Martens Monika, Chham Savina, Črt Zavrnik, Danhieux Katrien, Wouters Edwin, Chhim Srean, Susič Antonija Poplas, Ketiš Zalika Klemenc, Ir Por, Remmen Roy, Klipstein-Grobusch Kerstin, Van Damme Wim, Ku Grace Marie, Van Olmen Josefien
Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Department of Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Belgium.
Int J Integr Care. 2024 Nov 12;24(4):8. doi: 10.5334/ijic.7650. eCollection 2024 Oct-Dec.
The '' (SCUBY) project provides evidence on scaling-up integrated care (IC) in Cambodia, Slovenia, and Belgium. This paper examines macro-level barriers and facilitators to scaling up IC in these settings.
We used a multi-case study design, with each country being a case. Document review, focus groups, and stakeholder interviews were conducted. The WHO health system building blocks guided the thematic analysis. We then visualised and examined the interlinkages between barriers in each country.
Common challenges to scaling up IC across the three health systems relate to: governance and leadership; health workforce; inadequate health financing system; and fragmented health information systems. In Cambodia, access to non-communicable disease (NCD) services and medicine are important issues. IC scale-up is facilitated by its strong governance and public health service model in Slovenia but health workforce shortages risk progress. In Belgium, the fragmented governance system and predominant fee-for-service provider payment are important barriers. A common response to health workforce and workload challenges was task shifting: to primary care nurses in Belgium, peer supporters in Slovenia, and community health workers in Cambodia.
Examining differences and similarities between barriers in each health system stimulated reciprocal learning. Interactions between health system barriers in specific contexts require further attention to move complex health systems forward.
“扩大社区参与以改善健康”（SCUBY）项目提供了关于柬埔寨、斯洛文尼亚和比利时扩大综合护理（IC）的证据。本文探讨了在这些背景下扩大综合护理的宏观层面障碍和促进因素。
我们采用多案例研究设计，每个国家为一个案例。进行了文献回顾、焦点小组讨论和利益相关者访谈。世界卫生组织的卫生系统构建模块指导了主题分析。然后，我们可视化并研究了每个国家障碍之间的相互联系。
在这三个卫生系统中扩大综合护理的共同挑战涉及：治理与领导；卫生人力；卫生筹资系统不足；以及卫生信息系统碎片化。在柬埔寨，获得非传染性疾病（NCD）服务和药品是重要问题。斯洛文尼亚强大的治理和公共卫生服务模式促进了综合护理的扩大，但卫生人力短缺可能危及进展。在比利时，分散的治理系统和主要的按服务收费提供者支付方式是重要障碍。对卫生人力和工作量挑战的一个共同应对措施是任务转移：在比利时转给初级护理护士，在斯洛文尼亚转给同伴支持者，在柬埔寨转给社区卫生工作者。
审视每个卫生系统中障碍的差异和相似之处促进了相互学习。特定背景下卫生系统障碍之间的相互作用需要进一步关注，以推动复杂的卫生系统向前发展。
