World Health Organization, Geneva, Switzerland.
Lancet. 2010 Nov 20;376(9754):1785-97. doi: 10.1016/S0140-6736(10)61353-0. Epub 2010 Nov 10.
National health systems need strengthening if they are to meet the growing challenge of chronic diseases in low-income and middle-income countries. By application of an accepted health-systems framework to the evidence, we report that the factors that limit countries' capacity to implement proven strategies for chronic diseases relate to the way in which health systems are designed and function. Substantial constraints are apparent across each of the six key health-systems components of health financing, governance, health workforce, health information, medical products and technologies, and health-service delivery. These constraints have become more evident as development partners have accelerated efforts to respond to HIV, tuberculosis, malaria, and vaccine-preventable diseases. A new global agenda for health-systems strengthening is arising from the urgent need to scale up and sustain these priority interventions. Most chronic diseases are neglected in this dialogue about health systems, despite the fact that non-communicable diseases (most of which are chronic) will account for 69% of all global deaths by 2030 with 80% of these deaths in low-income and middle-income countries. At the same time, advocates for action against chronic diseases are not paying enough attention to health systems as part of an effective response. Efforts to scale up interventions for management of common chronic diseases in these countries tend to focus on one disease and its causes, and are often fragmented and vertical. Evidence is emerging that chronic disease interventions could contribute to strengthening the capacity of health systems to deliver a comprehensive range of services-provided that such investments are planned to include these broad objectives. Because effective chronic disease programmes are highly dependent on well-functioning national health systems, chronic diseases should be a litmus test for health-systems strengthening.
如果要应对低收入和中等收入国家中日益严重的慢性病挑战，国家卫生系统就需要加强。通过将公认的卫生系统框架应用于现有证据，我们发现，限制各国实施慢性病现有防治策略的能力的因素与卫生系统的设计和运行方式有关。在卫生筹资、治理、卫生人力、卫生信息、医疗产品和技术以及卫生服务提供这六个卫生系统的关键组成部分中，每个部分都存在着实质性的制约因素。随着发展伙伴加快应对艾滋病毒、结核病、疟疾和疫苗可预防疾病的努力，这些制约因素变得更加明显。需要加紧努力加强卫生系统，以扩大和维持这些重点干预措施，因此出现了新的全球卫生系统加强议程。在这场关于卫生系统的对话中，大多数慢性病都被忽视了，尽管到 2030 年，非传染性疾病（其中大多数为慢性病）将占全球所有死亡人数的 69%，而这些死亡人数中有 80%将发生在低收入和中等收入国家。与此同时，慢性病防治行动的倡导者并没有将卫生系统作为有效应对措施的一部分给予足够重视。在这些国家扩大常见慢性病管理干预措施的努力往往侧重于一种疾病及其病因，而且往往是分散和垂直的。有证据表明，慢性病干预措施有助于加强卫生系统提供全面服务的能力——只要此类投资计划包含这些广泛目标。由于有效的慢性病方案高度依赖运转良好的国家卫生系统，因此慢性病应该成为检验卫生系统加强的试金石。
