McDarby Geraldine, Reynolds Lindy, Zibwowa Zandile, Syed Shams, Kelley Ed, Saikat Sohel
Integrated Health Services, World Health Organization, Geneva, Switzerland.
BMJ Glob Health. 2019 Jul 29;4(4):e001687. doi: 10.1136/bmjgh-2019-001687. eCollection 2019.
Simulation Exercises (SimEx) are an established tool in defence and allied security sectors, applied extensively in health security initiatives under national or international legislative requirements, particularly the International Health Regulations (2005). There is, however, a paucity of information on SimEx application to test the functionality of health systems alongside emergency preparedness, response and recovery. Given the important implications health services resilience has for the protection and improvement of human life, this scoping review was undertaken to determine how the publicly available body of existing global SimEx materials considers health systems, together with health security functions in the event of disruptive emergencies. The global review identified 668 articles from literature and 73 products from institutional sources. Relevant screening identified 51 materials suitable to examine from a health system lens using the six health system building blocks as per the WHO Health System Framework. Eight materials were identified for further examination of their ability to test health system functionality from a resilience perspective. SimEx are an effective approach used extensively within health security and emergency response sectors but is not yet adequately used to test health system resilience. Currently available SimEx materials lack an integrated health system perspective and have a limited focus on the quality of services delivered within the context of response to a public health emergency. The materials do not focus on the ability of systems to effectively maintain core services during response. Without adjustment of the scope and focus, currently available SimEx materials do not have the capacity to test health systems to support the development of resilient health systems. Dedicated SimEx materials are urgently needed to fill this gap and harness their potential as an operational tool to contribute to improvements in health systems. They can act as effective global goods to allow testing of different functional aspects of health systems and service delivery alongside emergency preparedness and response. The work was conducted within the scope of the Tackling Deadly Diseases in Africa Programme, funded by the UK Department for International Development, which seeks to strengthen collaboration between the health system and health security clusters to promote health security and build resilient health systems.
模拟演练（SimEx）是国防及相关安全领域的一种既定工具，在国家或国际立法要求下，尤其是《国际卫生条例（2005）》的卫生安全倡议中得到广泛应用。然而，关于将模拟演练应用于测试卫生系统在应急准备、响应和恢复方面的功能的信息却很匮乏。鉴于卫生服务韧性对保护和改善人类生活具有重要意义，本次范围审查旨在确定现有的全球模拟演练公开资料如何看待卫生系统，以及在破坏性紧急情况下的卫生安全功能。全球审查从文献中识别出668篇文章，从机构来源识别出73种产品。相关筛选确定了51份适合从卫生系统角度进行审查的资料，这些资料按照世界卫生组织卫生系统框架使用六个卫生系统组成部分进行分析。确定了八份资料，以进一步考察它们从韧性角度测试卫生系统功能的能力。模拟演练是卫生安全和应急响应部门广泛使用的一种有效方法，但尚未充分用于测试卫生系统的韧性。目前可用的模拟演练资料缺乏综合的卫生系统视角，并且在应对突发公共卫生事件的背景下，对所提供服务质量的关注有限。这些资料没有关注系统在应对期间有效维持核心服务的能力。如果不调整范围和重点，目前可用的模拟演练资料就没有能力测试卫生系统，以支持建设有韧性的卫生系统。迫切需要专门的模拟演练资料来填补这一空白，并发挥其作为一种操作工具的潜力，以促进卫生系统的改善。它们可以作为有效的全球资源，用于测试卫生系统的不同功能方面以及服务提供情况，同时进行应急准备和响应。这项工作是在由英国国际发展部资助的“应对非洲致命疾病计划”范围内开展的，该计划旨在加强卫生系统和卫生安全集群之间的合作，以促进卫生安全并建设有韧性的卫生系统。
