Ernesto Báscolo, Natalia Houghton, Amalia Del Riego, James Fitzgerald, and Rachel Jarboe are with the Pan American Health Organization/World Health Organization, Washington, DC. Note. Authors hold sole responsibility for the views expressed in the article, which may not necessarily reflect the opinion or policy of the Revista Panamericana de Salud Pública/Pan American Journal of Public Health or the Pan American Health Organization.
Am J Public Health. 2022 Aug;112(S6):S615-S620. doi: 10.2105/AJPH.2022.306750.
This article uses a health stewardship perspective to interpret the strengths of and challenges to national health authorities' capacities to respond to the COVID-19 pandemic through the renewed essential public health functions (EPHF) framework. Based on a literature review, this article argues that the institutional capacities required by countries to respond to the COVID-19 pandemic in the Americas included all 4 stages of the new EPHF policy cycle: assessment, policy development, allocation of resources, and access. While health authorities provided these key functions (e.g., data analysis, intersectoral policy dialogues, allocation of additional funds), the interventions implemented depended on each country's own institutional structures. Health authorities faced significant challenges including fragmentation and the lack of institutional and personnel capacities, thus compromising the delivery of an effective and equitable response. In addition, the response to the pandemic has been uneven because of weaknesses in central leadership and coordination capacity, the politicization of the response, and differences in the capacity to respond at subnational levels. Such challenges reflect structural weaknesses that existed before the onset of the pandemic, as well as the low prioritization of public health in agendas for health systems strengthening. A future agenda should prioritize improving structural elements while strengthening the stewardship capacities of health authorities and developing institutional structures that guarantee access to and universal coverage of health services. (. 2022;112(S6):S615-S620. https://doi.org/10.2105/AJPH.2022.306750).
本文从卫生保健管理视角出发，通过重新审视基本公共卫生职能框架，解释了各国卫生当局应对 COVID-19 大流行的能力优势和挑战。基于文献回顾，本文认为，各国应对美洲 COVID-19 大流行所需的体制能力包括新的 EPHF 政策周期的所有 4 个阶段：评估、政策制定、资源分配和获取。尽管卫生当局提供了这些关键职能（如数据分析、部门间政策对话、额外资金分配），但实施的干预措施取决于每个国家自身的体制结构。卫生当局面临着重大挑战，包括碎片化以及体制和人员能力的缺乏，从而影响了有效和公平应对措施的实施。此外，由于中央领导和协调能力薄弱、应对措施政治化以及国家以下各级应对能力的差异，大流行应对措施参差不齐。这些挑战反映了大流行前存在的结构性弱点，以及卫生系统强化议程中对公共卫生的重视程度较低。未来的议程应优先考虑改善结构性要素，同时加强卫生当局的管理能力，并建立机构结构，以保障卫生服务的获取和普及。（2022；112（S6）：S615-S620. https://doi.org/10.2105/AJPH.2022.306750）。
