Hafner Tamara, Banda Marlon, Kohler Jillian, Babar Zaheer-Ud-Din, Lumpkin Murray, Adeyeye Mojisola Christianah, Nfor Emmanuel, Aboagye-Nyame Francis, Guzman Javier
USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, VA USA.
Churches Health Association of Zambia, Lusaka, Zambia.
J Pharm Policy Pract. 2020 Jun 25;13:38. doi: 10.1186/s40545-020-00242-2. eCollection 2020.
The response to emergency public health challenges such as HIV, TB, and malaria has been successful in mobilising resources and scaling up treatment for communicable diseases. However, many of the remaining challenges in improving access to and appropriate use of medicines and services require pharmaceutical systems strengthening. Incorporating pharmaceutical systems strengthening into global health programmes requires recognition of a few 'truths'. Systems strengthening is a lengthy and resource-intensive process that requires sustained engagement, which may not align with the short time frame for achieving targets in vertical-oriented programmes. Further, there is a lack of clarity on what key metrics associated with population and patient level outcomes should be tracked for systems strengthening interventions. This can hinder advocacy and communication with decision makers regarding health systems investments. Moving forward, it is important to find ways to balance the inherent tensions between the short-term focus on the efficiency of vertical programmes and broader, longer-term health and development objectives. Global health programme design should also shift away from a narrow view of medicines primarily as an input commodity to a more comprehensive view that recognizes the various structures and processes and their interactions within the broader health system that help ensure access to and appropriate use of medicines and related services.
应对诸如艾滋病毒、结核病和疟疾等突发公共卫生挑战在调动资源和扩大传染病治疗方面取得了成功。然而，在改善药品和服务的获取及合理使用方面，许多剩余挑战需要加强制药系统。将加强制药系统纳入全球卫生计划需要认识到一些“事实”。加强系统是一个漫长且资源密集的过程，需要持续参与，这可能与垂直导向计划中实现目标的短时间框架不一致。此外，对于加强系统干预措施应跟踪哪些与人群和患者层面结果相关的关键指标，目前尚不清楚。这可能会阻碍就卫生系统投资与决策者进行宣传和沟通。展望未来，找到平衡短期关注垂直计划效率与更广泛、更长期的健康和发展目标之间内在紧张关系的方法很重要。全球卫生计划设计也应从主要将药品视为一种投入商品的狭隘观点，转向更全面的观点，即认识到更广泛卫生系统内有助于确保药品及相关服务的获取和合理使用的各种结构、流程及其相互作用。
