Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
Lancet. 2022 May 7;399(10337):1830-1844. doi: 10.1016/S0140-6736(21)02532-0. Epub 2022 Apr 27.
Despite health gains over the past 30 years, children and adolescents are not reaching their health potential in many low-income and middle-income countries (LMICs). In addition to health systems, social systems, such as schools, communities, families, and digital platforms, can be used to promote health. We did a targeted literature review of how well health and social systems are meeting the needs of children in LMICs using the framework of The Lancet Global Health Commission on high-quality health systems and we reviewed evidence for structural reforms in health and social sectors. We found that quality of services for children is substandard across both health and social systems. Health systems have deficits in care competence (eg, diagnosis and management), system competence (eg, timeliness, continuity, and referral), user experience (eg, respect and usability), service provision for common and serious conditions (eg, cancer, trauma, and mental health), and service offerings for adolescents. Education and social services for child health are limited by low funding and poor coordination with other sectors. Structural reforms are more likely to improve service quality substantially and at scale than are micro-level efforts. Promising approaches include governing for quality (eg, leadership, expert management, and learning systems), redesigning service delivery to maximise outcomes, and empowering families to better care for children and to demand quality care from health and social systems. Additional research is needed on health needs across the life course, health system performance for children and families, and large-scale evaluation of promising health and social programmes.
尽管过去 30 年来取得了健康方面的进展，但在许多低收入和中等收入国家（LMICs），儿童和青少年的健康并未达到最佳状态。除了卫生系统外，学校、社区、家庭和数字平台等社会系统也可用于促进健康。我们使用《柳叶刀全球卫生委员会关于高质量卫生系统的框架》，针对卫生和社会系统在满足 LMIC 儿童需求方面的表现进行了目标明确的文献综述，并审查了卫生和社会部门结构改革的证据。我们发现，卫生和社会系统为儿童提供的服务质量都不达标。卫生系统在护理能力（如诊断和管理）、系统能力（如及时性、连续性和转诊）、用户体验（如尊重和可用性）、常见和严重疾病（如癌症、创伤和心理健康）的服务提供以及青少年服务方面存在缺陷。儿童健康的教育和社会服务受到资金不足和与其他部门协调不善的限制。结构改革比微观层面的努力更有可能大幅提高服务质量和规模。有前途的方法包括为质量治理（如领导力、专业管理和学习系统）、重新设计服务交付以最大限度地提高成果，以及增强家庭能力，以便更好地照顾儿童，并向卫生和社会系统要求提供优质护理。需要进一步研究整个生命过程中的健康需求、儿童和家庭的卫生系统绩效，以及对有前途的卫生和社会方案的大规模评估。
