International Health Department, Abt Associates, Inc, Bethesda, MD 20814, USA.
J Acquir Immune Defic Syndr. 2012 Aug 15;60 Suppl 3:S113-9. doi: 10.1097/QAI.0b013e31825d28d7.
Evidence demonstrates that scale-up of HIV services has produced stronger health systems and, conversely, that stronger health systems were critical to the success of the HIV scale-up. Increased access to and effectiveness of HIV treatment and care programs, attention to long-term sustainability, and recognition of the importance of national governance, and country ownership of HIV programs have resulted in an increased focus on structures that compromise the broader health system. Based on a review published literature and expert opinion, the article proposes 4 key health systems strengthening issues as a means to promote sustainability and country ownership of President's Emergency Plan for AIDS Relief and other global health initiatives. First, development partners need provide capacity building support and to recognize and align resources with national government health strategies and operational plans. Second, investments in human capital, particularly human resources for health, need to be guided by national institutions and supported to ensure the training and retention of skilled, qualified, and relevant health care providers. Third, a range of financing strategies, both new resources and improved efficiencies, need to be pursued as a means to create more fiscal space to ensure sustainable and self-reliant systems. Finally, service delivery models must adjust to recent advancements in areas of HIV prevention and treatment and aim to establish evidence-based delivery models to reduce HIV transmission rates and the overall burden of disease. The article concludes that there needs to be ongoing efforts to identify and implement strategic health systems strengthening interventions and address the inherent tension and debate over investments in health systems.
证据表明，艾滋病毒服务的扩大化已经产生了更强大的卫生系统，反之，更强大的卫生系统对于艾滋病毒扩大化的成功至关重要。增加艾滋病毒治疗和护理方案的可及性和有效性，关注长期可持续性，以及认识到国家治理和国家对艾滋病毒方案的自主权的重要性，都导致人们更加关注影响更广泛卫生系统的结构。基于对已发表文献和专家意见的审查，本文提出了 4 个关键的卫生系统加强问题，作为促进总统艾滋病紧急救援计划和其他全球卫生倡议的可持续性和国家自主权的手段。首先，发展伙伴需要提供能力建设支持，并认识到并将资源与国家政府的卫生战略和运营计划相协调。其次，需要以国家机构为指导，投资于人力资本，特别是卫生人力资源，以确保培训和留住熟练、合格和相关的医疗保健提供者。第三，需要采取一系列融资策略，包括新资源和提高效率，以创造更多的财政空间，确保可持续和自给自足的系统。最后，服务提供模式必须适应艾滋病毒预防和治疗领域的最新进展，并旨在建立基于证据的提供模式，以降低艾滋病毒传播率和疾病的总体负担。本文结论认为，需要不断努力确定和实施战略性卫生系统加强干预措施，并解决对卫生系统投资的内在紧张和争议。
