PDF(Pubmed)
Abstract：
Objectives: With the application of a systems thinking lens, we aimed to assess the national COVID-19 response across health systems components in Switzerland, Spain, Iran, and Pakistan. Methods: We conducted four case studies on the policy response of national health systems to the early phase of the COVID-19 pandemic. Selected countries include different health system typologies. We collected data prospectively for the period of January-July 2020 on 17 measures of the COVID-19 response recommended by the WHO that encompassed all health systems domains (governance, financing, health workforce, information, medicine and technology and service delivery). We further monitored contextual factors influencing their adoption or deployment. Results: The policies enacted coincided with a decrease in the COVID-19 transmission. However, there was inadequate communication and a perception that the measures were adverse to the economy, weakening political support for their continuation and leading to a rapid resurgence in transmission. Conclusion: Social pressure, religious beliefs, governance structure and level of administrative decentralization or global economic sanctions played a major role in how countries\' health systems could respond to the pandemic.
摘要：
目标：应用系统思维透镜，我们的目标是评估瑞士各卫生系统组成部分的国家COVID-19反应，西班牙,伊朗,和巴基斯坦。方法：我们对国家卫生系统对COVID-19大流行早期阶段的政策反应进行了四个案例研究。选定的国家包括不同的卫生系统类型。我们前瞻性地收集了2020年1月至7月期间关于世卫组织建议的COVID-19反应的17项措施的数据，这些措施涵盖了所有卫生系统领域(治理，融资，卫生劳动力，信息,医药、技术和服务提供)。我们进一步监测了影响其采用或部署的环境因素。结果：颁布的政策与COVID-19传播的减少相吻合。然而,沟通不足，认为这些措施对经济不利，削弱了对其延续的政治支持，并导致传播迅速复苏。结论：社会压力，宗教信仰,治理结构和行政权力下放或全球经济制裁的水平在各国卫生系统如何应对大流行方面发挥了重要作用。
