in West Africa5. Examine the impact of the Covid-19 has had on population movement and cross-border healthcare, and identify ways a health systems strategy adapted to population movement can increase a country's resilience to pandemics6. Use a participatory approach to design a set of health systems strategies for coordinating the health systems of The Gambia and Senegal.We will study the health system by dividing it into six components: human resources, medicines and technologies, governance, financing, service provision and information. We will use a mix of quantitative and qualitative methods to address the study objectives. We will undertake a survey of all major health centres in border regions and the capital cities of The Gambia and Senegal. The aim of this survey will be to assess the number and type of cross-border patients facilities have seen in the past three years. We will conduct document and literature reviews to assess cross-border healthcare arrangements between border regions in The Gambia and Senegal, and between other countries in West Africa. We will also conduct 130 interviews and 36 focus group discussions with policymakers, healthcare providers and cross-border patients to explore current and past cross-border healthcare practices between The Gambia and Senegal. Finally, we will hold a workshop with policymakers from The Gambia and Senegal to co-design a strategy to coordinate the health systems of both countries.