从 PERFORM 到 PERFORM2Scale:在三个非洲国家推广加强卫生管理干预措施以支持全民医保的经验教训。

IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Joanna Raven, Wesam Mansour, Moses Aikins, Susan Bulthuis, Kingsley Chikaphupha, Marjolein Dieleman, Maryse Kok, Tim Martineau, Freddie Ssengooba, Kaspar Wyss, Frédérique Vallières
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引用次数: 0

摘要

加强地区和地方卫生管理人员的管理和领导能力已成为加强卫生系统和实现全民医保(UHC)的常用方法。虽然文献中不乏旨在加强地区或地方卫生管理人员能力的本土化举措实例,尤其是在撒哈拉以南非洲地区,但对如何推广这些举措的科学性的关注却少得多。因此,本文旨在研究加强管理干预措施(MSI)的推广过程,并找出新的知识和主要经验教训,用于指导其他复杂卫生干预措施的推广过程,以支持全民健康计划。我们采用定性方法来确定在加纳、马拉维和乌干达推广 MSI 的经验教训。我们与地区卫生管理团队成员进行了 14 次访谈,与 20 名扩大规模的利益相关者进行了 3 次扩大规模评估,与 11 名研究团队成员进行了 3 次反思讨论。我们还记录了整个 MSI 和推广实施过程中的活动。我们对数据进行了记录、转录,并根据 "变革理论 "对数据进行了分析,以确定推广成果和影响这些成果的因素。MSI 最终在 27 个地区推广。结果发现,随着时间的推移,重复的 MSI 周期促进了地区卫生管理团队(DHMTs)在解决当地长期存在的问题方面有更大的自主权,在不依赖额外资金的情况下更创新地使用现有资源,并改善了团队合作。资源小组 "的使用和 MSI "倡导者 "的出现都有助于支持扩大规模的努力。MSI 可持续性面临的挑战包括政府支持有限和缺乏持续的财政投资。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
From PERFORM to PERFORM2Scale: lessons from scaling-up a health management strengthening intervention to support Universal Health Coverage in three African countries.

Strengthening management and leadership competencies among district and local health managers has emerged as a common approach for health systems strengthening and to achieve Universal Health Coverage (UHC). While the literature is rich with localized examples of initiatives that aim to strengthen the capacity of district or local health managers, particularly in sub-Saharan Africa, considerably less attention is paid to the science of 'how' to scale-up these initiatives. The aim of this paper is thus to examine the 'process' of scaling-up a management strengthening intervention (MSI) and identify new knowledge and key lessons learned that can be used to inform the scale-up process of other complex health interventions, in support of UHC. Qualitative methods were used to identify lessons learned from scaling-up the MSI in Ghana, Malawi and Uganda. We conducted 14 interviews with district health management team (DHMT) members, three scale-up assessments with 20 scale-up stakeholders, and three reflection discussions with 11 research team members. We also kept records of activities throughout MSI and scale-up implementation. Data were recorded, transcribed and analysed against the Theory of Change to identify both scale-up outcomes and the factors affecting these outcomes. The MSI was ultimately scaled-up across 27 districts. Repeated MSI cycles over time were found to foster greater feelings of autonomy among DHMTs to address longstanding local problems, a more innovative use of existing resources without relying on additional funding and improved teamwork. The use of 'resource teams' and the emergence of MSI 'champions' were instrumental in supporting scale-up efforts. Challenges to the sustainability of the MSI include limited government buy-in and lack of sustained financial investment.

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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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