Oliff Monique, Mayaud Philippe, Brugha Ruairí, Semakafu Ave Maria
Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), London, UK.
Reprod Health Matters. 2003 May;11(21):37-48.
Universal access to comprehensive reproductive health services, integrated into a well-functioning health system, remains an unfulfilled objective in many countries. In 2000-2001, in Tanzania, in-depth interviews were conducted with central level stakeholders and focus group discussions held with health management staff in three regional and nine district health offices, to assess progress in the integration of reproductive health services. Respondents at all levels reported stalled integration and lack of synchronisation in the planning and management of key services. This was attributed to fear of loss of power and resources among national level managers, uncertainty as to continuation of donor support and lack of linkages with the Health Sector Reform Secretariat. Among reproductive health programmes, sexually transmitted infection (STI) control alone retained its vertical planning, management and implementation structures. District-level respondents expressed frustration in their efforts to coordinate STI service delivery with other, more integrated programmes. They reported contradictory directives and poor communication channels with higher levels of the Ministry of Health; lack of technical skills at district level to undertake supervision of integrated services; low morale due to low salaries; and lack of district autonomy in decision-making. Integration requires a coherent policy environment. The uncoordinated and conflicting agendas of donors, on whom Tanzania is too heavily reliant, is a major obstacle.
在许多国家，普及全面的生殖健康服务并将其纳入运转良好的卫生系统，仍是一个尚未实现的目标。2000 - 2001年，在坦桑尼亚，对中央层面的利益相关者进行了深入访谈，并与三个地区和九个区卫生办公室的卫生管理人员进行了焦点小组讨论，以评估生殖健康服务整合方面的进展。各级受访者均表示，关键服务的整合停滞不前，规划和管理缺乏同步性。这归因于国家层面管理人员担心失去权力和资源、捐助方支持的持续性存在不确定性以及与卫生部门改革秘书处缺乏联系。在生殖健康项目中，仅性传播感染（STI）控制保留了其垂直的规划、管理和实施结构。区级受访者对其将性传播感染服务提供与其他更综合的项目进行协调的努力表示沮丧。他们报告称，收到相互矛盾的指令，与卫生部高层的沟通渠道不畅；区级缺乏监督综合服务的技术技能；由于薪资低，士气低落；以及在决策方面缺乏区级自主权。整合需要一个协调一致的政策环境。坦桑尼亚过度依赖的捐助方议程不协调且相互冲突，这是一个主要障碍。
