关键词: Ethiopia abortion global health health policy maternal health policy implementation priority-setting reproductive health

来  源:   DOI:10.1093/heapol/czae061

Abstract:
Improving access to abortion services has been coined a high priority by the Ethiopian Federal Ministry of Health. Nevertheless, many women are still struggling to access abortion services. The dedicated commitment to expanding abortion services by central authorities and the difficulties in further improving access to the services make for an interesting case to explore the real-life complexities of health priority setting. This article thus explores what it means to make abortion services a priority by drawing on in-depth interviews with healthcare bureaucrats and key stakeholders working closely with abortion service policy and implementation. Data was collected from February to April 2022. Health bureaucrats from nine of the twelve regional states in Ethiopia and the Federal Ministry of Health were interviewed in addition to key stakeholders from professional organizations and NGOs. The study found that political will and priority to abortion services by central authorities were not necessarily enough to ensure access to the service across the health sector. At the regional and local level, there were considerable challenges with a lack of funding, equipment, and human resources for implementing and expanding access to abortion services. The inadequacy of indicators and reporting systems hindered accountability and made it difficult to give priority to abortion services among the series of health programs and priorities that local health authorities had to implement. The situation was further challenged by the contested nature of the abortion issue itself, both in the general population, but also amongst health bureaucrats and hospital leaders. This study casts a light on the complex and entangled processes of turning national-level priorities into on-the-ground practice and highlights the real-life challenges of setting and implementing health priorities.
摘要:
埃塞俄比亚联邦卫生部已将改善获得堕胎服务的机会列为高度优先事项。然而,许多妇女仍在努力获得堕胎服务。中央当局致力于扩大堕胎服务的承诺以及进一步改善获得服务的困难,为探索确定健康优先事项的现实生活复杂性提供了一个有趣的案例。因此,本文通过对医疗保健官员和与堕胎服务政策和实施密切合作的主要利益相关者的深入访谈,探讨了将堕胎服务作为优先事项的含义。数据收集时间为2022年2月至4月。除专业组织和非政府组织的主要利益相关者外,还采访了埃塞俄比亚十二个地区州中的九个州和联邦卫生部的卫生官员。研究发现,中央当局的政治意愿和对堕胎服务的优先考虑并不一定足以确保整个卫生部门都能获得该服务。在区域和地方一级,缺乏资金存在相当大的挑战,设备,和人力资源,以实施和扩大获得堕胎服务的机会。指标和报告系统的不足阻碍了问责制,并难以在地方卫生当局必须实施的一系列卫生方案和优先事项中优先考虑堕胎服务。堕胎问题本身的争议性质进一步挑战了这种情况,无论是在普通人群中,还有卫生官员和医院领导人。这项研究揭示了将国家一级的优先事项转变为实地实践的复杂而纠结的过程,并强调了设定和实施卫生优先事项的现实挑战。
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