审查国家以下各级卫生系统的持续发展:南非西开普省的经验,1994-2016 年。

IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Lucy Gilson,Krish Vallabhjee,Tracey Naledi,Leanne Brady,Anthony Hawkridge,David Pienaar,Helen Schneider
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引用次数: 0

摘要

治理和领导力被认为是中低收入国家卫生系统发展的核心,但现有研究很少考虑多级治理系统的影响。南非是许多(准)联邦国家之一。省政府负责在国家政策框架和规范内管理医疗服务的提供。在种族隔离后的早期,全国范围内都在努力解决种族隔离遗留下来的医疗系统不公平和低效率问题,但随后许多省份的医疗系统转型都停滞不前。相比之下,西开普省卫生厅在 1994-2016 年期间持续进行服务提供改革,并加强了管理流程。该省卫生厅可被视为 "相对官僚效率的袖珍机构"(POE):与其他机构相比,它在履行职能、追求公共利益方面相对有效的组织实体。本文探讨了 1994-2016 年间西开普省卫生系统发展的有利因素。数据收集分为两个阶段,包括文件审查、参与式研讨会、对西开普省内外特意挑选的关键信息提供者进行的 43 次深入访谈,以及对初步见解进行测试的结构化调查(回复率为 42%)。分析包括各数据集之间的三角测量、西开普省与其他省份经验的比较,以及借鉴 POE 理论和公共管理文献对这些经验的深入思考。分析强调了西开普省的经验,即在特定的省级历史和政治经济背景下,保持稳定和精明的国家以下各级治理和领导,以及随着时间的推移不断深化行政和技术能力,从而维持政治和行政权力的分离。多层次的治理体系可以为国家以下各级 POE 创造空间,使其在调解更广泛的政治经济力量的过程中崭露头角,为技术娴熟的改革领导者创造空间,使其能够为公众利益采取行动,支持分布式领导的出现,并制定强有力的管理程序。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Examining sustained sub-national health system development: experience from the Western Cape province, South Africa, 1994-2016.
Governance and leadership are recognised as central to health system development in low- and middle-income countries, yet few existing studies consider the influence of multi-level governance systems. South Africa is one of many (quasi-)federal states. Provincial governments have responsibility for managing health care delivery within national policy frameworks and norms. The early post-apartheid period saw country-wide efforts to address the apartheid legacy of health system inequity and inefficiency, but health system transformation subsequently stalled in many provinces. In contrast, the Western Cape provincial health department sustained service delivery reform and strengthened management processes over the period 1994-2016. This department can be considered a 'pocket of relative bureaucratic effectiveness' (POE): an organisational entity that, compared to others, is relatively effective in carrying out its functions in pursuit of the public good. This paper considers what factors enabled the development of the Western Cape health system in the period 1994-2016. Two phases of data collection entailed document review, participatory workshops, 43 in-depth interviews with purposively selected key informants from inside and outside the Western Cape, and a structured survey testing initial insights (response rate 42%). Analysis included triangulation across data sets, comparison between the Western Cape and other provincial experience and deeper reflection on these experiences drawing on POE theory and public administration literature. The analysis highlights the Western Cape experience of stable and astute sub-national governance and leadership and the deepening of administrative and technical capacity over time - within a specific provincial historical and political economy context that sustained the separation of political and administrative powers. Multi-level governance systems can create the space for sub-national POEs to emerge in their mediation of wider political economy forces, generating spaces for skilled reform leaders to act in the public interest, support the emergence of distributed leadership and develop robust management processes.
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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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