Reid Simon A, Rodney Anna, Kama Mike, Hill Peter S
The University of Queensland, School of Public Health, Herston, QLD, 4006, Australia.
Fiji Centre for Communicable Disease Control, Ministry of Health and Medical Services, Suva, Fiji.
BMC Public Health. 2017 Aug 22;17(1):671. doi: 10.1186/s12889-017-4673-1.
Zoonotic diseases such as leptospirosis occur as a result of the often complex interactions that exist at the human-animal-environment interface. The most obvious consequence of this complexity is the need for the health sector to partner with institutions in other sectors of society such as agriculture, labour and local government. This multisectoral engagement is complicated by the different agendas and cultures of the various institutions and their ability to "see" their role and ant benefits in a collaborative response.
The research used a realist review methodology combined with systems thinking frameworks to determine the optimal strategy and governance for the prevention and control of leptospirosis in Fiji. The process included facilitated workshops with multiple stakeholders to determine the needs, issues and potential interventions that was guided by a synthesis of locally available data and information on the impact of leptospirosis. This process was informed by interviews with bureaucrats from different government ministries.
Stakeholders concurred that leptospirosis generally only received wide-spread attention in outbreaks, when there is media coverage of deaths or a large number of hospitalisations. In general, all ministries expressed support for a multisectoral strategy but saw the Ministry of Health and Medical Services as the lead agency with overall responsibility. The final consultation workshop yielded a clearly articulated goal to reduce the case fatality rate attributable to leptospirosis by 50% by 2020 and 4 overarching strategies: 1) improved clinical management of leptospirosis, 2) improved surveillance for leptospirosis, 3) enhanced communication to minimise risk and improve health seeking behaviours, and 4) strengthening coordination and governance structures.
Human mortality and morbidity remained the primary drive for government action, defining leptospirosis as a human health problem. The process of deliberative consultation, and the engagement of multidisciplinary partners has provided a platform for collaborative policy development, and a consensus for a National Action Plan from which further negotiated collaboration will be possible.
钩端螺旋体病等动物源性疾病是人类-动物-环境界面存在的复杂相互作用的结果。这种复杂性最明显的后果是卫生部门需要与农业、劳工和地方政府等社会其他部门的机构合作。各机构不同的议程和文化以及它们在协作应对中“认识”自身作用和益处的能力，使这种多部门参与变得复杂。
该研究采用了现实主义综述方法，并结合系统思维框架来确定斐济预防和控制钩端螺旋体病的最佳策略和治理方式。该过程包括与多个利益相关者举办的促进性研讨会，以确定需求、问题和潜在干预措施，这些研讨会以当地可得的关于钩端螺旋体病影响的数据和信息的综合分析为指导。该过程还参考了对不同政府部委官员的访谈。
利益相关者一致认为，钩端螺旋体病通常只有在疫情爆发时，即有媒体报道死亡或大量住院情况时，才会受到广泛关注。总体而言，所有部委都表示支持多部门战略，但认为卫生与医疗服务部是承担总体责任的牵头机构。最后的协商研讨会明确提出了一个目标，即到2020年将钩端螺旋体病导致的病死率降低50%，并提出了4项总体战略：1）改善钩端螺旋体病的临床管理；2）加强钩端螺旋体病监测；3）加强沟通以降低风险并改善就医行为；4）加强协调和治理结构。
人类的死亡率和发病率仍然是政府采取行动的主要驱动力，将钩端螺旋体病定义为一个人类健康问题。审议协商过程以及多学科合作伙伴的参与提供了一个合作制定政策的平台，并就国家行动计划达成了共识，在此基础上有可能进一步进行协商合作。
