Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia.
Department of Epidemiology and Global Health, Umeå University, Umeå, Umeå, 901 87, Sweden.
BMC Health Serv Res. 2024 Aug 22;24(1):971. doi: 10.1186/s12913-024-11419-9.
Over the years, low-and middle-income countries have adopted several policy initiatives to strengthen community health systems as means to attain Universal Health Coverage (UHC). In this regard, Zambia passed a Community Health Strategy in 2017 that was later halted in 2019. This paper explores the processes that led to the halting and re-issuing of this strategy with the view of drawing lessons to inform the development of such strategies in Zambia and other similar settings.
We employed a qualitative case study comprising 20 semi-structured interviews with key stakeholders who had participated in either the development, halting, or re-issuing of the two strategies, respectively. These stakeholders represented the Ministry of Health, cooperating partners and other non-government organizations. Inductive thematic analysis approach was used for analysis.
The major reasons for halting and re-issuing the community health strategy included the need to realign it with the national development framework such as the 7th National Development Plan, lack of policy ownership, political influence, and the need to streamline the coordination of community health interventions. The policy process inadequately addressed the key tenets of community health systems such as complexity, adaptation, resilience and engagement of community actors resulting in shortcomings in the policy content. Furthermore, the short implementation period, lack of dedicated staff, and inadequate engagement of stakeholders from other sectors threatened the sustainability of the re-issued strategy.
This study underscores the complexity of community health systems and highlights the challenges these complexities pose to health policymaking efforts. Countries that embark on health policymaking for community health systems must reflect on issues such as persistent fragmentation, which threaten the policy development process. It is crucial to ensure that these complexities are considered within similar policy engagement processes.
多年来，中低收入国家采取了多项政策举措来加强社区卫生系统，以此实现全民健康覆盖（UHC）。在这方面，赞比亚于 2017 年通过了一项社区卫生战略，但后来在 2019 年停止。本文探讨了导致该战略停止和重新发布的过程，以期从中吸取教训，为赞比亚和其他类似环境制定此类战略提供信息。
我们采用了定性案例研究方法，包括对分别参与制定、停止或重新发布这两项战略的 20 名关键利益相关者进行的 20 次半结构化访谈。这些利益相关者代表卫生部、合作伙伴以及其他非政府组织。我们采用了归纳主题分析方法进行分析。
停止和重新发布社区卫生战略的主要原因包括需要使其与国家发展框架（如第 7 个国家发展计划）保持一致、缺乏政策自主权、政治影响以及需要精简社区卫生干预措施的协调。政策过程没有充分解决社区卫生系统的关键原则，如复杂性、适应性、弹性和社区行为者的参与，导致政策内容存在不足。此外，实施期限短、缺乏专门人员以及其他部门利益相关者参与不足，威胁到重新发布战略的可持续性。
本研究强调了社区卫生系统的复杂性，并突出了这些复杂性对卫生政策制定工作带来的挑战。那些为社区卫生系统制定卫生政策的国家必须反思诸如持续碎片化等问题，这些问题威胁到政策制定过程。至关重要的是，要确保在类似的政策参与过程中考虑到这些复杂性。
