Godt Sue, Mhatre Sharmila, Schryer-Roy Anne-Marie
Maternal and Child Health Program, International Development Research Centre, PO Box 62084, 00200, Nairobi, Kenya.
Open Society Foundation, New York, NY, 10019, United States of America.
Health Res Policy Syst. 2017 Jul 12;15(Suppl 1):52. doi: 10.1186/s12961-017-0208-6.
West Africa was the focus of global attention during the Ebola virus disease outbreak, when systemic health system weaknesses compounded a serious emergency and complicated response efforts. Following the crisis, calls were made to strengthen health systems, but investments to date have fallen short of delivering the support needed to build strong health systems able to prevent and manage future outbreaks.In part, this reality serves to highlight the shortcomings of the solutions being repeatedly prioritised by external funders and experts, solutions that often fail to consider the wealth of West African evidence and actors actively working to strengthen the leadership and health systems needed to drive and sustainably improve national health outcomes. Unfortunately, this knowledge and experience are rarely heard in the global arena.This journal supplement is a contribution, although small, to changing this practice by putting the perspectives, experiences and knowledge of West Africans on the table. It presents findings from a series of research and capacity development projects in West Africa funded by the International Development Research Centre's Maternal and Child Health programme (formerly Governance for Equity in Health Systems).The evidence presented here centres around two key themes. First, the theme that context matters. The evidence shows how context can change the shape of externally imposed interventions or policies resulting in unintended outcomes. At the same time, it highlights evidence showing how innovative local actors are developing their own approaches, usually low-cost and embedded in the context, to bring about change. Second, the collection of articles discusses the critical need to overcome the existing fragmentation of expertise, knowledge and actors, and to build strong working relationships amongst all actors so they can effectively work together to identify priority issues that can realistically be addressed given the available windows of opportunity.Vibrant West African-led collaborations amongst researchers, decision-makers and civil society, which are effectively supported by national, regional and global funding, need to foster, strengthen and use locally-generated evidence to ensure that efforts to strengthen health systems and improve regional health outcomes are successful. The solutions are clearly not to be found in the 'travelling models' of standardised interventions.
在埃博拉病毒病疫情爆发期间，西非成为全球关注的焦点，当时卫生系统的系统性弱点使一场严重的紧急情况更加恶化，并使应对工作变得复杂。危机过后，人们呼吁加强卫生系统，但迄今为止的投资未能提供建设强大卫生系统所需的支持，而这样的卫生系统能够预防和应对未来的疫情爆发。在一定程度上，这一现实凸显了外部资助者和专家反复优先考虑的解决方案的不足之处，这些解决方案往往没有考虑到西非丰富的证据以及积极致力于加强领导能力和卫生系统以推动并可持续改善国家卫生成果的行动者。不幸的是，这种知识和经验在全球舞台上很少被听到。本期刊增刊虽贡献微薄，但通过展示西非人的观点、经验和知识，有助于改变这种状况。它呈现了由国际发展研究中心母婴健康项目（前身为卫生系统公平治理项目）资助的一系列西非研究和能力发展项目的成果。这里展示的证据围绕两个关键主题。首先，背景很重要这一主题。证据表明背景如何改变外部强加的干预措施或政策的形式，从而导致意外结果。同时，它突出了一些证据，显示创新的当地行动者如何开发自己的方法，这些方法通常成本低廉且因地制宜，以实现变革。其次，这组文章讨论了克服现有专业知识、知识和行动者碎片化问题的迫切需求，并在所有行动者之间建立牢固的工作关系，以便他们能够有效地共同努力，确定在现有机会窗口下能够切实解决的优先问题。由国家、区域和全球资金有效支持的、充满活力的、由西非主导的研究人员、决策者和民间社会之间的合作，需要得到培育、加强并利用本地产生的证据，以确保加强卫生系统和改善区域卫生成果的努力取得成功。显然，标准化干预的“移植模式”中找不到解决方案。
