Research for Health System Strengthening in Northern Syria (R4HSSS), Union for Medical and Relief Organizations, Incili Pinar MAH, 27090, Gaziantep, Turkey.
Strategic Research Center (ÖZ SRC), Gaziantep, Turkey.
Health Res Policy Syst. 2023 Aug 30;21(1):88. doi: 10.1186/s12961-023-01042-1.
Since the withdrawal of government forces from Northwest Syria due to the conflict, several national initiatives have aimed to create alternative governance approaches to replace the central governmental system. One of the recent initiatives was the formulation of so-called 'Central Bodies' as institutional governance structures responsible for thematic planning and service provision; for example, the referral unit is responsible for planning and delivering medical referral services. However, the governance and administrative rules of procedures of these bodies could be immature or unsystematic. Assessing the governance of this approach cannot be condoned, especially with the urgent need for a methodical approach to strategic planning, achieving strategic humanitarian objectives, and efficiently utilizing available resources. Multiple governance assessment frameworks have been developed. However, none were created to be applied in protracted humanitarian settings. This research aims to assess the extent to which the existing health governance structure (central bodies) was capable of performing the governance functions in the absence of a legitimate government in Northwest Syria.
A governance assessment framework was adopted after an extensive literature review and group discussions. Four principles for the governance assessment framework were identified; legitimacy, accountability and transparency, effectiveness and efficiency, and strategic vision. Focus Group Discussions were held to assess the levels of the selected principles on the governance thermometer scale. Qualitative and quantitative data were analyzed using NVivo 12 and SPSS 22 software programs, respectively.
The level of the four principles on the governance thermometer scale was between the lowest and middle quintiles; 'very poor or inactive' and 'fair and requires improvement', respectively. The results indicate that the governance approach of Central Bodies in NWS is underdeveloped and summons comprehensive systematic development. The poor internal mechanisms, poor planning and coordination, and the absence of strategic vision were among the most frequent challenges to developing the approach.
Humanitarian actors and donors should pay more attention to health governance approaches and tools in protracted crises. The central bodies must improve coordination with the stakeholders and, most importantly, strategic planning. Establishing or utilizing an independent planning committee, with financial and administrative independence, is crucial to maintain and improving contextual governance mechanisms in Northwest Syria.
由于政府部队因冲突撤出叙利亚西北部，因此出现了一些旨在寻找替代中央政府系统的治理方法的国家倡议。最近的一项倡议是制定所谓的“中央机构”，作为负责专题规划和提供服务的机构治理结构；例如，转诊股负责规划和提供医疗转诊服务。然而，这些机构的治理和行政程序规则可能不成熟或不系统。评估这种方法的治理情况是不能被原谅的，尤其是在需要有系统的方法来进行战略规划、实现战略人道主义目标和有效地利用现有资源的情况下。已经制定了多个治理评估框架，但没有一个是为在旷日持久的人道主义环境中应用而创建的。本研究旨在评估在叙利亚西北部缺乏合法政府的情况下，现有的卫生治理结构（中央机构）在履行治理职能方面的能力。
在广泛的文献回顾和小组讨论后，采用了治理评估框架。确定了治理评估框架的四项原则；合法性、问责制和透明度、有效性和效率以及战略眼光。举行了焦点小组讨论，以评估所选原则在治理温度计量表上的水平。使用 NVivo 12 和 SPSS 22 软件程序分别对定性和定量数据进行分析。
四项原则在治理温度计量表上的水平介于最低和中间五分位之间；分别为“非常差或不活跃”和“公平且需要改进”。结果表明，中央机构在叙利亚西北部的治理方法还不成熟，需要全面系统的发展。内部机制薄弱、规划和协调不善以及缺乏战略眼光是发展该方法的最常见挑战之一。
人道主义行为体和捐助者应更加关注旷日持久危机中的卫生治理方法和工具。中央机构必须改善与利益攸关方的协调，最重要的是，要进行战略规划。建立或利用一个具有财务和行政独立性的独立规划委员会，对于维护和改善叙利亚西北部的背景治理机制至关重要。
