Manyazewal Tsegahun, Oosthuizen Martha J, Matlakala Mokgadi C
Department of Health Studies, College of Human Science, University of South Africa, Pretoria, South Africa Ethiopian Public Health Association, Addis Ababa, Ethiopia.
Department of Health Studies, College of Human Science, University of South Africa, Pretoria, South Africa.
BMJ Open. 2016 Sep 20;6(9):e012582. doi: 10.1136/bmjopen-2016-012582.
Many resource-limited countries have adopted and implemented healthcare reform to improve the quality of healthcare, but few have had much impact and strategies in support of these efforts remain limited. We aimed to explore and propose evidence-based strategies to strengthen implementation of healthcare reform in resource-limited settings.
Descriptive and exploratory designs in two phases. Phase I involved assessing the effectiveness of the healthcare reform implemented in Ethiopia in the form of business process reengineering, with evidence compiled from healthcare professionals through a self-administered questionnaire; and phase II involved proposing strategies and seeking consensus from experts using Delphi method.
Public hospitals in central Ethiopia.
406 healthcare professionals and 10 senior health policy experts.
The healthcare reform that we evaluated was able to restructure hospital departments into case teams, with the goal of adopting a 'one-stop shopping' approach. However, shortages of critical infrastructure, furniture and supplies and job dissatisfaction continued to hamper the system. The most important predictors that influenced implementation of the reform were financial resources, top management commitment and support, collaborative working environment and information technology (IT). Five strategies with 14 operational objectives and 67 potential interventions that could strengthen the reform are proposed based on their strategic priority, which are as follows: reinforce patient-centred quality of care services; foster a healthy and respectful workforce environment; efficient and accountable leadership and governance; efficient use of hospital financing and maximise innovations and the use of health technologies.
Effective implementation of healthcare reform remained a challenge for governments in resource-limited settings. Resilient operational, clinical and governance functions of health systems, as well as a motivated and committed health workforce, are important to move healthcare reform processes forward. Political commitments at this juncture might be critical though there need to be a clear demarcation between political and technical engagements.
许多资源有限的国家已采用并实施医疗改革以提高医疗质量，但很少有国家取得显著成效，支持这些努力的策略仍然有限。我们旨在探索并提出基于证据的策略，以加强资源有限环境下医疗改革的实施。
分两个阶段的描述性和探索性设计。第一阶段涉及评估埃塞俄比亚以业务流程再造形式实施的医疗改革的有效性，通过自填式问卷从医疗专业人员收集证据；第二阶段涉及使用德尔菲法提出策略并寻求专家共识。
埃塞俄比亚中部的公立医院。
406名医疗专业人员和10名高级卫生政策专家。
我们评估的医疗改革能够将医院科室重组为病例团队，目标是采用“一站式服务”方法。然而，关键基础设施、家具和用品短缺以及工作满意度低继续阻碍该系统。影响改革实施的最重要预测因素是财政资源、高层管理承诺与支持、协作工作环境和信息技术（IT）。根据其战略优先级，提出了五项具有14个运营目标和67项潜在干预措施的策略，可加强改革，具体如下：加强以患者为中心的护理服务质量；营造健康且相互尊重的工作环境；高效且负责的领导与治理；有效利用医院资金并最大限度地创新和使用卫生技术。
在资源有限的环境中，有效实施医疗改革对政府而言仍然是一项挑战。卫生系统具有弹性的运营、临床和治理功能，以及积极主动且敬业的卫生人力，对于推动医疗改革进程很重要。尽管政治和技术参与需要明确划分，但此时的政治承诺可能至关重要。
