Ozano Kim, Dean Laura, Adekeye Oluwatosin, Bettee Anthony K, Dixon Ruth, Gideon Ntuen Uduak, Gwani Noela, Isiyaku Sunday, Kollie Karsor, Lar Luret, Oluwole Akinola, Piotrowski Helen, Siakeh Alice, Thomson Rachael, Yashiyi James, Zawolo Georgina, Theobald Sally
Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L35QA, UK.
Sightsavers, Nigeria Country Office, Golf Course Road, City Centre, Kaduna, Nigeria.
Health Policy Plan. 2020 Nov 1;35(Supplement_2):ii137-ii149. doi: 10.1093/heapol/czaa123.
Global health gains can be achieved through strengthening health systems to identify and address implementation challenges in low- and middle-income countries. Participatory research, that promotes joint problem and solution finding between communities and different health systems actors, supports policy implementation analysis at all levels. Within the neglected tropical disease programmes in Liberia and Nigeria, we applied participatory action research (PAR) to address programmatic and health system bottlenecks with health systems strengthening embedded. This paper shares learning from 20 interviews with co-researchers, from national and sub-national levels and academic researchers who worked collaboratively to understand challenges, co-create solutions and advocate for policy change. Through analysis and reflections of existing PAR principles, we inductively identified five additional guiding principles for quality, ethical standards and ongoing learning within PAR projects that aim to strengthen health systems. (1) Recognize communities as units of identity and define stakeholder participation to ensure equitable engagement of all actors; (2) enable flexible action planning that builds on existing structures whilst providing opportunities for embedding change; (3) address health systems and research power differentials that can impede co-production of knowledge and solution development; (4) embed relational practices that lead to new political forms of participation and inquiry within health systems and (5) develop structures for ongoing learning at multiple levels of the health system. PAR can strengthen health systems by connecting and co-creating potentially sustainable solutions to implementation challenges. Additional research to explore how these five additional principles can support the attainment of quality and ethical standards within implementation research using a PAR framework for health systems strengthening is needed.
通过加强卫生系统以识别和应对低收入和中等收入国家的实施挑战，可以实现全球卫生收益。参与式研究促进社区与不同卫生系统行为者共同发现问题和解决方案，支持各级政策实施分析。在利比里亚和尼日利亚的被忽视热带病项目中，我们应用参与式行动研究（PAR）来解决项目和卫生系统瓶颈问题，并加强卫生系统建设。本文分享了对20位共同研究者的访谈所得，这些研究者来自国家和国家以下层面以及学术领域，他们共同努力以了解挑战、共同创造解决方案并倡导政策变革。通过对现有PAR原则的分析和反思，我们归纳出了PAR项目中旨在加强卫生系统的质量、道德标准和持续学习的另外五条指导原则。（1）将社区视为身份认同单位，并界定利益相关者的参与，以确保所有行为者公平参与；（2）制定灵活的行动计划，在现有结构的基础上进行构建，同时提供嵌入变革的机会；（3）解决可能阻碍知识共同生产和解决方案开发的卫生系统与研究权力差异；（4）在卫生系统中嵌入能够带来新的政治参与形式和探究形式的关系实践；（5）建立卫生系统多层次持续学习的结构。PAR可以通过连接和共同创造针对实施挑战的潜在可持续解决方案来加强卫生系统。需要开展更多研究，以探索这另外五条原则如何支持在使用PAR框架加强卫生系统的实施研究中实现质量和道德标准。
