Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Soc Sci Med. 2013 Feb;78:42-9. doi: 10.1016/j.socscimed.2012.11.026. Epub 2012 Dec 1.
Recovery of the health sector in post-conflict countries is increasingly initiated through a Basic Package of Health Services (BPHS) approach. The country government and partners, including international donors, typically contract international and local NGOs to deliver the BPHS. Evidence from routine data suggests that a BPHS approach results in rapid increases in service coverage, coordination, equity, and efficiency. However, studies also show progress may then slow down, the cause of which is not immediately obvious from routine data. Qualitative research can provide insight into possible barriers in the implementation process, particularly the role of health workers delivering the BPHS services. The aim of this study was to explore perceptions of health service providers and policy makers on the implementation of the BPHS in post-conflict Liberia, using SRH services as a tracer and Lipsky's work on "street-level bureaucrats" as a theoretical framework. In July-October 2010, 63 interviews were conducted with midwives, officers-in-charge, and supervisors in two counties of Liberia, and with policy makers in Monrovia. The findings suggest health workers had a limited understanding of the BPHS and associated it with low salaries, difficult working conditions, and limited support from policy makers. Health workers responded by sub-optimal delivery of certain services (such as facility-based deliveries), parallel private services, and leaving their posts. These responses risk distorting and undermining the BPHS implementation. There were also clear differences in the perspectives of health workers and policy makers on the BPHS implementation. The findings suggest the need for greater dialogue between policy makers and health workers to improve understanding of the BPHS and recognition of the working conditions in order to help achieve the potential benefits of the BPHS in Liberia.
在冲突后国家，卫生部门的恢复越来越多地通过基本医疗服务包（BPHS）方法启动。国家政府和合作伙伴（包括国际捐助者）通常与国际和当地非政府组织签订合同，以提供 BPHS。常规数据表明，BPHS 方法可迅速提高服务覆盖面、协调性、公平性和效率。然而，研究还表明，进展随后可能会放缓，而从常规数据中并不能立即看出其原因。定性研究可以深入了解实施过程中可能存在的障碍，特别是提供 BPHS 服务的卫生工作者的作用。本研究旨在探讨卫生服务提供者和决策者对利比里亚冲突后实施 BPHS 的看法，将生殖健康服务作为示踪剂，并以 Lipsky 的“基层官僚”工作为理论框架。2010 年 7 月至 10 月，在利比里亚的两个县对助产士、主管和监督员以及蒙罗维亚的政策制定者进行了 63 次访谈。研究结果表明，卫生工作者对 BPHS 的理解有限，将其与低工资、艰难的工作条件和政策制定者的有限支持联系起来。卫生工作者的反应是提供某些服务（如基于设施的分娩）的服务质量下降、提供平行的私人服务和离职。这些反应有可能扭曲和破坏 BPHS 的实施。卫生工作者和政策制定者对 BPHS 实施的看法也存在明显差异。研究结果表明，需要在政策制定者和卫生工作者之间进行更多的对话，以增进对 BPHS 的理解和对工作条件的认识，以帮助利比里亚实现 BPHS 的潜在效益。
