Berlan David
Florida State University, 650 Bellamy Building, Tallahassee, FL 32306-2250, USA
Health Policy Plan. 2016 Apr;31 Suppl 1(Suppl 1):i33-47. doi: 10.1093/heapol/czv070. Epub 2015 Oct 5.
Advocacy, policy, research and intervention efforts against childhood pneumonia have lagged behind other health issues, including malaria, measles and tuberculosis. Accelerating progress on the issue began in 2008, following decades of efforts by individuals and organizations to address the leading cause of childhood mortality and establish a global health network. This article traces the history of this network's formation and evolution to identify lessons for other global health issues. Through document review and interviews with current, former and potential network members, this case study identifies five distinct eras of activity against childhood pneumonia: a period of isolation (post WWII to 1984), the duration of WHO's Acute Respiratory Infections (ARI) Programme (1984-1995), Integrated Management of Childhood illness's (IMCI) early years (1995-2003), a brief period of network re-emergence (2003-2008) and recent accelerating progress (2008 on). Analysis of these eras reveals the critical importance of building a shared identity in order to form an effective network and take advantage of emerging opportunities. During the ARI era, an initial network formed around a relatively narrow shared identity focused on community-level care. The shift to IMCI led to the partial dissolution of this network, stalled progress on addressing pneumonia in communities and missed opportunities. Frustrated with lack of progress on the issue, actors began forming a network and shared identity that included a broad spectrum of those whose interests overlap with pneumonia. As the network coalesced and expanded, its members coordinated and collaborated on conducting and sharing research on severity and tractability, crafting comprehensive strategies and conducting advocacy. These network activities exerted indirect influence leading to increased attention, funding, policies and some implementation.
针对儿童肺炎的宣传、政策、研究和干预工作落后于其他健康问题，包括疟疾、麻疹和结核病。在个人和组织为解决儿童死亡的主要原因并建立全球卫生网络付出数十年努力之后，2008年开始加快在该问题上的进展。本文追溯了这个网络的形成和演变历史，以确定对其他全球卫生问题的借鉴经验。通过文献回顾以及对现任、前任和潜在网络成员的访谈，本案例研究确定了对抗儿童肺炎的五个不同活动阶段：隔离期（二战后至1984年）、世卫组织急性呼吸道感染（ARI）项目开展期间（1984 - 1995年）、儿童疾病综合管理（IMCI）的早期阶段（1995 - 2003年）、网络短暂重新出现阶段（2003 - 2008年）以及最近的加速进展阶段（2008年至今）。对这些阶段的分析揭示了建立共同身份对于形成有效网络并利用新出现机会的至关重要性。在ARI阶段，一个围绕相对狭隘的共同身份形成的初始网络专注于社区层面的护理。向IMCI的转变导致了这个网络的部分瓦解，在解决社区肺炎问题上的进展停滞，并错失了机会。由于对该问题缺乏进展感到沮丧，各方行动者开始形成一个网络和共同身份，其中包括广泛的利益与肺炎相关的群体。随着网络的凝聚和扩展，其成员在开展和分享关于严重程度和可处理性的研究、制定全面战略以及进行宣传方面进行协调与合作。这些网络活动产生了间接影响，导致关注度提高、资金增加、政策出台以及一些措施得以实施。
