PDF(Pubmed)
Abstract：
BACKGROUND: Globally, there is growing attention towards health system strengthening, and the importance of quality in health systems. However, fragile and conflict-affected states present particular challenges. The aim of this study was to explore health system strengthening in fragile and conflict-affected states by synthesising the evidence from published literature.
METHODS: We conducted a review of systematic reviews (Prospero Registration Number: CRD42022371955) by searching Ovid (Medline, Embase, and Global Health), Scopus, Web of Science, and the Cochrane Library databases. Only English-language publications were considered. The Joanna Briggs Institute (JBI) Critical Appraisal Tool was employed to assess methodological quality of the included studies. The findings were narratively synthesised and presented in line with the Lancet\'s \'high-quality health system framework\'.
RESULTS: Twenty-seven systematic reviews, out of 2,704 identified records, considered key dimensions of health systems in fragile and conflict-affected states, with the \'foundations\' domain having most evidence. Significant challenges to health system strengthening, including the flight of human capital due to safety concerns and difficult working conditions, as well as limited training capacities and resources, were identified. Facilitators included community involvement, support systems and innovative financing mechanisms. The importance of coordinated and integrated responses tailored to the context and stage of the crisis situation was emphasised in order to strengthen fragile health systems. Overall, health system strengthening initiatives included policies encouraging the return and integration of displaced healthcare workers, building local healthcare workers capacity, strengthening education and training, integrating healthcare services, trust-building, supportive supervision, and e-Health utilisation.
CONCLUSIONS: The emerging body of evidence on health system strengthening in fragile and conflict-affected states highlights its complexity. The findings underscore the significance of adopting a comprehensive approach and engaging various stakeholders in a coordinated manner considering the stage and context of the situation.
METHODS: We conducted a review of systematic reviews (Prospero Registration Number: CRD42022371955) by searching Ovid (Medline, Embase, and Global Health), Scopus, Web of Science, and the Cochrane Library databases. Only English-language publications were considered. The Joanna Briggs Institute (JBI) Critical Appraisal Tool was employed to assess methodological quality of the included studies. The findings were narratively synthesised and presented in line with the Lancet\'s \'high-quality health system framework\'.
RESULTS: Twenty-seven systematic reviews, out of 2,704 identified records, considered key dimensions of health systems in fragile and conflict-affected states, with the \'foundations\' domain having most evidence. Significant challenges to health system strengthening, including the flight of human capital due to safety concerns and difficult working conditions, as well as limited training capacities and resources, were identified. Facilitators included community involvement, support systems and innovative financing mechanisms. The importance of coordinated and integrated responses tailored to the context and stage of the crisis situation was emphasised in order to strengthen fragile health systems. Overall, health system strengthening initiatives included policies encouraging the return and integration of displaced healthcare workers, building local healthcare workers capacity, strengthening education and training, integrating healthcare services, trust-building, supportive supervision, and e-Health utilisation.
CONCLUSIONS: The emerging body of evidence on health system strengthening in fragile and conflict-affected states highlights its complexity. The findings underscore the significance of adopting a comprehensive approach and engaging various stakeholders in a coordinated manner considering the stage and context of the situation.
摘要：
背景：在全球范围内，人们越来越重视加强卫生系统，以及质量在卫生系统中的重要性。然而,脆弱和受冲突影响的国家面临特殊挑战。这项研究的目的是通过综合已发表文献中的证据，探索脆弱和受冲突影响国家的卫生系统加强。
方法：我们通过搜索Ovid（Medline，Embase,和全球健康)，Scopus,WebofScience,和Cochrane图书馆数据库.只考虑了英文出版物。采用JoannaBriggs研究所（JBI）批判性评估工具来评估纳入研究的方法学质量。根据《柳叶刀》的“高质量卫生系统框架”，对研究结果进行了叙述综合和介绍。
结果：27项系统评价，在2,704条确定的记录中，考虑到脆弱和受冲突影响国家卫生系统的关键方面，与\“基金会\”域有最多的证据。加强卫生系统面临的重大挑战，包括由于安全问题和艰难的工作条件而导致的人力资本外逃，以及有限的培训能力和资源，已确定。调解人包括社区参与，支持体系和创新融资机制。强调了针对危机局势的背景和阶段采取协调和综合对策的重要性，以加强脆弱的卫生系统。总的来说,加强卫生系统的举措包括鼓励流离失所的医护人员返回和融合的政策，建设当地医护人员的能力，加强教育和培训，整合医疗服务，建立信任,支持性监督,和电子健康利用。
结论：关于脆弱和受冲突影响国家卫生系统加强的新证据凸显了其复杂性。调查结果强调了采取全面方法并考虑到局势的阶段和背景以协调的方式让各利益攸关方参与的重要性。
方法：我们通过搜索Ovid（Medline，Embase,和全球健康)，Scopus,WebofScience,和Cochrane图书馆数据库.只考虑了英文出版物。采用JoannaBriggs研究所（JBI）批判性评估工具来评估纳入研究的方法学质量。根据《柳叶刀》的“高质量卫生系统框架”，对研究结果进行了叙述综合和介绍。
结果：27项系统评价，在2,704条确定的记录中，考虑到脆弱和受冲突影响国家卫生系统的关键方面，与\“基金会\”域有最多的证据。加强卫生系统面临的重大挑战，包括由于安全问题和艰难的工作条件而导致的人力资本外逃，以及有限的培训能力和资源，已确定。调解人包括社区参与，支持体系和创新融资机制。强调了针对危机局势的背景和阶段采取协调和综合对策的重要性，以加强脆弱的卫生系统。总的来说,加强卫生系统的举措包括鼓励流离失所的医护人员返回和融合的政策，建设当地医护人员的能力，加强教育和培训，整合医疗服务，建立信任,支持性监督,和电子健康利用。
结论：关于脆弱和受冲突影响国家卫生系统加强的新证据凸显了其复杂性。调查结果强调了采取全面方法并考虑到局势的阶段和背景以协调的方式让各利益攸关方参与的重要性。
