George Asha, LeFevre Amnesty Elizabeth, Jacobs Tanya, Kinney Mary, Buse Kent, Chopra Mickey, Daelmans Bernadette, Haakenstad Annie, Huicho Luis, Khosla Rajat, Rasanathan Kumanan, Sanders David, Singh Neha S, Tiffin Nicki, Ved Rajani, Zaidi Shehla Abbas, Schneider Helen
School of Public Health, University of the Western Cape, Cape Town, South Africa.
School of Public Health and Family Medicine, University of CapeTown, Cape Town, Maryland.
BMJ Glob Health. 2019 Jun 24;4(Suppl 4):e001316. doi: 10.1136/bmjgh-2018-001316. eCollection 2019.
Health systems are critical for health outcomes as they underpin intervention coverage and quality, promote users' rights and intervene on the social determinants of health. Governance is essential for health system endeavours as it mobilises and coordinates a multiplicity of actors and interests to realise common goals. The inherently social, political and contextualised nature of governance, and health systems more broadly, has implications for measurement, including how the health of women, children and adolescents health is viewed and assessed, and for whom. Three common lenses, each with their own views of power dynamics in policy and programme implementation, include a service delivery lens aimed at scaling effective interventions, a societal lens oriented to empowering people with rights to effect change and a systems lens concerned with creating enabling environments for adaptive learning. We illustrate the implications of each lens for the , and of measuring health system drivers across micro, meso and macro health systems levels, through three examples (digital health, maternal and perinatal death surveillance and review, and multisectoral action for adolescent health). Appreciating these underpinnings of measuring health systems and governance drivers of the health of women, children and adolescents is essential for a holistic learning and action agenda that engages a wider range of stakeholders, which includes, but also goes beyond, indicator-based measurement. Without a broadening of approaches to measurement and the types of research partnerships involved, continued investments in the health of women, children and adolescents will fall short.
卫生系统对健康结果至关重要，因为它们是干预覆盖范围和质量的基础，促进用户权利，并对健康的社会决定因素进行干预。治理对于卫生系统的努力至关重要，因为它调动和协调众多行为者和利益相关方以实现共同目标。治理以及更广泛意义上的卫生系统固有的社会、政治和情境化性质对衡量产生影响，包括如何看待和评估妇女、儿童和青少年的健康状况以及为谁进行评估。三个常见的视角，每个视角对政策和项目实施中的权力动态都有各自的看法，包括旨在扩大有效干预措施规模的服务提供视角、旨在赋予人们改变权利的社会视角以及关注为适应性学习创造有利环境的系统视角。我们通过三个例子（数字健康、孕产妇和围产期死亡监测与审查以及青少年健康的多部门行动）来说明每个视角对在微观、中观和宏观卫生系统层面衡量卫生系统驱动因素的 、 和 的影响。认识到这些衡量卫生系统以及妇女、儿童和青少年健康的治理驱动因素的基础，对于一个让更广泛利益相关方参与的全面学习和行动议程至关重要，这一议程包括但不限于基于指标的衡量。如果不拓宽衡量方法以及所涉及的研究伙伴关系类型，对妇女、儿童和青少年健康的持续投资将无法达到预期效果。
