PDF(Pubmed)
Abstract：
BACKGROUND: Lesotho experienced high rates of maternal (566/100,000 live births) and under-five mortality (72.9/1000 live births). A 2013 national assessment found centralized healthcare management in Ministry of Health led to fragmented, ineffective district health team management. Launched in 2014 through collaboration between the Ministry of Health and Partners In Health, Lesotho\'s Primary Health Care Reform (LPHCR) aimed to improve service quality and quantity by decentralizing healthcare management to the district level. We conducted a qualitative study to explore health workers\' perceptions regarding the effectiveness of LPHCR in enhancing the primary health care system.
METHODS: We conducted 21 semi-structured key informant interviews (KII) with healthcare workers and Ministry of Health officials purposively sampled from various levels of Lesotho\'s health system, including the central Ministry of Health, district health management teams, health centers, and community health worker programs in four pilot districts of the LPHCR initiative. The World Health Organization\'s health systems building blocks framework was used to guide data collection and analysis. Interviews assessed health care workers\' perspectives on the impact of the LPHCR initiative on the six-health system building blocks: service delivery, health information systems, access to essential medicines, health workforce, financing, and leadership/governance. Data were analyzed using directed content analysis.
RESULTS: Participants described benefits of decentralization, including improved efficiency in service delivery, enhanced accountability and responsiveness, increased community participation, improved data availability, and better resource allocation. Participants highlighted how the reform resulted in more efficient procurement and distribution processes and increased recognition and status in part due to the empowerment of district health management teams. However, participants also identified limited decentralization of financial decision-making and encountered barriers to successful implementation, such as staff shortages, inadequate management of the village health worker program, and a lack of clear communication regarding autonomy in utilizing and mobilizing donor funds.
CONCLUSIONS: Our study findings indicate that the implementation of decentralized primary health care management in Lesotho was associated a positive impact on health system building blocks related to primary health care. However, it is crucial to address the implementation challenges identified by healthcare workers to optimize the benefits of decentralized healthcare management.
METHODS: We conducted 21 semi-structured key informant interviews (KII) with healthcare workers and Ministry of Health officials purposively sampled from various levels of Lesotho\'s health system, including the central Ministry of Health, district health management teams, health centers, and community health worker programs in four pilot districts of the LPHCR initiative. The World Health Organization\'s health systems building blocks framework was used to guide data collection and analysis. Interviews assessed health care workers\' perspectives on the impact of the LPHCR initiative on the six-health system building blocks: service delivery, health information systems, access to essential medicines, health workforce, financing, and leadership/governance. Data were analyzed using directed content analysis.
RESULTS: Participants described benefits of decentralization, including improved efficiency in service delivery, enhanced accountability and responsiveness, increased community participation, improved data availability, and better resource allocation. Participants highlighted how the reform resulted in more efficient procurement and distribution processes and increased recognition and status in part due to the empowerment of district health management teams. However, participants also identified limited decentralization of financial decision-making and encountered barriers to successful implementation, such as staff shortages, inadequate management of the village health worker program, and a lack of clear communication regarding autonomy in utilizing and mobilizing donor funds.
CONCLUSIONS: Our study findings indicate that the implementation of decentralized primary health care management in Lesotho was associated a positive impact on health system building blocks related to primary health care. However, it is crucial to address the implementation challenges identified by healthcare workers to optimize the benefits of decentralized healthcare management.
摘要：
背景：莱索托的产妇死亡率很高（566/100,000活产）和5岁以下儿童死亡率（72.9/1000活产）。2013年的一项国家评估发现，卫生部的集中式医疗保健管理导致了分散，区卫生队伍管理不力。2014年通过卫生部与卫生部合作伙伴之间的合作启动，莱索托的初级卫生保健改革（LPHCR）旨在通过将医疗保健管理下放给地区一级来提高服务质量和数量。我们进行了一项定性研究，以探讨卫生工作者对LPHCR在增强初级卫生保健系统中的有效性的看法。
方法：我们对莱索托各级卫生系统的医护人员和卫生部官员进行了21次半结构化关键线人访谈（KII），包括中央卫生部,地区卫生管理团队，健康中心,以及LPHCR倡议四个试点地区的社区卫生工作者计划。世界卫生组织的卫生系统构建块框架用于指导数据收集和分析。访谈评估了卫生保健工作者对LPHCR倡议对六个卫生系统组成部分的影响的看法：服务提供，卫生信息系统,获得基本药物，卫生劳动力，融资，领导/治理。使用定向内容分析对数据进行分析。
结果：参与者描述了权力下放的好处，包括提高服务交付效率，加强问责制和响应能力，增加社区参与，提高数据可用性，和更好的资源分配。与会者强调了改革如何导致更有效的采购和分配过程以及部分由于地区卫生管理小组的赋权而提高的认可和地位。然而,与会者还确定了财务决策的权力下放有限，并遇到了成功实施的障碍，例如员工短缺，对乡村卫生工作者计划的管理不足，在利用和调动捐助资金的自主权方面缺乏明确的沟通。
结论：我们的研究结果表明，在莱索托实施分散的初级卫生保健管理对与初级卫生保健相关的卫生系统构件产生了积极影响。然而,至关重要的是，要解决医疗工作者确定的实施挑战，以优化分散医疗管理的好处。
方法：我们对莱索托各级卫生系统的医护人员和卫生部官员进行了21次半结构化关键线人访谈（KII），包括中央卫生部,地区卫生管理团队，健康中心,以及LPHCR倡议四个试点地区的社区卫生工作者计划。世界卫生组织的卫生系统构建块框架用于指导数据收集和分析。访谈评估了卫生保健工作者对LPHCR倡议对六个卫生系统组成部分的影响的看法：服务提供，卫生信息系统,获得基本药物，卫生劳动力，融资，领导/治理。使用定向内容分析对数据进行分析。
结果：参与者描述了权力下放的好处，包括提高服务交付效率，加强问责制和响应能力，增加社区参与，提高数据可用性，和更好的资源分配。与会者强调了改革如何导致更有效的采购和分配过程以及部分由于地区卫生管理小组的赋权而提高的认可和地位。然而,与会者还确定了财务决策的权力下放有限，并遇到了成功实施的障碍，例如员工短缺，对乡村卫生工作者计划的管理不足，在利用和调动捐助资金的自主权方面缺乏明确的沟通。
结论：我们的研究结果表明，在莱索托实施分散的初级卫生保健管理对与初级卫生保健相关的卫生系统构件产生了积极影响。然而,至关重要的是，要解决医疗工作者确定的实施挑战，以优化分散医疗管理的好处。
