确保在长期危机背景下卫生系统业务层面的领导。一项涵盖刚果民主共和国东部8个卫生区的横断面定性研究

Rosine Nshobole Bigirinama, Samuel Lwamushi Makali, Mamothena Carol Mothupi, Christian Zalinga Chiribagula, Patricia St Louis, Pacifique Lyabayungu Mwene-Batu, Ghislain Balaluka Bisimwa, Albert Tambwe Mwembo, Denis Georges Porignon
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引用次数: 0

摘要

摘要背景:本研究探讨了在长期危机背景下,如何在卫生系统的运营层面提供领导力。尽管医学科学和技术取得了进步,但低收入和中等收入国家的卫生系统仍难以向所有公民提供高质量的医疗服务。确立了领导在促进卫生系统恢复力和积极转变方面的作用。然而,在刚果民主共和国(DRC),关于这个问题的文献很少。本研究描述了刚果民主共和国东部受危机影响的卫生区卫生管理人员经验丰富和认识到的领导能力。方法于2021年在八个农村卫生区(对应于刚果民主共和国卫生系统组织的卫生区)进行定性横断面研究。通过深度访谈和非参与性观察收集数据。参与者是每个地区的主要保健行为者。该研究运用英国国家卫生服务领导学院的领导力框架概念方法,演绎探索了与领导力相关的六个主题。从这些主题中,归纳分析提炼出新兴的次主题。结果该研究揭示了卫生区管理和组织、管理团队内部协作以及这些团队与卫生区外部合作伙伴之间协作的不足。沟通、临床和管理能力被确定为在改善地区领导方面需要加强的关键因素。调查结果还突出表明,卫生区外部合作伙伴和分层管理者的纵向干预对区领导的规划、人力资源管理和决策自主权产生了不利影响,削弱了他们的领导能力。结论:尽管各区分散的基本运作结构经受住了几十年的危机和政府在保健方面投资不足的考验,但各区仍难以发挥其领导作用和自治权。作者建议加大对卫生人力的个人和专业发展的支持,加上增加政府投资,以进一步加强这些环境中的卫生系统能力。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Ensuring leadership at the operational level of a health system in protracted crisis context. A cross-sectional qualitative study covering 8 health districts in Eastern Democratic Republic of Congo
Abstract Background This study examines how leadership is provided at the operational level of a health system in a protracted crisis context. Despite advances in medical science and technology, health systems in low- and middle-income countries struggle to deliver quality care to all their citizens. The role of leadership in fostering resilience and positive transformation of a health system is established. However, there is little literature on this issue in Democratic Republic of the Congo (DRC). This study describes leadership as experienced and perceived by health managers in crisis affected health districts in Eastern DRC. Methods A qualitative cross-sectional study was conducted in eight rural health districts (corresponding to health zones, in DRC’s health system organization), in 2021. Data were collected through in-depth interviews and non-participatory observations. Participants were key health actors in each district. The study deductively explored six themes related to leadership, using an adapted version of the Leadership Framework conceptual approach to leadership from the United Kingdom National Health Service’s Leadership Academy. From these themes, an inductive analysis extracted emerging subthemes. Results The study has revealed deficiencies regarding Management and Organisation of the health zones, Internal collaboration within their management teams as well as collaboration between these teams and the health zone’s external partners. Communication and clinical and managerial capacities were identified as key factors to be strengthened in improving leadership within the districts. The findings have also highlighted the detrimental influence of vertical interventions from external partners and hierarchical supervisors in health zones on planning, human resource management and decision-making autonomy of district leaders, weakening their leadership. Conclusions Despite their decentralized basic operating structure, which has withstood decades of crisis and insufficient government investment in healthcare, the districts still struggle to assert their leadership and autonomy. The authors suggest greater support for personal and professional development of the health workforce, coupled with increased government investment, to further strengthen health system capacities in these settings.
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