Department of International Health, Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA.
International Development Division, Abt Associates Inc , Rockville , MD , USA.
Glob Public Health. 2019 Dec;14(12):1829-1846. doi: 10.1080/17441692.2019.1622758. Epub 2019 Jun 3.
Evidence on the implementation of health systems strengthening (HSS) interventions is scarce. Donors need this information to prioritise investments and lobby for continued financial support. To develop a deeper understanding of the implementation dynamics of robust HSS interventions, we retrospectively compared five USAID-supported projects in the Dominican Republic, Ethiopia, Kazakhstan, Rwanda, and Zambia. A document review and key informant interviews ( = 44) were conducted, coded, and analysed in each of the five cases using an integrated implementation framework. The framework was organised by four phases of implementation. For the pre-condition phase, data-driven HSS interventions were nested in a range of political contexts and with differing levels of financial support. In pre-implementation, cases relied on diverse teams that created a data-informed, inclusive, and transparent project ethos for implementation. Implementation was located at multiple tiers of the health system, used interventions as catalysts for government initiatives, supported governance/accountability initiatives, and responded nimbly to contextual changes in the implementation climate. There was less evidence of maintenance and evolution but all cases were designed with an eye towards sustainability. This research yields important insights about the dynamics of HSS, identifying ways donors can better support countries to achieve universal health coverage.
关于卫生系统强化（HSS）干预措施实施情况的证据很少。捐助者需要这些信息来确定投资重点，并游说继续提供财政支持。为了更深入地了解强有力的 HSS 干预措施的实施动态，我们对美国国际开发署（USAID）在多米尼加共和国、埃塞俄比亚、哈萨克斯坦、卢旺达和赞比亚支持的五个项目进行了回顾性比较。在每个案例中，我们都进行了文件审查和关键知情者访谈（ = 44），并使用综合实施框架对这些数据进行了编码和分析。该框架按实施的四个阶段进行组织。在预备阶段，数据驱动的 HSS 干预措施嵌套在一系列政治背景中，并具有不同程度的财政支持。在实施前阶段，案例依赖于各种团队，这些团队为实施创建了一个数据驱动、包容和透明的项目理念。实施位于卫生系统的多个层次，利用干预措施作为政府倡议的催化剂，支持治理/问责倡议，并对实施环境的变化做出灵活反应。维护和演变的证据较少，但所有案例的设计都着眼于可持续性。这项研究提供了有关 HSS 动态的重要见解，确定了捐助者可以更好地支持各国实现全民健康覆盖的方式。
