Parkhurst Justin Oliver, Penn-Kekana Loveday, Blaauw Duane, Balabanova Dina, Danishevski Kirill, Rahman Syed Azizur, Onama Virgil, Ssengooba Freddie
Department of Public Health and Policy, Health Policy Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
Health Policy. 2005 Aug;73(2):127-38. doi: 10.1016/j.healthpol.2004.11.001. Epub 2004 Dec 15.
It is widely understood that maternal health care relies on the entire health system. However, little empirical, country-specific, research has been done to trace out the ways in which health system elements can shape maternal health outcomes. This study seeks to redress this situation, by providing an example of how a health systems approach can benefit the understanding of maternal health services. A comparative analysis was conducted based on extensive case studies of maternal health and health systems in Bangladesh, Russia, South Africa, and Uganda. A number of cross-cutting health system characteristics affecting maternal health were identified by comparing these diverse settings. The most important common systems issues underlying maternal health care were found to be the human resource structures, the public-private mix of service provision, and the changes involved with health sector reforms. Specific country contexts can further determine many factors influencing maternal health outcomes and service performance. Systems issues were found to influence the access to and utilization of services, quality of care provided, and ultimately maternal health outcomes. This paper provides a first step in tracing out how such broad systems issues actually work to influence maternal health.
人们普遍认为，孕产妇保健依赖于整个卫生系统。然而，针对特定国家的实证研究很少，以探究卫生系统要素影响孕产妇健康结果的方式。本研究旨在通过提供一个卫生系统方法如何有助于理解孕产妇保健服务的例子来纠正这种情况。基于对孟加拉国、俄罗斯、南非和乌干达孕产妇健康与卫生系统的广泛案例研究进行了比较分析。通过比较这些不同的情况，确定了一些影响孕产妇健康的贯穿各领域的卫生系统特征。发现孕产妇保健背后最重要的共同系统问题是人力资源结构、服务提供的公私混合以及卫生部门改革所涉及的变化。具体国家情况可进一步确定影响孕产妇健康结果和服务绩效的许多因素。发现系统问题会影响服务的可及性和利用率、所提供护理的质量以及最终的孕产妇健康结果。本文为探究此类广泛的系统问题实际如何影响孕产妇健康迈出了第一步。
