Department of Public Administration and Policy, American University, Washington, DC 20016, USA.
Health Policy Plan. 2013 Jan;28(1):41-50. doi: 10.1093/heapol/czs023. Epub 2012 Mar 8.
After a period of proliferation of disease-specific initiatives, over the past decade and especially since 2005 many organizations involved in global health have come to direct attention and resources to the issue of health systems strengthening. We explore how and why such attention emerged. A qualitative methodology, process-tracing, was used to construct a case history and analyse the factors shaping and inhibiting global political attention for health systems strengthening. We find that the critical factors behind the recent burst of attention include fears among global health actors that health systems problems threaten the achievement of the health-related Millennium Development Goals, concern about the adverse effects of global health initiatives on national health systems, and the realization among global health initiatives that weak health systems present bottlenecks to the achievement of their organizational objectives. While a variety of actors now embrace health systems strengthening, they do not constitute a cohesive policy community. Moreover, the concept of health systems strengthening remains vague and there is a weak evidence base for informing policies and programmes for strengthening health systems. There are several reasons to question the sustainability of the agenda. Among these are the global financial crisis, the history of pendulum swings in global health and the instrumental embrace of the issue by some actors.
经过一段时间的疾病专项倡议的发展，在过去十年中，尤其是自 2005 年以来，许多参与全球卫生的组织已经开始关注并投入资源加强卫生系统。我们探讨了这种关注是如何出现的，以及为什么会出现这种关注。采用定性方法，即过程追踪法，构建了一个案例历史，并分析了影响和制约全球卫生系统强化政治关注的因素。我们发现，最近关注热潮背后的关键因素包括全球卫生行为者担心卫生系统问题威胁到与卫生相关的千年发展目标的实现，担心全球卫生倡议对国家卫生系统的不利影响，以及全球卫生倡议认识到薄弱的卫生系统是实现其组织目标的瓶颈。虽然现在有各种各样的行为者支持加强卫生系统，但他们并没有形成一个凝聚力强的政策共同体。此外，加强卫生系统的概念仍然模糊，而且缺乏有力的证据基础来为加强卫生系统的政策和方案提供信息。该议程的可持续性存在几个问题，其中包括全球金融危机、全球卫生领域的钟摆摆动历史以及一些行为者对该问题的工具性接受。
