Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
PLoS One. 2011;6(6):e20741. doi: 10.1371/journal.pone.0020741. Epub 2011 Jun 14.
Increasingly seen as a useful tool of health policy, Essential or Minimal Health Packages direct resources to interventions that aim to address the local burden of disease and be cost-effective. Less attention has been paid to the delivery mechanisms for such interventions. This study aimed to assess the degree to which the Essential Health Package (EHP) in Malawi was available to its population and what health system constraints impeded its full implementation. The first phase of this study comprised a survey of all facilities in three districts including interviews with all managers and clinical staff. In the second and third phase, results were discussed with District Health Management Teams and national level stakeholders, respectively, including representatives of the Ministry of Health, Central Medical Stores, donors and NGOs. The EHP in Malawi is focussing on the local burden of disease; however, key constraints to its successful implementation included a widespread shortage of staff due to vacancies but also caused by frequent trainings and meetings (only 48% of expected man days of clinical staff were available; training and meetings represented 57% of all absences in health centres). Despite the training, the percentage of health workers aware of vital diagnostic and therapeutic approaches to EHP conditions was weak. Another major constraint was shortages of vital drugs at all levels of facilities (e.g. Cotrimoxazole was sufficiently available to treat the average number of patients in only 27% of health centres). Although a few health workers noted some improvement in infrastructure and working conditions, they still considered them to be widely inadequate. In Malawi, as in similar resource poor countries, greater attention needs to be given to the health system constraints to delivering health care. Removal of these constraints should receive priority over the considerable focus on the development and implementation of essential packages of interventions.
越来越多的人认为基本医疗保健包是卫生政策的有用工具，它将资源用于旨在解决当地疾病负担且具有成本效益的干预措施。然而，对于这些干预措施的实施机制，人们的关注较少。本研究旨在评估马拉维的基本医疗保健包（EHP）在多大程度上为其人民提供服务，以及卫生系统的哪些限制因素阻碍了其全面实施。本研究的第一阶段包括对三个地区的所有医疗机构进行调查，包括对所有管理人员和临床工作人员进行访谈。在第二和第三阶段，分别与地区卫生管理团队和国家利益相关者（包括卫生部、中央医疗用品商店、捐助者和非政府组织的代表）讨论了结果。马拉维的 EHP 侧重于当地的疾病负担；然而，其成功实施的关键限制因素包括由于职位空缺导致的工作人员普遍短缺，也包括频繁的培训和会议导致的短缺（只有 48%的预期临床工作人员工作天数可用；培训和会议占卫生中心所有缺勤的 57%）。尽管进行了培训，但了解 EHP 疾病基本诊断和治疗方法的卫生工作者比例仍然较弱。另一个主要限制因素是各级医疗机构基本药物短缺（例如，复方新诺明的供应仅足以治疗卫生中心 27%的平均患者人数）。尽管一些卫生工作者注意到基础设施和工作条件有所改善，但他们仍认为这些条件远远不够。在马拉维，与其他资源匮乏的国家一样，需要更加关注提供医疗保健方面的卫生系统限制因素。消除这些限制因素应优先于对基本干预措施包的开发和实施的大量关注。
