Iyer Hari S, Chukwuma Adanna, Mugunga Jean Claude, Manzi Anatole, Ndayizigiye Melino, Anand Sudhir
Doctoral candidate in the Department of Epidemiology at the Harvard T. H. Chan School of Public Health, Boston, MA, USA.
Young professional at the World Bank Group, Washington, DC, USA.
Health Hum Rights. 2018 Jun;20(1):199-211.
Strong primary health care systems are essential for implementing universal health coverage and fulfilling health rights entitlements, but disagreement exists over how best to create them. Comparing countries with similar histories, lifestyle practices, and geography but divergent health outcomes can yield insights into possible mechanisms for improvement. Rwanda and Burundi are two such countries. Both faced protracted periods of violence in the 1990s, leading to significant societal upheaval. In subsequent years, Rwanda's improvement in health has been far greater than Burundi's. To understand how this divergence occurred, we studied trends in life expectancy following the periods of instability in both countries, as well as the health policies implemented after these conflicts. We used the World Bank's World Development Indicators to assess trends in life expectancy in the two countries and then evaluated health policy reforms using Walt and Gilson's framework. Following both countries' implementation of health sector policies in 2005, we found a statistically significant increase in life expectancy in Rwanda after adjusting for GDP per capita (14.7 years, 95% CI: 11.4-18.0), relative to Burundi (4.6 years, 95% CI: 1.8-7.5). Strong public sector leadership, investments in health information systems, equity-driven policies, and the use of foreign aid to invest in local capacity helped Rwanda achieve greater health gains compared to Burundi.
强大的初级卫生保健系统对于实现全民健康覆盖和落实健康权利至关重要，但对于如何最好地创建这些系统存在分歧。比较历史、生活方式和地理条件相似但健康结果不同的国家，可以深入了解可能的改善机制。卢旺达和布隆迪就是这样两个国家。两国在20世纪90年代都经历了长期暴力，导致社会发生重大动荡。在随后的几年里，卢旺达的健康改善情况远远超过布隆迪。为了了解这种差异是如何产生的，我们研究了两国不稳定时期之后的预期寿命趋势，以及这些冲突后实施的卫生政策。我们使用世界银行的《世界发展指标》评估两国的预期寿命趋势，然后使用沃尔特和吉尔森的框架评估卫生政策改革。在两国于2005年实施卫生部门政策之后，我们发现，在调整人均国内生产总值后，卢旺达的预期寿命有统计学意义的显著增加（14.7岁，95%置信区间：11.4 - 18.0），而布隆迪为（4.6岁，95%置信区间：1.8 - 7.5）。与布隆迪相比，强大的公共部门领导力、对卫生信息系统的投资、公平驱动的政策以及利用外国援助投资当地能力，帮助卢旺达在健康方面取得了更大的成果。
