Stockton Deborah A, Fowler Cathrine, Debono Deborah, Travaglia Joanne
Centre for Health Services Management, Faculty of Health University of Technology Sydney Ultimo New South Wales Australia.
School of Nursing and Midwifery University of Technology Sydney Ultimo New South Wales Australia.
Health Sci Rep. 2021 Mar 9;4(2):e254. doi: 10.1002/hsr2.254. eCollection 2021 Jun.
Developing and adapting health service models to effectively meet the needs of rural and remote communities is an international priority given inequities in health outcomes compared with metropolitan counterparts. This integrative review aims to inform rural and remote health service delivery systems by drawing on the WHO Framework building blocks to identify lessons learned from the literature describing experiences of rural and remote community health service planning and implementation; and inform recommendations to strengthen often disadvantaged rural and remote health systems for policy makers, health service managers, and those implementing international healthcare initiatives within these contexts.
The integrative review examined the literature reporting rural and remote community health service delivery published from 2007 to 2017 (the decade following the release of the WHO Framework). Using an analytic frame, a structured template was developed to extract data and categorized against the WHO building blocks, followed by a synthesis of the key findings.
This integrative review identified that WHO Framework building blocks such as "Service Delivery" and "Health Workforce" are commonly reflected in rural and remote community health service delivery literature in the decade since the Framework's release. However, others such as "Sustainable Funding and Social Protection" are less commonly reported in the literature despite these elements being identified by the WHO as being integral to successful, sustainable health service delivery systems.
We found that collaboration across the health system governance continuum from local to policy level is an essential enabler for rural and remote health service delivery. Community-based participatory action research provides an opportunity to learn from one another, build capacity, optimize service model suitability, and promotes cultural safety by demonstrating respect and inclusivity in decision-making. Policy makers and funders need to acknowledge the time and resources required to build trust and community coalitions to inform effective planning and implementation.
鉴于农村和偏远社区与大城市地区相比在健康结果方面存在不平等现象，开发和调整卫生服务模式以有效满足这些社区的需求已成为一项国际优先事项。本综合综述旨在通过借鉴世界卫生组织（WHO）的框架构建要素，为农村和偏远地区的卫生服务提供系统提供参考，以确定从描述农村和偏远社区卫生服务规划与实施经验的文献中吸取的教训；并为政策制定者、卫生服务管理者以及在这些背景下实施国际医疗保健倡议的人员提供建议，以加强往往处于劣势的农村和偏远卫生系统。
本综合综述研究了2007年至2017年（WHO框架发布后的十年）发表的关于农村和偏远社区卫生服务提供的文献。使用一个分析框架，开发了一个结构化模板来提取数据，并根据WHO的构建要素进行分类，随后对关键发现进行综合。
本综合综述发现，自框架发布后的十年里，农村和偏远社区卫生服务提供文献中普遍反映了WHO框架的构建要素，如“服务提供”和“卫生人力”。然而，其他要素，如“可持续筹资和社会保护”，尽管WHO认为这些要素是成功、可持续的卫生服务提供系统不可或缺的，但在文献中较少被提及。
我们发现，从地方到政策层面的整个卫生系统治理连续体之间的合作是农村和偏远地区卫生服务提供的关键推动因素。基于社区的参与式行动研究提供了一个相互学习、建设能力、优化服务模式适用性的机会，并通过在决策中表现出尊重和包容性来促进文化安全。政策制定者和资助者需要认识到建立信任和社区联盟以实现有效规划和实施所需的时间和资源。
