Shukor Ali R, Klazinga Niek S, Kringos Dionne S
Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
BMC Health Serv Res. 2017 Aug 23;17(1):592. doi: 10.1186/s12913-017-2501-z.
This study presents a descriptive synthesis of Kurdistan Region of Iraq's (KRI) primary care system, which is undergoing comprehensive primary care reforms within the context of a cross-cutting structural economic adjustment program and protracted security, humanitarian, economic and political crises.
The descriptive analysis used a framework operationalizing Starfield's classic primary care model for health services research. A scoping review was performed using relevant sources, and expert consultations were conducted for completing and validating data.
The descriptive analysis presents a complex narrative of a primary care system undergoing classical developmental processes of transitioning middle-income countries. The system is simultaneously under tremendous pressure to adapt to the continuously changing, complex and resource-intensive needs of sub-populations exhibiting varying morbidity patterns, within the context of protracted security, humanitarian, economic, and political crises. Despite exhibiting significant resilience in the face of the ongoing crises, the continued influx of IDPs and Syrian refugees, coupled with extremely limited resources and weak governance at policy, organizational and clinical levels threaten the sustainability of KRI's public primary care system. Diverse trajectories to the strengthening and development of primary care are underway by local and international actors, notably the World Bank, RAND Corporation, UN organizations and USAID, focusing on varying imperatives related to the protracted humanitarian and economic crises.
The convergence, interaction and outcomes of the diverse initiatives and policy approaches in relation to the development of KRI's primary care system are complex and highly uncertain. A common vision of primary care is required to align resources, initiatives and policies, and to enable synergy between all local and international actors involved in the developmental and humanitarian response. Further research that integrates the knowledge synthesized in this article, and enables actors in KRI to learn from their own experiences and efforts, along with those of other jurisdictions, would be invaluable towards the ongoing development of primary care.
本研究对伊拉克库尔德斯坦地区（KRI）的初级保健系统进行了描述性综合分析，该系统正在跨部门结构经济调整计划以及长期的安全、人道主义、经济和政治危机背景下进行全面的初级保健改革。
描述性分析采用了一个将Starfield的经典初级保健模型用于卫生服务研究的框架。使用相关来源进行了范围审查，并进行了专家咨询以完善和验证数据。
描述性分析呈现了一个初级保健系统的复杂情况，该系统正经历中等收入国家转型的经典发展过程。在长期的安全、人道主义、经济和政治危机背景下，该系统同时面临巨大压力，需要适应发病率模式各异的亚人群不断变化、复杂且资源密集的需求。尽管在面对持续危机时展现出显著的复原力，但境内流离失所者和叙利亚难民的持续涌入，加上资源极度有限以及政策、组织和临床层面治理薄弱，威胁着KRI公共初级保健系统的可持续性。地方和国际行为体，特别是世界银行、兰德公司、联合国组织和美国国际开发署，正在采取多种途径加强和发展初级保健，重点关注与长期人道主义和经济危机相关的不同当务之急。
与KRI初级保健系统发展相关的各种举措和政策方法的趋同、相互作用及成果复杂且高度不确定。需要一个关于初级保健的共同愿景来协调资源、举措和政策，并使参与发展和人道主义应对的所有地方和国际行为体之间产生协同效应。进一步的研究若能整合本文所综合的知识，并使KRI的行为体能够从自身经验和努力以及其他司法管辖区的经验中学习，将对初级保健的持续发展具有巨大价值。
