Abstract：
BACKGROUND: Public health sector service delivery challenges leading to poor population health outcomes have been observed in the Free State province of South Africa for the past decade. A multi-method situation appraisal of the different functional domains revealed serious health system deficiencies and operational defects, notably fragmentation of healthcare programmes and frontline services, as well as challenges related to governance, accountability and human resources for health. It was therefore necessary to develop a system-wide intervention to comprehensively address defects in the operation of the public health system and its major components.
METHODS: This study describes the development of the \'Health Systems Governance & Accountability\' (HSGA) intervention model by the Free State Department of Health (FSDoH) in collaboration with the community and other stakeholders following a participatory action approach. Documented information collected during routine management processes were reviewed for this paper. Starting in March 2013, the development of the HSGA intervention model and the concomitant application of Kaplan and Norton\'s (1992) Balanced Scorecard performance measurement tool was informed by the World Health Organization\'s (2007) conceptual framework for health system strengthening and reform comprised of six health system \'building blocks.\' The multiple and overlapping processes and actions to develop the intervention are described according to the four steps in Kaplan et al.\'s (2013) systems approach to health systems strengthening: (i) problem identification, (ii) description, (iii) alteration and (iv) implementation.
RESULTS: The finalisation of the HSGA intervention model before end-2013 was a prelude to the development of the FSDoH\'s Strategic Transformation Plan 2015-2030. The HSGA intervention model was used as a tool to implement and integrate the Plan\'s programmes moving forward with a consistent focus on the six building blocks for health systems strengthening and the all-important linkages between them.
CONCLUSIONS: The model was developed to address fragmentation and improve public health service delivery by the provincial health department. In January 2016, the intervention model became an official departmental policy, meaning that it was approved for implementation, compliance, monitoring and reporting, and became the guiding framework for health systems strengthening and transform in the Free State.
METHODS: This study describes the development of the \'Health Systems Governance & Accountability\' (HSGA) intervention model by the Free State Department of Health (FSDoH) in collaboration with the community and other stakeholders following a participatory action approach. Documented information collected during routine management processes were reviewed for this paper. Starting in March 2013, the development of the HSGA intervention model and the concomitant application of Kaplan and Norton\'s (1992) Balanced Scorecard performance measurement tool was informed by the World Health Organization\'s (2007) conceptual framework for health system strengthening and reform comprised of six health system \'building blocks.\' The multiple and overlapping processes and actions to develop the intervention are described according to the four steps in Kaplan et al.\'s (2013) systems approach to health systems strengthening: (i) problem identification, (ii) description, (iii) alteration and (iv) implementation.
RESULTS: The finalisation of the HSGA intervention model before end-2013 was a prelude to the development of the FSDoH\'s Strategic Transformation Plan 2015-2030. The HSGA intervention model was used as a tool to implement and integrate the Plan\'s programmes moving forward with a consistent focus on the six building blocks for health systems strengthening and the all-important linkages between them.
CONCLUSIONS: The model was developed to address fragmentation and improve public health service delivery by the provincial health department. In January 2016, the intervention model became an official departmental policy, meaning that it was approved for implementation, compliance, monitoring and reporting, and became the guiding framework for health systems strengthening and transform in the Free State.
摘要：
背景：在过去的十年中，南非自由州的公共卫生部门服务提供挑战导致了不良的人口健康结果。对不同功能领域的多方法情况评估揭示了严重的卫生系统缺陷和操作缺陷，特别是医疗保健计划和一线服务的分散，以及与治理有关的挑战，问责制和卫生人力资源。因此，有必要制定全系统干预措施，以全面解决公共卫生系统及其主要组成部分运作中的缺陷。
方法：本研究描述了自由州卫生部（FSDoH）与社区和其他利益相关者合作，按照参与性行动方法开发的“卫生系统治理与问责制”（HSGA）干预模型。本文回顾了在常规管理过程中收集的文档信息。从2013年3月开始，HSGA干预模型的开发以及Kaplan和Norton（1992）的平衡计分卡绩效测量工具的同时应用是由世界卫生组织（2007）的卫生系统概念框架加强和改革组成的六个卫生系统模块。根据Kaplan等人的四个步骤，描述了制定干预措施的多重和重叠过程和行动。(2013)加强卫生系统的系统方法：(I)问题识别，(ii)说明，（三）变更和（四）实施。
结果：在2013年底之前完成HSGA干预模型是制定FSDoH《2015-2030年战略转型计划》的前奏。HSGA干预模式被用作实施和整合该计划的方案的工具，这些方案始终侧重于加强卫生系统的六个组成部分以及它们之间至关重要的联系。
结论：该模型是由省级卫生部门开发的，旨在解决碎片化问题并改善公共卫生服务的提供。2016年1月，干预模式成为正式的部门政策，这意味着它被批准实施，合规,监测和报告，并成为自由州加强和改造卫生系统的指导框架。
方法：本研究描述了自由州卫生部（FSDoH）与社区和其他利益相关者合作，按照参与性行动方法开发的“卫生系统治理与问责制”（HSGA）干预模型。本文回顾了在常规管理过程中收集的文档信息。从2013年3月开始，HSGA干预模型的开发以及Kaplan和Norton（1992）的平衡计分卡绩效测量工具的同时应用是由世界卫生组织（2007）的卫生系统概念框架加强和改革组成的六个卫生系统模块。根据Kaplan等人的四个步骤，描述了制定干预措施的多重和重叠过程和行动。(2013)加强卫生系统的系统方法：(I)问题识别，(ii)说明，（三）变更和（四）实施。
结果：在2013年底之前完成HSGA干预模型是制定FSDoH《2015-2030年战略转型计划》的前奏。HSGA干预模式被用作实施和整合该计划的方案的工具，这些方案始终侧重于加强卫生系统的六个组成部分以及它们之间至关重要的联系。
结论：该模型是由省级卫生部门开发的，旨在解决碎片化问题并改善公共卫生服务的提供。2016年1月，干预模式成为正式的部门政策，这意味着它被批准实施，合规,监测和报告，并成为自由州加强和改造卫生系统的指导框架。
