School of Public Health, the University of Queensland, Brisbane, Australia.
Health Social Science and Development Research Institute, Kathmandu, Nepal.
PLoS One. 2023 Aug 10;18(8):e0289816. doi: 10.1371/journal.pone.0289816. eCollection 2023.
Multisectoral actions (MSAs) on health are key to implementation of primary health care (PHC) and achieving the targets of the Sustainable Development Goal 3. However, there is limited understanding and interpretation of how MSAs on health articulate and mediate health outcomes. This realist review explored how MSAs influence on implementing PHC towards universal health coverage (UHC) in the context of multilevel health systems.
We reviewed published evidence that reported the MSAs, PHC and UHC. The keywords used in the search strategy were built on these three key concepts. We employed Pawson and Tilley's realist review approach to synthesize data following Realist and Meta-narrative Evidence Syntheses: Evolving Standards publication standards for realist synthesis. We explained findings using a multilevel lens: MSAs at the strategic level (macro-level), coordination and partnerships at the operational level (meso-level) and MSAs employing to modify behaviours and provide services at the local level (micro-level).
A total of 40 studies were included in the final review. The analysis identified six themes of MSAs contributing to the implementation of PHC towards UHC. At the macro-level, themes included influence on the policy rules and regulations for governance, and health in all policies for collaborative decision makings. The meso-level themes were spillover effects of the non-health sector, and the role of community health organizations on health. Finally, the micro-level themes were community engagement for health services/activities of health promotion and addressing individuals' social determinants of health.
Multisectoral actions enable policy and actions of other sectors in health involving multiple stakeholders and processes. Multisectoral actions at the macro-level provide strategic policy directions; and operationalise non-health sector policies to mitigate their spillover effects on health at the meso-level. At micro-level, MSAs support service provision and utilisation, and lifestyle and behaviour modification of people leading to equity and universality of health outcomes. Proper functional institutional mechanisms are warranted at all levels of health systems to implement MSAs on health.
卫生领域的多部门行动是实施初级卫生保健和实现可持续发展目标 3 目标的关键。然而，对于卫生领域的多部门行动如何表达和调节卫生结果，人们的理解和解释有限。本真实主义综述探讨了在多层次卫生系统背景下，卫生领域的多部门行动如何影响实现全民健康覆盖的初级卫生保健。
我们综述了报告多部门行动、初级卫生保健和全民健康覆盖的已发表证据。搜索策略中使用的关键词建立在这三个关键概念的基础上。我们采用 Pawson 和 Tilley 的真实主义综述方法，根据真实主义和元叙述证据综合：为真实主义综合制定的演进标准，对数据进行综合。我们使用多层次视角来解释发现：战略层面（宏观层面）的多部门行动、协调和伙伴关系层面（中观层面）的运营以及旨在改变行为和提供服务的地方层面（微观层面）的多部门行动。
最终综述共纳入 40 项研究。分析确定了促进实现全民健康覆盖的初级卫生保健的六项多部门行动主题。在宏观层面，主题包括影响治理的政策规则和法规，以及所有政策中促进合作决策的健康。中观层面的主题是其他非卫生部门的溢出效应，以及社区卫生组织在卫生方面的作用。最后，微观层面的主题是社区参与健康服务/促进健康活动和解决个人健康的社会决定因素。
多部门行动使其他部门参与卫生的政策和行动成为可能，涉及多个利益相关者和过程。宏观层面的多部门行动提供战略政策方向；并使非卫生部门的政策运作化，以减轻其对中观层面卫生的溢出效应。在微观层面，多部门行动支持服务的提供和利用，以及个人生活方式和行为的改变，从而实现健康结果的公平性和普遍性。需要在各级卫生系统建立适当的职能机构机制，以实施卫生领域的多部门行动。
