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首页> 外文期刊>BMC Health Services Research >Systems thinking in practice: the current status of the six WHO building blocks for health system strengthening in three BHOMA intervention districts of Zambia: a baseline qualitative study
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Systems thinking in practice: the current status of the six WHO building blocks for health system strengthening in three BHOMA intervention districts of Zambia: a baseline qualitative study

机译：实践中的系统思考：赞比亚三个BHOMA干预区中加强卫生系统的六个WHO组成部分的当前状况：基线定性研究

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Background The primary bottleneck to achieving the MDGs in low-income countries is health systems that are too fragile to deliver the volume and quality of services to those in need. Strong and effective health systems are increasingly considered a prerequisite to reducing the disease burden and to achieving the health MDGs. Zambia is one of the countries that are lagging behind in achieving millennium development targets. Several barriers have been identified as hindering the progress towards health related millennium development goals. Designing an intervention that addresses these barriers was crucial and so the Better Health Outcomes through Mentorship (BHOMA) project was designed to address the challenges in the Zambia’s MOH using a system wide approach. We applied systems thinking approach to describe the baseline status of the Six WHO building blocks for health system strengthening. Methods A qualitative study was conducted looking at the status of the Six WHO building blocks for health systems strengthening in three BHOMA districts. We conducted Focus group discussions with community members and In-depth Interviews with key informants. Data was analyzed using Nvivo version 9. Results The study showed that building block specific weaknesses had cross cutting effect in other health system building blocks which is an essential element of systems thinking. Challenges noted in service delivery were linked to human resources, medical supplies, information flow, governance and finance building blocks either directly or indirectly. Several barriers were identified as hindering access to health services by the local communities. These included supply side barriers: Shortage of qualified health workers, bad staff attitude, poor relationships between community and health staff, long waiting time, confidentiality and the gender of health workers. Demand side barriers: Long distance to health facility, cost of transport and cultural practices. Participating communities seemed to lack the capacity to hold health workers accountable for the drugs and services. Conclusion The study has shown that building block specific weaknesses had cross cutting effect in other health system building blocks. These linkages emphasised the need to use system wide approaches in assessing the performance of health system strengthening interventions.
机译：背景信息在低收入国家中实现千年发展目标的主要瓶颈是卫生系统，该系统过于脆弱，无法为有需要的人提供大量和优质的服务。强大和有效的卫生系统越来越被认为是减轻疾病负担和实现卫生千年发展目标的先决条件。赞比亚是在实现千年发展目标方面落后的国家之一。已经确定了一些障碍，阻碍了与卫生有关的千年发展目标的实现。设计解决这些障碍的干预措施至关重要，因此，旨在通过全系统方法解决“通过指导改善健康”（BHOMA）项目来应对赞比亚卫生部的挑战。我们采用系统思维方法来描述世卫组织加强卫生系统的六个基本要素的基线状态。方法进行了定性研究，研究了三个BHOMA地区加强卫生系统的六个WHO组成部分的状况。我们与社区成员进行了焦点小组讨论，并与关键线人进行了深入访谈。使用Nvivo版本9对数据进行了分析。结果研究表明，构建基块的特定弱点在其他卫生系统构建基块中具有交叉影响，这是系统思考的基本要素。服务提供中提到的挑战直接或间接地与人力资源，医疗用品，信息流，治理和财务基础模块相关。确定了一些障碍，阻碍了当地社区获得卫生服务。其中包括供应方面的障碍：合格医务人员短缺，工作人员态度恶劣，社区与医务人员之间的关系不良，等待时间长，机密性和医务人员的性别。需求方面的障碍：距离医疗机构的距离，运输成本和文化习俗。参与社区似乎缺乏使医务人员对毒品和服务负责的能力。结论研究表明，构建基块的特定弱点在其他卫生系统构建基块中具有交叉作用。这些联系强调必须使用全系统方法来评估加强卫生系统干预措施的绩效。

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