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什么使得初级医疗保健能够抵御COVID-19? 尼日利亚的一项混合方法正偏差研究
Rachel Neill1, Michael A Peters2, Segun Bello3
1The Global Financing Facility for Women, Children, and Adolescents, Washington, District of Columbia, USA rneill@worldbank.org.
BMJ global health
|November 20, 2023
概括
尼日利亚的初级医疗保健系统在COVID-19期间表现出了弹性. 高绩效地区利用灵活的融资,人员配置和领导力来更快地恢复服务,突出了对综合战略的需求.
科学领域:
- 公共卫生 公共卫生
- 卫生系统研究 卫生系统研究
- 流行病学 流行病学
背景情况:
- 在全球范围内,COVID-19大流行严重影响了初级医疗保健 (PHC) 服务提供.
- 尼日利亚在亚国家级的PHC系统弹性方面表现出显著的差异.
- 了解有助于PHC恢复力的因素对于未来的流行病准备至关重要.
研究的目的:
- 确定尼日利亚高绩效地方政府区域 (LGAs) 的特点,这些地方政府区域在COVID-19大流行期间在PHC服务提供方面表现出了弹性.
- 分析能够在特定的LGA中更快地恢复门诊和产前护理服务的因素.
主要方法:
- 采用了一种连续解释混合方法设计.
- 基于使用健康管理信息系统数据的PHC服务恢复速度,定量分析确定了"积极偏差"的LGA.
- 来自70次半结构面试的质量数据与LGA官员,设施官员和社区领导人提供了深入的见解.
主要成果:
- 在490个LGA中,有57个被确定为正偏差,显示出门诊和产前护理服务的更快恢复.
- 积极偏差的LGA与缓慢恢复的对比者相比,显示出更集成,更意识和更自我调节的卫生系统.
- 需求侧的适应在性LGA中更为普遍,而比较者则专注于供给侧的解决方案;持续的融资和劳动力差距被认为是障碍.
结论:
- 灵活的融资,足够的医疗保健中心人员和有效的当地领导力是危机期间卫生系统恢复的关键推动因素.
- 建立有弹性的初级医疗保健需要采取协调的方法,整合自下而上的和自上而下的能力.
- 强大的当地领导层在连接和优化卫生系统功能以提高弹性方面发挥着关键作用.
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