是什么让初级卫生保健能够抵御 COVID-19？尼日利亚的一项混合方法积极偏差研究。
What made primary health care resilient against COVID-19? A mixed-methods positive deviance study in Nigeria.
机构信息
The Global Financing Facility for Women, Children, and Adolescents, Washington, District of Columbia, USA
The Global Financing Facility for Women, Children, and Adolescents, Washington, District of Columbia, USA.
出版信息
BMJ Glob Health. 2023 Nov;8(11). doi: 10.1136/bmjgh-2023-012700.
INTRODUCTION
The SARS-CoV-2 (COVID-19) pandemic overwhelmed some primary health care (PHC) systems, while others adapted and recovered. In Nigeria, large, within-state variations existed in the ability to maintain PHC service volumes. Identifying characteristics of high-performing local government areas (LGAs) can improve understanding of subnational health systems resilience.
METHODS
Employing a sequential explanatory mixed-methods design, we quantitatively identified 'positive deviant' LGAs based on their speed of recovery of outpatient and antenatal care services to prepandemic levels using service volume data from Nigeria's health management information system and matched them to comparators with similar baseline characteristics and slower recoveries. 70 semistructured interviews were conducted with LGA officials, facility officers and community leaders in sampled LGAs to analyse comparisons based on Kruk's resilience framework.
RESULTS
A total of 57 LGAs were identified as positive deviants out of 490 eligible LGAs that experienced a temporary decrease in PHC-level outpatient and antenatal care service volumes. Positive deviants had an average of 8.6% higher outpatient service volume than expected, and comparators had 27.1% lower outpatient volume than expected after the initial disruption to services. Informants in 12 positive deviants described health systems that were more integrated, aware and self-regulating than comparator LGAs. Positive deviants were more likely to employ demand-side adaptations, whereas comparators primarily focused on supply-side adaptations. Barriers included long-standing financing and PHC workforce gaps.
CONCLUSION
Sufficient flexible financing, adequate PHC staffing and local leadership enabled health systems to recover service volumes during COVID-19. Resilient PHC requires simultaneous attention to bottom-up and top-down capabilities connected by strong leadership.
简介
SARS-CoV-2（COVID-19）大流行使一些初级卫生保健（PHC）系统不堪重负，而其他系统则适应并恢复。在尼日利亚，不同州内维持 PHC 服务量的能力存在很大差异。确定表现出色的地方政府区域（LGA）的特征可以提高对国家以下卫生系统弹性的理解。
方法
采用顺序解释性混合方法设计，我们根据服务量数据，从尼日利亚卫生管理信息系统中定量确定“正偏离”LGA，这些数据显示门诊和产前护理服务以恢复到大流行前水平的速度，使用门诊和产前护理服务量数据，并将其与具有相似基线特征和较慢恢复速度的对照物进行匹配。在抽样的 LGA 中，对 LGA 官员、设施官员和社区领导人进行了 70 次半结构化访谈，根据 Kruk 的弹性框架对比较进行分析。
结果
在经历了 PHC 级门诊和产前护理服务量暂时下降的 490 个符合条件的 LGA 中，共有 57 个 LGA 被确定为正偏离。正偏离的门诊服务量平均比预期高 8.6%，而对照的门诊服务量在服务中断后比预期低 27.1%。在 12 个正偏离的 LGA 中，信息提供者描述了比对照 LGA 更具整合性、意识性和自我监管性的卫生系统。正偏离更有可能采用需求方适应措施，而对照主要侧重于供应方适应措施。障碍包括长期存在的筹资和 PHC 劳动力差距。
结论
足够灵活的筹资、充足的 PHC 人员配备和地方领导使卫生系统能够在 COVID-19 期间恢复服务量。有弹性的 PHC 需要同时关注由强大领导能力连接的自下而上和自上而下的能力。
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