universal health coverage

全民健康覆盖
  • 文章类型: Journal Article
    全民健康覆盖(UHC)是各国实现可持续发展目标的最重要战略之一。为了实现UHC,政府需要私营部门的参与。
    本研究的目的是确定影响私营部门参与实现全民健康覆盖的因素。
    该研究是利用Arkesy&O\'Malley框架的范围审查。数据收集在MEDLINE进行,WebofSciences,Embase,ProQuest,SID,以及MagIran数据库和GoogleScholar搜索引擎。此外,手动搜索期刊和网站,参考检查,使用特定的关键词进行灰色文献检索。为了管理和筛选研究,使用EndNoteX8软件。由研究小组的两名成员进行数据提取和分析,独立使用内容分析。
    根据结果,纳入588项研究中的43项研究。大多数研究是国际性的(18项研究)。提取的数据分为四大类:挑战,障碍,主持人,目标,以及订婚的原因。在排除和整合已识别的数据后,这些类别按以下方式分类:障碍和挑战,59个项目和13个类别,50个项目和9个类别的主持人,有30个项目的原因,5个类别和目标,24个项目和6个类别。
    利用不同国家的经验,挑战和障碍,主持人,原因,并对目标进行了分析和分类。这项调查可用于发展私营部门的参与和组织的协同作用,以实现决策者和计划者的全民健康覆盖。
    主要发现:政府是医疗保健提供的关键,但是私营部门的参与对于全民健康覆盖越来越重要。增加的知识:本文探讨了私营部门在全民健康覆盖中不断演变的作用,分析障碍,挑战,主持人,原因,和参与目标,同时建议进一步探索的领域。全球卫生对政策和行动的影响:私营部门对实现全民健康覆盖的贡献需要全面的政策框架和有针对性的行动,以确保全球公平和可持续的卫生成果。
    UNASSIGNED: Universal Health Coverage (UHC) is one of the most important strategies adopted by countries in achieving goals of sustainable development. To achieve UHC, the governments need the engagement of the private sector.
    UNASSIGNED: The aim of this study was to identify factors affecting private sector engagement in achieving universal health coverage.
    UNASSIGNED: The study is a scoping review that utilizes Arkesy & O\'Malley frameworks. Data collection was conducted in MEDLINE, Web of Sciences, Embase, ProQuest, SID, and MagIran databases and the Google Scholar search engine. Also, manual searches of journals and websites, reference checks, and grey literature searches were done using specific keywords. To manage and screen the studies, EndNote X8 software was used. Data extraction and analysis was done by two members of the research team, independently and using content analysis.
    UNASSIGNED: According to the results, 43 studies out of 588 studies were included. Most of the studies were international (18 studies). Extracted data were divided into four main categories: challenges, barriers, facilitators, goals, and reasons for engagement. After exclusion and integration of identified data, these categories were classified in the following manner: barriers and challenges with 59 items and in 13 categories, facilitators in 50 items and 9 categories, reasons with 30 items, and in 5 categories and goals with 24 items and 6 categories.
    UNASSIGNED: Utilizing the experience of different countries, challenges and barriers, facilitators, reasons, and goals were analyzed and classified. This investigation can be used to develop the engagement of the private sector and organizational synergy in achieving UHC by policymakers and planners.
    Main findings: Governments are key in healthcare provision, but the private sector’s involvement is increasingly vital for universal health coverage.Added knowledge: This paper explores the evolving role of the private sector in universal health coverage, analysing barriers, challenges, facilitators, reasons, and goals for engagement while suggesting areas for further exploration.Global health impact for policy and action: The private sector’s contributions to achieving Universal Health Coverage necessitate comprehensive policy frameworks and targeted actions to ensure equitable and sustainable health outcomes worldwide.
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  • 文章类型: Journal Article
    各国政府在卫生筹资系统方面的努力和改革旨在实现全民健康覆盖。家庭在医疗保健方面的支出在实现这一目标方面发挥着非常重要的作用。这项系统审查的目的是评估国际汽联在不同地区测量的自付医疗支出不平等,在2030年实现UHC的背景下。在PubMed中进行了全面系统的搜索,Scopus,和WebofScience数据库,以确定2016年至2022年间以英语发布的原始定量和混合方法研究。初步确定共336篇文章,在筛选过程之后,系统评价包括15篇文章,删除不符合纳入标准的重复项和文章后。尽管整体回归,保险制度普遍改善了人口覆盖率,减少了就业人口自付医疗支出的不平等,但是区域研究强调了在微观层面审查局势的重要性。该研究的结果提供了进一步的证据支持这样的观点,即医疗保健融资系统较少依赖公共资金和直接税融资,而更多地依赖私人支付与灾难性医疗支出的更高患病率相关,并在医疗保健融资方面表现出更多的回归模式。强调需要采取政策干预措施来解决这些不平等问题。由于财政脆弱人群经历的不平等,各国政府在实现全民健康覆盖方面面临重大挑战,包括药品的高额自付费用,非正式指控,以及医疗保健融资管理方面的地区差异。
    Government efforts and reforms in health financing systems in various countries are aimed at achieving universal health coverage. Household spending on healthcare plays a very important role in achieving this goal. The aim of this systematic review was to assess out-of-pocket health expenditure inequalities measured by the FIA across different territories, in the context of achieving UHC by 2030. A comprehensive systematic search was conducted in the PubMed, Scopus, and Web of Science databases to identify original quantitative and mixed-method studies published in the English language between 2016 and 2022. A total of 336 articles were initially identified, and after the screening process, 15 articles were included in the systematic review, following the removal of duplicates and articles not meeting the inclusion criteria. Despite the overall regressivity, insurance systems have generally improved population coverage and reduced inequality in out-of-pocket health expenditures among the employed population, but regional studies highlight the importance of examining the situation at a micro level. The results of the study provide further evidence supporting the notion that healthcare financing systems relying less on public funding and direct tax financing and more on private payments are associated with a higher prevalence of catastrophic health expenditures and demonstrate a more regressive pattern in terms of healthcare financing, highlighting the need for policy interventions to address these inequities. Governments face significant challenges in achieving universal health coverage due to inequalities experienced by financially vulnerable populations, including high out-of-pocket payments for pharmaceutical goods, informal charges, and regional disparities in healthcare financing administration.
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  • 文章类型: Journal Article
    逐步向全民健康覆盖(UHC)迈进是许多国家的重要问题。这项研究的目的是确定补充健康保险在实现全民覆盖中的作用。
    进行了这项全面的回顾研究,以确定补充健康保险在实现全民健康覆盖中的作用。在数据库中的搜索中发现了4894篇文章(Scopus,PubMed,和网络科学),最后选出42篇文章。考虑到标题和摘要的标准,对审查过的文章进行了评估,并采用专题分析方法对收集的数据进行分析。
    评论显示了7个维度中的52个子维度。决策者可以借鉴国际经验,通过在国家卫生筹资政策框架内澄清私人健康保险的作用,确保私人健康保险有助于实现全民健康覆盖。增强对补充健康保险如何影响医疗保健系统绩效的理解。他们正在改善对私人医疗保险的监督,规范金融保护和消费者支持,并在私营和公共部门之间实施全面的市场监督和适当的卫生补贴分配。
    补充保险有望成为实现全民健康覆盖的补充工具。弥补初级保险方面的差距和提供额外的财政保护有助于增加获得,提高护理质量,减少医疗服务的财务障碍。然而,必须仔细注意负担能力,股本,regulation,并与主要保险计划进行协调,以确保其有效实施并防止意外后果。
    UNASSIGNED: The gradual movement towards universal health coverage (UHC) is an important issue in many countries. The aim of this study is to identify the role of supplementary health insurance in achieving universal coverage.
    UNASSIGNED: This comprehensive review study was conducted to identify the role of supplementary health insurance in achieving universal health coverage. 4894 articles were found in the search in databases (Scopus, PubMed, and Web Science), and finally42 articles were selected. Considering the criteria of titles and abstracts, the reviewed articles were assessed, and a thematic analysis approach was used to analyze the collected data.
    UNASSIGNED: The review showed 52 Sub dimensions in 7 dimensions. Policymakers can draw on international experiences to ensure that private health insurance contributes to achieving universal health coverage by Providing clarity within the national health financing policy framework regarding the role of private health insurance. Enhancing understanding of how supplementary health insurance impacts the performance of the healthcare system. They are improving oversight of private health insurance, regulating financial protection and consumer support, and implementing thorough market surveillance and proper allocation of health subsidies between the private and public sectors.
    UNASSIGNED: Supplementary insurance holds promise as a complementary tool in achieving universal health coverage. Addressing gaps in primary insurance and providing additional financial protection can contribute to enhanced access, improved quality of care, and reduced financial barriers to healthcare services. However, careful attention must be given to affordability, equity, regulation, and coordination with primary insurance schemes to ensure its effective implementation and prevent unintended consequences.
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  • 文章类型: Journal Article
    世界卫生组织(WHO)于2016年接受了以人为中心的综合卫生服务(IPCHS)框架,将其作为在分散的卫生系统中实现全民健康覆盖的重要组成部分。我们旨在研究WHOIPCHS框架的经验应用,以指导其在加强卫生服务研究中的使用。
    搜索了学术数据库和IPCHS网站,以查找2016年至2023年7月之间发布的相关文章。两名评审员独立筛选和提取研究设计的数据,设置,IPCHS框架组件,以及实施IPCHS战略的促进者和障碍。进行了描述性和内容分析。
    使用IPCHS框架确定了六项研究。研究已经检查了五种IPCHS策略的组合。所有研究都报告了建立强大的初级保健系统和协调个人护理。持续的关系和信任,共同制作卫生方案,医疗保健团队的多样性,技术是主要的推动者,虽然健康素养低,缺乏初级设置能力和医疗劳动力是IPCHS实施的主要障碍。
    本范围审查概述了医疗保健研究中采用的IPCHS策略。一般来说,IPCHS框架在初级研究中仍未得到充分利用。这些结果为未来的研究提供了指导,以支持有效的医疗保健服务。
    UNASSIGNED: The World Health Organisation (WHO) accepted the Integrated People-centred Health Services (IPCHS) framework in 2016 as an essential component for achieving universal health coverage in fragmented health systems. We aimed to examine the empirical applications of the WHO IPCHS framework to guide its use in strengthening health-service research.
    UNASSIGNED: Academic databases and the IPCHS website were searched for relevant articles published between 2016 and July 2023. Two reviewers independently screened and extracted data on the study design, setting, IPCHS framework components, and facilitators and barriers to implementing the IPCHS strategies. Descriptive and content analyses were conducted.
    UNASSIGNED: Six studies were identified using the IPCHS framework. Studies have examined a combination of the five IPCHS strategies. All studies reported building strong primary care-based systems and coordinating care for individuals. Continued relationships and trust, co-production of health programmes, diversity of health care team, and technology were major facilitators, while low health literacy, lack of primary setting capacity and healthcare workforce were principal barriers to IPCHS implementation.
    UNASSIGNED: This scoping review offers an overview of IPCHS strategies employed in healthcare research. Generally, the IPCHS framework remains underutilised in primary research. These results offer guidance for future research to support effective healthcare delivery.
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  • 文章类型: Systematic Review
    加纳于1999年建立了以社区为基础的卫生规划和服务(CHPS)作为初级卫生保健的主要联系点。此后,CHPS已成为该国提供贴近客户医疗保健服务的主要战略,由于其实施,记录了许多积极的健康结果。有,然而,目前缺乏对CHPS文献的系统评价。这项研究的目的不仅是调查以社区为基础的健康规划和服务的主要趋势和研究主题,而且还要追踪CHPS干预从开始到现在的演变。
    我们对在GoogleScholar上搜索的精选文章采用了系统的审查方法,PubMed,和Scopus数据库。该研究是在系统评价和荟萃分析(PRISMA)指南的首选报告项目下进行和指导的。然后,我们在综合结果时应用了反身主题分析方法。
    搜索产生了127篇文章,其中59篇被列入最终审查。二十(20)篇针对国家一级的论文,区域级别的十八(18),十六(16)区一级,二(2)个街道级别,和三(3)篇针对社区的论文。2017年和2019年被记录为加纳CHPS出版物数量最多的年份。
    基于社区的健康规划和服务(CHPS)是解决障碍和挑战的有效工具,以获得对健康造成重大影响的优质和负担得起的医疗保健。它在社区中提供接近客户的医疗保健服务。
    Ghana established Community-based Health Planning and Services (CHPS) as the primary point of contact for primary healthcare in 1999. CHPS has since emerged as the country\'s primary strategy for providing close-to-client healthcare delivery, with numerous positive health outcomes recorded as a result of its implementation. There is, however currently a paucity of systematic reviews of the literature on CHPS. The purpose of this study was not only to investigate dominant trends and research themes in Community-based Health Planning and Services, but also to track the evolution of the CHPS intervention from its inception to the present.
    We adopted a systematic review approach for selected articles that were searched on Google Scholar, PubMed, and Scopus databases. The study was conducted and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. We then applied a reflexive thematic analysis approach in synthesizing the results.
    The search resulted in 127 articles of which 59 were included in the final review. Twenty (20) papers targeted the national level, eighteen (18) for the regional level, sixteen (16) for the district level, two (2) for the sub-district level, and three (3) papers targeted the community. The years 2017 and 2019 were recorded to be the years with the highest number of publications on CHPS in Ghana.
    Community-based Health Planning and Services (CHPS) is an effective tool in addressing barriers and challenges to accessing quality and affordable health care causing significant effects on health. It provides close-to-client healthcare delivery in the community.
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  • 文章类型: Journal Article
    数量不足,分布不均,自然减员,技能组合不足是广泛的卫生和护理劳动力(HCWF)挑战。跨部门包容不同政府部门,非国家行为者,私营部门的合作和行动是发展反应迅速和可持续的HCWF的基础。这篇综述提供了关于如何跨部门合作教育的证据,招募,并保留可持续的HCWF,强调部门间合作的好处和挑战的例子。我们对科学和灰色文献进行了范围审查,并围绕部门间治理和HCWF机制进行了纳入标准。框架分析,以识别和整理与教育相关的因素,招募,并进行HCWF的保留。包括56份文件。我们为支持教育的部门间活动提出了广泛的建议,招募,和HCWF的保留。对于HCWF教育:使部门间决策机构正规化;使HCWF教育与人口健康需求保持一致;扩大培训能力;参与和规范私营部门的培训;寻求国际培训机会和支持;并通过利用数字技术进行培训创新。对于HCWF的招聘:确保部门间的明确性和合作;确保双边协议符合道德标准;进行数据知情招聘;并向COVID-19学习如何动员国内劳动力。对于HCWF保留:围绕可用员工进行创新,特别是在工作人员稀缺的地方;改善工作和就业条件;并让私营部门参与进来。政治意愿和相应的投资必须强调HCWF的任何部门间合作。
    Inadequate numbers, maldistribution, attrition, and inadequate skill-mix are widespread health and care workforce (HCWF) challenges. Intersectoral-inclusive of different government sectors, non-state actors, and the private sector-collaboration and action are foundational to the development of a responsive and sustainable HCWF. This review presents evidence on how to work across sectors to educate, recruit, and retain a sustainable HCWF, highlighting examples of the benefits and challenges of intersectoral collaboration. We carried out a scoping review of scientific and grey literature with inclusion criteria around intersectoral governance and mechanisms for the HCWF. A framework analysis to identify and collate factors linked to the education, recruitment, and retention of the HCWF was carried out. Fifty-six documents were included. We identified a wide array of recommendations for intersectoral activity to support the education, recruitment, and retention of the HCWF. For HCWF education: formalise intersectoral decision-making bodies; align HCWF education with population health needs; expand training capacity; engage and regulate private sector training; seek international training opportunities and support; and innovate in training by leveraging digital technologies. For HCWF recruitment: ensure there is intersectoral clarity and cooperation; ensure bilateral agreements are ethical; carry out data-informed recruitment; and learn from COVID-19 about mobilising the domestic workforce. For HCWF retention: innovate around available staff, especially where staff are scarce; improve working and employment conditions; and engage the private sector. Political will and commensurate investment must underscore any intersectoral collaboration for the HCWF.
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  • 文章类型: Systematic Review
    背景:弹性卫生系统(RHS)对于实现全民健康覆盖(UHC)和健康安全至关重要。然而,对RHS改善UHC和健康安全的策略知之甚少。本系统综述旨在综合文献,以了解针对UHC和健康安全构建RHS的方法。
    方法:进行了系统搜索,包括2000年1月1日至2021年12月31日发表的研究。在三个数据库中搜索了研究(PubMed,Embase,和Scopus)在四个域下使用搜索词:弹性,卫生系统,全民健康覆盖,和健康安全。我们使用Rees及其同事的质量评估清单对文章进行批判性评估,以评估论文的质量。使用世界卫生组织的卫生系统构建块框架进行了系统的叙事综合,以分析和综合数据。
    结果:共有57篇文章被纳入最终综述。基于上下文的卫生工作者再分配,任务转移政策,和基于结果的卫生筹资政策有助于建立RHS。高度的政治承诺,基于社区的应对计划,和多部门合作对于实现全民健康覆盖和健康安全至关重要。相反,缺乏访问,无响应,不公平的医疗服务,监控不力,领导能力薄弱,收入不平等是实现全民健康覆盖和健康安全的制约因素。此外,缺乏基本的医疗基础设施,技能不足的卫生劳动力,缺乏明确的政府政策,利益相关者角色缺乏明确性,卫生机构和卫生工作者分布不均是实现全民健康覆盖和卫生安全的挑战。
    结论:先进的医疗基础设施和足够数量的医护人员对于实现全民健康覆盖和健康安全至关重要。然而,它们并不能单独保护卫生系统免受潜在故障的影响。根据具体情况重新分配卫生工作者,任务转移,基于结果的卫生筹资政策,以及综合和多部门方法,根据初级卫生保健的原则,对于建立面向UHC和健康安全的RHS是必要的。
    BACKGROUND: Resilient health system (RHS) is crucial to achieving universal health coverage (UHC) and health security. However, little is known about strategies towards RHS to improve UHC and health security. This systematic review aims to synthesise the literature to understand approaches to build RHS toward UHC and health security.
    METHODS: A systematic search was conducted including studies published from 01 January 2000 to 31 December 2021. Studies were searched in three databases (PubMed, Embase, and Scopus) using search terms under four domains: resilience, health system, universal health coverage, and health security. We critically appraised articles using Rees and colleagues\' quality appraisal checklist to assess the quality of papers. A systematic narrative synthesis was conducted to analyse and synthesise the data using the World Health Organization\'s health systems building block framework.
    RESULTS: A total of 57 articles were included in the final review. Context-based redistribution of health workers, task-shifting policy, and results-based health financing policy helped to build RHS. High political commitment, community-based response planning, and multi-sectorial collaboration were critical to realising UHC and health security. On the contrary, lack of access, non-responsive, inequitable healthcare services, poor surveillance, weak leadership, and income inequalities were the constraints to achieving UHC and health security. In addition, the lack of basic healthcare infrastructures, inadequately skilled health workforces, absence of clear government policy, lack of clarity of stakeholder roles, and uneven distribution of health facilities and health workers were the challenges to achieving UHC and health security.
    CONCLUSIONS: Advanced healthcare infrastructures and adequate number of healthcare workers are essential to achieving UHC and health security. However, they are not alone adequate to protect the health system from potential failure. Context-specific redistribution of health workers, task-shifting, result-based health financing policies, and integrated and multi-sectoral approaches, based on the principles of primary health care, are necessary for building RHS toward UHC and health security.
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  • 文章类型: Journal Article
    背景:口腔疾病影响全球近35亿人,世界卫生组织(WHO)呼吁将口腔健康纳入全民健康覆盖(UHC)议程。
    目的:整理和综合有关将口腔健康纳入东南亚区域办事处11个国家UHC覆盖的卫生系统的状况的信息。
    方法:借鉴世卫组织设计的卫生系统六个组成部分的框架,我们比较了公共牙科护理覆盖模式,这些国家的重点是门诊牙科护理。我们从公开资源中收集了这些信息,数据库和同行评审的出版物,以填充世卫组织卫生系统构建模块指导的模板。
    结果:我们发现无法获得口腔保健,人力分布不平衡,摇摇欲坠的健康信息系统,和私营部门的统治以及门诊程序的融资机制不足或缺乏。除泰国和斯里兰卡外,私营部门在所有国家都占主导地位。大多数国家缺乏资金,泰国和印度尼西亚缺乏资金。除印度外,大多数国家的牙科劳动力不足,斯里兰卡,和泰国。卫生信息系统薄弱,没有价格控制下的牙科用品。更好的UHC指标并不能保证较低的口腔疾病负担。
    结论:我们的审查强调了服务质量与人力资源之间的紧密联系,治理,和金融。有必要建立各国统一采用的标准化牙科治疗指南,将口腔健康纳入国家健康和发展计划,通过收集强有力的监测来推动功能性口腔健康研究,经济,和社会影响数据,并制定符合每个国家独特需求的成本效益战略。
    BACKGROUND: Oral diseases affect close to 3.5 billion people worldwide and there has been a call by the World Health Organization (WHO) to integrate oral health into the Universal Health Coverage (UHC) agenda.
    OBJECTIVE: To collate and synthesise information regarding the status of integration of oral health into the health systems covered by UHC across the 11 countries in the South East Asian Regional Office.
    METHODS: Drawing on the framework of the six building blocks of health systems as devised by WHO, we compared the public dental care coverage models, with a focus on outpatient dental care in these countries. We gathered this information from publicly available resources, databases and peer-reviewed publications to populate the template guided by the WHO Health System Building Blocks.
    RESULTS: We found a poor access to oral health care, lopsided distribution of manpower, rickety health information systems, and private sector domination and inadequate or absent financing mechanisms for outpatient procedures. The private sector was dominant in all countries except Thailand and Srilanka. Financing was absent in most countries and deficient in Thailand and Indonesia. Dental workforce was deficient in most countries except India, Srilanka, and Thailand. Health information systems were weak with no dental items under price control. Better UHC indicators did not guarantee a lower oral disease burden.
    CONCLUSIONS: Our review highlighted the close connection between service quality and human resources, governance, and finance. There is a need to establish standardised dental treatment guidelines that are uniformly adopted across countries, integrate oral health into national health and development programs, push for functional oral health research through collecting robust surveillance, economic, and social impact data and the development of cost-effective strategies tailored to each country\'s unique needs.
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  • 文章类型: Journal Article
    UNASSIGNED: The WHO emphasises that rehabilitation services must be integrated into primary healthcare as an inherent part of universal health coverage. However, there is limited research on the integration of rehabilitation services in primary healthcare in low- and middle-income countries. The purpose of this paper is to identify and describe the literature on service guidelines, models, and protocols that support the integration of rehabilitation services in primary healthcare in the BRICS countries (Brazil, Russia, India, China, and South Africa).
    UNASSIGNED: A scoping review guided by Arksey and O\'Malley\'s framework was conducted. Structured database and website searches identified published and unpublished records from 2010, which were subjected to eligibility criteria. Mendeley, JBI SUMARI, and Microsoft Excel were used to extract and synthesise the data.
    UNASSIGNED: The search strategy identified 542 records. Thirty-two records met the inclusion criteria. Shared care and community-based rehabilitation were the most reported practice models, and the implementation of the models, guidelines, and protocols was mostly described in mental health services.
    UNASSIGNED: This review discusses BRICS countries\' rehabilitation service guidelines, models, and protocols for primary healthcare integration and implementation challenges. Rehabilitation professionals should rethink, realign, and apply existing models because of the lack of primary healthcare integration directives.
    The integration of rehabilitation services in low-resourced and remote settings can be improved by involving community health workers and community rehabilitation workers in transdisciplinary teams.Peer support workers and community health workers can improve rehabilitation outcomes, particularly through shared care models that emphasize peer-to-peer learning, mentoring, and coaching.Self-management interventions can have a positive impact on functional outcomes.Integrated rehabilitation services in primary healthcare can be supported through community-based rehabilitation, which emphasises community involvement and engagement.
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  • 文章类型: Journal Article
    背景:世界卫生组织(WHO)估计到2030年将有1000万卫生工作者短缺。尽管这种短缺,一些低收入非洲国家自相矛盾地与卫生工作者的盈余作斗争。从技术上讲,这些卫生工作者需要达到卫生工作者与人口的最低比例,但是公共和私营部门的就业机会不足使现有的卫生工作者失业。这导致移民和失业或就业不足,因为很少有国家制定政策或计划来吸收这种过剩的产能。塞拉利昂,利比里亚和几内亚采取了不同的方法;卫生当局和/或公立医院“招募”医学和护理毕业生不受薪,承诺最终有偿公共就业。塞拉利昂50%的卫生劳动力目前没有工资。本范围审查审查了塞拉利昂无薪卫生工作者(UHW)的现有证据,以确定他们对公平提供护理的影响。
    方法:使用JoannaBriggs研究所的指导进行范围审查。Medline,PubMed,Scopus,检索WebofScience以确定相关文献。还包括灰色文献(报告)以及卫生部和卫生政策文件。
    结果:36个文本,包含UHW相关数据,符合纳入标准。调查结果分为两类和九个子类别:收取应免费的护理和药物;信任和不信任;问责制;非正式提供护理,私人执业和缺乏监管。卫生工作者的过度生产;UHW政策和战略中的问题;缺乏人员数据破坏了MoHS计划;卫生部门的财务。
    结论:塞拉利昂的例子表明,UHWs破坏了公平获得医疗保健的机会,如果他们采取一系列应对策略来在经济上生存,有些人这样做。它们的影响范围广泛,如果不解决,将破坏塞拉利昂实现全民健康覆盖的努力。这些发现与其他具有类似卫生工作者盈余的LIC相关。
    BACKGROUND: The World Health Organisation (WHO) estimates a 10 million health worker shortage by 2030. Despite this shortage, some low-income African countries paradoxically struggle with health worker surpluses. Technically, these health workers are needed to meet the minimum health worker-population ratio, but insufficient job opportunities in the public and private sector leaves available health workers unemployed. This results in emigration and un- or underemployment, as few countries have policies or plans in place to absorb this excess capacity. Sierra Leone, Liberia and Guinea have taken a different approach; health authorities and/or public hospitals \'recruit\' medical and nursing graduates on an unsalaried basis, promising eventual paid public employment. 50% Sierra Leone\'s health workforce is currently unsalaried. This scoping review examines the existing evidence on Sierra Leone\'s unsalaried health workers (UHWs) to establish what impact they have on the equitable delivery of care.
    METHODS: A scoping review was conducted using Joanna Briggs Institute guidance. Medline, PubMed, Scopus, Web of Science were searched to identify relevant literature. Grey literature (reports) and Ministry of Health and Sanitation policy documents were also included.
    RESULTS: 36 texts, containing UHW related data, met the inclusion criteria. The findings divide into two categories and nine sub-categories: Charging for care and medicines that should be free; Trust and mistrust; Accountability; Informal provision of care, Private practice and lack of regulation. Over-production of health workers; UHW issues within policy and strategy; Lack of personnel data undermines MoHS planning; Health sector finance.
    CONCLUSIONS: Sierra Leone\'s example demonstrates that UHWs undermine equitable access to healthcare, if they resort to employing a range of coping strategies to survive financially, which some do. Their impact is wide ranging and will undermine Sierra Leone\'s efforts to achieve Universal Health Coverage if unaddressed. These findings are relevant to other LICs with similar health worker surpluses.
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