Vanderbilt Institute for Global Health, Vanderbilt University, 2525 West End Avenue, Nashville, TN, USA.
Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, USA.
Health Policy Plan. 2019 Feb 1;34(1):24-36. doi: 10.1093/heapol/czy105.
Despite numerous international and national efforts, only 12 countries in the World Health Organization's African Region met the Millennium Development Goal #4 (MDG#4) to reduce under-five mortality by two-thirds by 2015. Given the variability across sub-Saharan Africa, a four-country study was undertaken to examine barriers and facilitators of child survival prior to 2015. Liberia and Zambia were chosen to represent countries making substantial progress towards MDG#4, while Kenya and Zimbabwe represented countries making less progress. Our individual case studies suggested that strong health governance and leadership (HGL) was a significant driver of the greater success in Liberia and Zambia compared with Kenya and Zimbabwe. To elucidate specific components of national HGL that may have substantially influenced the pace of reductions in child mortality, we conducted a cross-country analysis of national policies and strategies pertaining to maternal, neonatal and child health (MNCH) and qualitative interviews with individuals working in MNCH in each of the four study countries. The three aspects of HGL identified in this study which most consistently contributed to the different progress towards MDG#4 among the four study countries were (1) establishing child survival as a top national priority backed by a comprehensive policy and strategy framework and sufficient human, financial and material resources; (2) bringing together donors, strategic partners, health and non-health stakeholders and beneficiaries to collaborate in strategic planning, decision-making, resource-allocation and coordination of services; and (3) maintaining accountability through a 'monitor-review-act' approach to improve MNCH. Although child mortality in sub-Saharan Africa remains high, this comparative study suggests key health leadership and governance factors that can facilitate reduction of child mortality and may prove useful in tackling current Sustainable Development Goals.
尽管国际和各国做出了众多努力，但在世界卫生组织非洲区域，仅有 12 个国家实现了千年发展目标 4（MDG#4），即在 2015 年之前将五岁以下儿童死亡率降低三分之二。鉴于撒哈拉以南非洲各国的情况各不相同，开展了一项四国研究，以调查 2015 年之前儿童生存的障碍和促进因素。选择利比里亚和赞比亚代表在实现 MDG#4 方面取得实质性进展的国家，而肯尼亚和津巴布韦则代表进展较少的国家。我们的个案研究表明，强有力的卫生治理和领导（HGL）是利比里亚和赞比亚相对于肯尼亚和津巴布韦取得更大成功的重要驱动因素。为了阐明可能对降低儿童死亡率的速度产生重大影响的国家 HGL 的具体组成部分，我们对与母婴、新生儿和儿童健康（MNCH）相关的国家政策和战略进行了跨国分析，并对四个研究国家中从事 MNCH 工作的个人进行了定性访谈。本研究确定的 HGL 的三个方面最一致地促进了四个研究国家在实现 MDG#4 方面的不同进展，分别是：（1）将儿童生存确立为国家首要任务，以全面的政策和战略框架以及充足的人力、财力和物质资源为后盾；（2）汇集捐助者、战略伙伴、卫生和非卫生利益攸关方以及受益者，共同参与战略规划、决策制定、资源分配和服务协调；（3）通过“监测-审查-行动”方法保持问责制，以改善母婴健康。尽管撒哈拉以南非洲的儿童死亡率仍然很高，但这项比较研究提出了促进儿童死亡率降低的关键卫生领导和治理因素，这可能对实现当前的可持续发展目标有所帮助。
