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首页> 美国卫生研究院文献>Journal of Health Population and Nutrition >Can Social Inclusion Policies Reduce Health Inequalities in Sub-Saharan Africa?—A Rapid Policy Appraisal
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Can Social Inclusion Policies Reduce Health Inequalities in Sub-Saharan Africa?—A Rapid Policy Appraisal

机译：社会融合政策能否减少撒哈拉以南非洲的健康不平等现象？-一项快速的政策评估

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The global resurgence of interest in the social determinants of health provides an opportunity for determined action on unacceptable and unjust health inequalities that exist within and between countries. This paper reviews three categories of social inclusion policies: cash-transfers; free social services; and specific institutional arrangements for programme integration in six selected countries—Botswana, Mozambique, South Africa, Ethiopia, Nigeria, and Zimbabwe. The policies were appraised as part of the Social Exclusion Knowledge Network (SEKN) set up under the auspices of the World Health Organization's Commission on Social Determinants of Health. The paper highlights the development landscape in sub-Saharan Africa and presents available indicators of the scale of inequity in the six countries. A summary of the policies appraised is presented, including whether or what the impact of these policies has been on health inequalities. Cross-cutting benefits include poverty alleviation, notably among vulnerable children and youths, improved economic opportunities for disadvantaged households, reduction in access barriers to social services, and improved nutrition intake. The impact of these benefits, and hence the policies, on health status can only be inferred. Among the policies reviewed, weaknesses or constraints were in design and implementation. The policy design weaknesses include targeting criteria, their enforcement and latent costs, inadequate parti-cipation of the community and failure to take the cultural context into account. A major weakness of most policies was the lack of a monitoring and evaluation system, with clear indicators that incorporate system responsiveness. The policy implementation weaknesses include uneven regional implementation with rural areas worst affected; inadequate or poor administrative and implementation capacity; insufficient resources; problems of fraud and corruption; and lack of involvement of civil servants, exacerbating implementation capacity problems. The key messages to sub-Saharan African governments include: health inequalities must be measured; social policies must be carefully designed and effectively implemented addressing the constraints identified; monitoring and evaluation systems need improvement; and participation of the community needs to be encouraged through conducive and enabling environments. There is a need for a strong movement by civil society to address health inequalities and to hold governments accountable for improved health and reduced health inequalities.
机译：对健康的社会决定因素的全球兴趣的重新兴起为针对国家内部和国家之间存在的不可接受和不公正的健康不平等问题采取坚决行动提供了机会。本文回顾了三类社会融合政策：现金转移支付；免费的社会服务；六个特定国家（博茨瓦纳，莫桑比克，南非，埃塞俄比亚，尼日利亚和津巴布韦）的计划整合的具体体制安排。这些政策是在世界卫生组织健康问题社会决定因素委员会主持下建立的社会排斥知识网络（SEKN）的一部分进行评估的。本文重点介绍了撒哈拉以南非洲的发展前景，并提出了六个国家不平等规模的可用指标。介绍了所评估政策的摘要，包括这些政策对健康不平等的影响或影响。跨部门利益包括减轻贫困，特别是在弱势儿童和青年中的贫困，为处境不利的家庭增加经济机会，减少获得社会服务的障碍，以及增加营养摄入。这些益处以及由此产生的政策对健康状况的影响只能推断出来。在所审查的政策中，设计和实施存在弱点或制约因素。政策设计的弱点包括目标标准，其执行和潜在成本，对社区的参与不足以及未能考虑到文化背景。大多数政策的主要缺点是缺乏监控和评估系统，缺乏包含系统响应能力的明确指标。政策执行方面的弱点包括区域执行不平衡，农村地区受影响最严重；行政和执行能力不足或差强人意；资源不足；欺诈和腐败问题；以及公务员缺乏参与，加剧了执行能力问题。给撒哈拉以南非洲国家政府的主要信息包括：必须衡量健康不平等；必须精心设计和有效执行社会政策，以解决所发现的制约因素；监测和评估系统需要改进；需要通过有利和有利的环境来鼓励社区的参与。民间社会需要采取积极行动解决健康不平等问题，并使政府对改善健康和减少健康不平等负有责任。

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