Researchers claim to have found a "clear gap" between what most international health organisations say they are doing to strengthen health systems, and the reality on the ground. 科学家说他们发现在大多数国际卫生组织宣称正在加强卫生体系和实际情况之间的一个“明显的鸿沟”。 Writing in PLoS Medicine, they say that although 'global health actors' (GHAs) may claim to be strengthening health systems, they actually engage almost exclusively with activities that match their own specific aims. 他们在《公共科学图书馆?医学》杂志上的文章中说,尽管“全球卫生参与者”(GHAs)可能声称正在强化卫生体系,它们实际上几乎只是参与符合它们自己的目标的活动。” Global health initiatives such as the US President's Emergency Plan for AIDS Relief (PEPFAR) and Roll Back Malaria tend to concentrate on single diseases. This ignores the wider problem of fragile health systems in developing countries, say the researchers. 诸如美国总统防治艾滋病紧急救援计划(PEPFAR)以及遏制疟疾计划倾向于把重点放在单一疾病上。这组科学家说,这忽略了发展中国家脆弱的卫生体系的更广泛的问题。 The team, from the public health department at the Institute of Tropical Medicine in Antwerp, Belgium, reviewed GHAs' strategic documents. They found that "virtually all GHAs claim to support health systems, but instead focus on disease-specific interventions or on activities targeting system functions essential for implementing their own programmes". 来自比利时安特卫普的热带医学研究所公共卫生系的这个研究组回顾了GHAs的战略文件。他们发现“几乎所有GHAs都声称支持卫生体系,但是其实把重点放在了针对疾病的干预手段或针对贯彻它们自己的项目必需的系统功能的活动上”。 For example, the Global Alliance for Vaccines and Immunisation focuses on strengthening elements of health systems essential to immunisation programmes. 例如,全球疫苗免疫联盟把重点放在了强化卫生体系中对于免疫接种项目至关重要的组成部分上。 Part of the problem, say the researchers, is that GHAs use the term 'health system strengthening' for any capacity building. "We need a definition that is both shared and consistently applied," they write. 科学家说,这个问题部分在于GHAs把“卫生体系强化”这个词用在了任何能力建设上。“我们需要一个既共用、又能一致地使用的定义。”他们写道。 They also suggest GHAs' "enormous financial leverage" may be undermining individual countries' health systems. 他们还提出GHAs的“庞大的财政杠杆”可能会破坏一些国家的卫生体系。 In 2005, the Ugandan government health budget of US$112 million was overshadowed by US$167 million spent by three GHAs. 在2005年,乌干达政府的1.12亿美元的卫生预算与3个GHAs投入的1.67亿美元相比黯然失色。 Such well-resourced programmes can attract local health workers, drawing them away from the general health system into disease-specific programmes. 这些资源充足的项目可能吸引当地的卫生工作者,把他们从一般的卫生体系吸引到了针对特定疾病的项目中来。 Badara Samb, a senior advisor on health systems and services for the WHO, told SciDev.Net that shifting GHA policy is "fraught with challenges" because there is little research-based evidence showing how to improve interactions between national health systems and GHAs. 世界卫生组织关于卫生体系和服务的高级顾问Badara Samb告诉本网站说,改变GHA的政策“充满了挑战”,因为几乎没有基于研究的证据表明如何改善国家卫生体系和GHAs之间的相互作用。 "Aligning the efforts of [GHAs] with the need to strengthen health systems has become a new imperative," he says. “协调[GHAs的]举措和加强卫生体系的需求已经成为了一个新的必要事项。”他说。 Samb says the WHO led studies last year to identify ways for GHAs to achieve their objectives and strengthen countries' health systems. The results should be available this month (June). Samb说世界卫生组织主导的研究去年提出了GHAs实现它们的目标并加强各国卫生体系的一些方法。结果可能在本月(6月)公布。 Meanwhile the Belgian research team's findings are reflected in another new PLoS Medicine paper analysing whether the rollout of antiretroviral medication in Ethiopia was effective. 与此同时,比利时的这个研究组的发现反映在了《公共科学图书馆?医学》的另一篇新论文中。该论文分析了埃塞俄比亚分发抗逆转录病毒药物是否有效。 The study suggests the programme, led by GHAs including PEPFAR, may have caused an 'internal brain drain' of doctors. Numbers in the public sector dropped during the rollout, while numbers of non-profit staff increased. 这项研究提出,由PEPFAR等GHAs领导的这一项目可能导致了医生的“内部人才流失”。在这一项目进行期间,公共部门的医生数量下降,而非营利机构的人数增加。 (责任编辑:泉水) |