Mayhew Susannah H, Adjei Sam
London School of Hygiene and Tropical Medicine, UK.
Health Policy Plan. 2004 Oct;19 Suppl 1:i50-i61. doi: 10.1093/heapol/czh045.
Many countries are undertaking widespread structural change of their health sectors. There is mounting concern that priority-setting mechanisms used in planning the reforms are not suited to recognizing or taking account of the needs and priorities of sexual and reproductive health (SRH) services. The main aim of this research was to assess the sensitivity of the priority-setting tools and mechanisms used in the development of the health sector reforms in Ghana, to the needs and priorities of SRH services, and to consider how priority-setting mechanisms could be improved. We conclude that priority-setting tools in Ghana's reform process were rudimentary, and SRH donors and advocates were little involved. While it is tempting for a strong programme like Ghana's SRH programme to remain independent, we argue that closer involvement in system-wide reforms is a preferable long-term objective. Clearly, SRH priorities need safeguarding within a systems approach and we suggest a number of ways in which this can be achieved. Most importantly, the SRH community, in collaboration with the wider development community, needs to challenge current priority-setting mechanisms and the long-held view that traditional disease-ranking and cost-effectiveness measures are necessarily the best, most accurate way to measure health priorities. Traditional priority-setting tools do not adequately reflect the long-term benefits of preventive interventions such as family planning, and are therefore not an adequate reflection of holistic health sector planning needs. In response to this, there needs to be greater commitment from the international development and research communities to: (1) support collaboration between economists and reproductive health specialists to develop better measures for the effectiveness and impact of SRH services; and (2) in the interim, accept proxies for priority-setting which may include small-scale, qualitative research data combined with priorities identified by SRH specialists. To achieve this, the priority-setting processes need to become more inclusive and SRH specialists need to be proactive in their engagement with health sector decision-makers.
许多国家正在对其卫生部门进行广泛的结构改革。人们越来越担心，用于规划改革的优先事项确定机制并不适合识别或考虑性与生殖健康（SRH）服务的需求和优先事项。本研究的主要目的是评估加纳卫生部门改革中使用的优先事项确定工具和机制对SRH服务需求和优先事项的敏感性，并考虑如何改进优先事项确定机制。我们得出的结论是，加纳改革进程中的优先事项确定工具很不完善，SRH捐助者和倡导者几乎没有参与其中。虽然像加纳的SRH计划这样强大的项目倾向于保持独立，但我们认为更密切地参与全系统改革是一个更可取的长期目标。显然，SRH优先事项需要在系统方法中得到保障，我们提出了一些可以实现这一目标的方法。最重要的是，SRH界需要与更广泛的发展界合作，挑战当前的优先事项确定机制以及长期以来认为传统疾病排名和成本效益措施必然是衡量卫生优先事项的最佳、最准确方法的观点。传统的优先事项确定工具没有充分反映计划生育等预防性干预措施的长期效益，因此不能充分反映整体卫生部门规划的需求。对此，国际发展和研究界需要做出更大承诺：（1）支持经济学家和生殖健康专家之间的合作，以制定更好的衡量SRH服务有效性和影响的措施；（2）在此期间，接受优先事项确定的替代方法，其中可能包括小规模的定性研究数据以及SRH专家确定的优先事项。为了实现这一目标，优先事项确定过程需要更加包容，SRH专家需要积极与卫生部门决策者接触。
