Health Policy and Management, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa;
Health Policy and Management, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.
Glob Health Action. 2014 Feb 13;7:23568. doi: 10.3402/gha.v7.23568. eCollection 2014.
The rising burden of disease and weak health systems are being compounded by the persistent economic downturn, re-emerging diseases, and violent conflicts. There is a growing recognition that the global health agenda needs to shift from an emphasis on disease-specific approaches to strengthening of health systems, including dealing with social, environmental, and economic determinants through multisectoral responses.
A review and analysis of data on strengthening health sector reform and health systems was conducted. Attention was paid to the goal of health and interactions between health sector reforms and the functions of health systems. Further, we explored how these interactions contribute toward delivery of health services, equity, financial protection, and improved health.
Health sector reforms cannot be developed from a single global or regional policy formula. Any reform will depend on the country's history, values and culture, and the population's expectations. Some of the emerging ingredients that need to be explored are infusion of a health systems agenda; development of a comprehensive policy package for health sector reforms; improving alignment of planning and coordination; use of reliable data; engaging 'street level' policy implementers; strengthening governance and leadership; and allowing a holistic and developmental approach to reforms.
The process of reform needs a fundamental rather than merely an incremental and evolutionary change. Without radical structural and systemic changes, existing governance structures and management systems will continue to fail to address the existing health problems.
不断加剧的疾病负担和薄弱的卫生系统，加之持续的经济衰退、重新出现的疾病和暴力冲突，使情况更为复杂。人们越来越认识到，全球卫生议程需要从侧重于针对具体疾病的方法转变为加强卫生系统，包括通过多部门应对措施处理社会、环境和经济决定因素。
对加强卫生部门改革和卫生系统的数据进行了审查和分析。关注的重点是健康目标以及卫生部门改革与卫生系统职能之间的相互作用。此外，我们还探讨了这些相互作用如何有助于提供卫生服务、公平性、财务保护和改善健康。
卫生部门改革不能从单一的全球或区域政策方案中产生。任何改革都将取决于国家的历史、价值观和文化以及民众的期望。需要探索的一些新出现的因素包括：将卫生系统议程纳入；制定全面的卫生部门改革政策方案；改进规划和协调的一致性；使用可靠的数据；让“基层”政策执行者参与；加强治理和领导；并允许对改革采取整体和发展性的方法。
改革进程需要根本性的而非仅仅是渐进和演进性的变化。如果不进行根本性的结构和系统性变革，现有的治理结构和管理系统将继续无法解决现有的卫生问题。
