United Nations Children's Fund, Regional Office, Senegal.
Centre for Tropical Medicine and Global Health, University of Oxford, UK.
J Glob Health. 2021 Mar 10;11:07002. doi: 10.7189/jogh.11.07002.
Arising from the Ebola virus disease (EVD) outbreak, the 2015-2021 Investment Plan aimed to improve the health status of the Liberian population through building a resilient health system that contributes to achieving equitable health outcomes. Recognizing the significance of community participation in overcoming the EVD outbreak, strengthening community systems emerged as one of the most important strategies for bridging the gap in accessing primary health care (PHC) services. This study reviewed the community health policy development process in order to draw lessons from the health system strengthening efforts in Liberia post-EVD crisis.
A government-led health system analysis approach was applied to assess, review and revise the community health program in Liberia. The mixed method approach combines the use of an adapted tool to assess bottlenecks and solutions during workshops, a qualitative survey (key informant interviews and focus group discussions) to assess perceptions of challenges and perspectives from different stakeholders, and an inter-agency framework - a benchmarks matrix - to jointly review program implementation gaps using the evidence compiled, and identify priorities to scale up of the community program.
Stakeholders identified key health system challenges and proposed policy and programmatic shifts to institutionalize a standardized community health program with fit for purpose and incentivized community health assistants to provide PHC services to the targeted populations. The community health program in Liberia is currently at the phase of implementation and requires strengthened leadership, local capacities, and resources for sustainability. Lessons learned from this review included the importance of: establishing a coordination mechanism and leveraging partnership support; using a systems approach to better inform policy shifts; strengthening community engagement; and conducting evidence-based planning to inform policy-makers.
This article contributes toward the existing body of knowledge about policy development processes and reforms on community health in Liberia, and most likely other African settings with weak health systems. Community-based systems will play an even bigger role as we move toward building resilience for future shocks and strengthening PHC, which will require that communities be viewed as actors in the health system rather than just clients of health services.
埃博拉病毒病（EVD）疫情发生后，2015-2021 年投资计划旨在通过建立一个有弹性的卫生系统来改善利比里亚人民的健康状况，该系统有助于实现公平的健康结果。认识到社区参与克服埃博拉疫情的重要性，加强社区系统成为弥合初级卫生保健（PHC）服务获取差距的最重要战略之一。本研究审查了社区卫生政策制定过程，以便从埃博拉疫情后利比里亚卫生系统加强努力中吸取经验教训。
采用政府主导的卫生系统分析方法，评估、审查和修订利比里亚的社区卫生方案。混合方法结合了使用经改编的工具在研讨会上评估瓶颈和解决方案、进行定性调查（关键知情人访谈和焦点小组讨论）以评估不同利益攸关方的看法和观点、以及机构间框架——基准矩阵——共同使用所汇编的证据审查方案执行差距，并确定扩大社区方案的优先事项。
利益攸关方确定了关键的卫生系统挑战，并提出了政策和方案转变建议，将标准化的社区卫生方案制度化，并激励有针对性的社区卫生助理向目标人群提供 PHC 服务。利比里亚的社区卫生方案目前处于实施阶段，需要加强领导力、地方能力和资源，以实现可持续性。从这次审查中吸取的经验教训包括：建立协调机制和利用伙伴关系支持的重要性；使用系统方法更好地为政策转变提供信息；加强社区参与；以及进行循证规划，为决策者提供信息。
本文为利比里亚以及可能其他卫生系统薄弱的非洲国家的社区卫生政策制定过程和改革方面的现有知识体系做出了贡献。随着我们为未来的冲击建立弹性和加强 PHC，以社区为基础的系统将发挥更大的作用，这将要求将社区视为卫生系统的参与者，而不仅仅是卫生服务的客户。
