| 引用本文：Tamara Hafner,Jeremy Shiffman.全球开始关注卫生体系加强[J].中国卫生政策研究,2013,6(8):58-68 |
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| 全球开始关注卫生体系加强 |
| 投稿时间：2013-04-20 修订日期：2013-06-08 PDF全文浏览 HTML全文浏览 |
| Tamara Hafner1, Jeremy Shiffman1 |
| 美国大学公共管理与政策系 |
| 摘要:在过去很长一段时间内，某一具体疾病是主要研究对象，但近几十年特别是2005年以来，许多组织开始参与全球卫生研究并关注卫生体系加强。本文对这一关注产生的原因及方式展开研究。研究采用了过程追踪的定性方法，并对政治层面引发和限制其关注的因素进行分析。研究发现加强卫生体系之所以得到广泛关注，主要是因为：全球卫生的参与者担心卫生体系方面的问题会影响千年发展目标的实现，并担心全球卫生行动可能会给国家卫生体系带来负面影响。此外，许多全球卫生组织已经意识到，薄弱的卫生体系会成为实现组织既定目标的瓶颈。尽管目前有众多的参与者支持加强卫生体系，但这些行动者还未形成有凝聚力的政策联盟。此外，加强卫生体系的概念不清晰，而且加强卫生体系的证据很薄弱。由于全球金融危机、全球卫生政策的不确定性以及一些行动者暂时性地支持等，对加强卫生体系的关注是否具有可持续性，目前尚未有定论。 |
| 关键词:卫生体系加强 政治优先 全球卫生 |
| 基金项目:洛克菲勒基金会项目（2008PSH 218） |
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| The emergence of global attention to health systems strengthening |
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| Abstract:After a period of proliferation of disease specific initiatives, over the past decade and especially since 2005 many organizations involved in global health have come to direct attention and resources to the issue of health systems strengthening. We explore how and why such attention emerged. A qualitative methodology, process tracing, was used to construct a case history and analyze the factors shaping and inhibiting global political attention for health systems strengthening. We find that the critical factors behind the recent burst of attention include fears among global health actors that health systems problems threaten the achievement of the health related Millennium Development Goals, concern about the adverse effects of global health initiatives on national health systems, and the realization among global health initiatives that weak health systems present bottlenecks to the achievement of their organizational objectives. While a variety of actors now embrace health systems strengthening, they do not constitute a cohesive policy community. Moreover, the concept of health systems strengthening remains vague and there is a weak evidence base for informing policies and programmes for strengthening health systems. There are several reasons to question the sustainability of the agenda. Among these are the global financial crisis, the history of pendulum swings in global health and the instrumental embrace of the issue by some actors. |
| Key words:Health systems strengthening Political priority Global health |
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