From political priority to service delivery: complexities to real-life priority of abortion services in Ethiopia.

IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Emily McLean, Ingrid Miljeteig, Astrid Blystad, Alemnesh H Mirkuzie, Marte E S Haaland
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Abstract

Improving access to abortion services has been coined a high priority by the Ethiopian Federal Ministry of Health. Nevertheless, many women are still struggling to access abortion services. The dedicated commitment to expanding abortion services by central authorities and the difficulties in further improving access to the services make for an interesting case to explore the real-life complexities of health priority setting. This article thus explores what it means to make abortion services a priority by drawing on in-depth interviews with healthcare bureaucrats and key stakeholders working closely with abortion service policy and implementation. Data were collected from February to April 2022. Health bureaucrats from 9 of the 12 regional states in Ethiopia and the Federal Ministry of Health were interviewed in addition to key stakeholders from professional organizations and NGOs. The study found that political will and priority to abortion services by central authorities were not necessarily enough to ensure access to the service across the health sector. At the regional and local level, there were considerable challenges with a lack of funding, equipment and human resources for implementing and expanding access to abortion services. The inadequacy of indicators and reporting systems hindered accountability and made it difficult to give priority to abortion services among the series of health programmes and priorities that local health authorities had to implement. The situation was further challenged by the contested nature of the abortion issue itself, both in the general population, but also amongst health bureaucrats and hospital leaders. This study casts a light on the complex and entangled processes of turning national-level priorities into on-the-ground practice and highlights the real-life challenges of setting and implementing health priorities.

从政治优先到提供服务:埃塞俄比亚堕胎服务在现实生活中的复杂性。
埃塞俄比亚联邦卫生部将改善堕胎服务列为高度优先事项。然而,许多妇女仍在为获得堕胎服务而苦苦挣扎。中央政府致力于扩大堕胎服务,但在进一步改善堕胎服务的可及性方面却困难重重,这为我们提供了一个有趣的案例,来探讨现实生活中确定卫生优先事项的复杂性。因此,本文通过对与人工流产服务政策和实施密切相关的医疗官僚和主要利益相关者进行深入访谈,探讨了将人工流产服务作为优先事项的意义。数据收集时间为 2022 年 2 月至 4 月。除来自专业组织和非政府组织的主要利益相关者外,还采访了埃塞俄比亚十二个地区州中九个州的卫生官员和联邦卫生部。研究发现,中央当局对堕胎服务的政治意愿和重视程度并不一定足以确保整个卫生部门都能获得堕胎服务。在地区和地方一级,由于缺乏资金、设备和人力资源,在实施和扩大堕胎服务方面面临相当大的挑战。指标和报告系统的不足阻碍了问责制的实施,也使得地方卫生当局难以在一系列必须实施的卫生计划和优先事项中优先考虑堕胎服务。堕胎问题本身的争议性,无论是在普通民众中,还是在卫生官员和医院领导中,都对这种情况提出了进一步的挑战。本研究揭示了将国家级优先事项转化为实地实践的复杂而纠结的过程,并强调了制定和实施卫生优先事项所面临的现实挑战。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Health policy and planning
Health policy and planning 医学-卫生保健
CiteScore
6.00
自引率
3.10%
发文量
98
审稿时长
6 months
期刊介绍: Health Policy and Planning publishes health policy and systems research focusing on low- and middle-income countries. Our journal provides an international forum for publishing original and high-quality research that addresses questions pertinent to policy-makers, public health researchers and practitioners. Health Policy and Planning is published 10 times a year.
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