背景:与公共卫生部门合作的私营医疗机构是建立可持续卫生系统并确保低收入国家所有人的健康和福祉的一种选择。作为非洲第二大人口大国,经济快速增长,埃塞俄比亚对保健服务的需求正在增加,其四分之一的保健设施是私人拥有的。私人卫生部门计划(PHSP)由美国国际开发署资助,从2004年到2020年,在卫生项目中实施了一系列公私伙伴关系,以解决几个公共卫生优先事项,包括肺结核,疟疾,艾滋病毒/艾滋病,和计划生育。我们评估了PHSP在领导和治理方面的表现,获得药物,健康管理信息系统,人力资源,服务提供,和金融。
方法:世界卫生组织的卫生系统加强框架,它围绕六个卫生系统构建模块组织,指导评估。我们在PHSP的支持下,对106家私人医疗机构进行了50次关键线人访谈和医疗机构评估,以评估其绩效。
结果:该计划解决了所有六个组成部分,主要信息提供者分享了一些政策和战略变化有利于支持私人医疗机构的运作。公共医药物流系统免费提供药品,放宽严格的监管政策,限制通过私营部门提供服务,培训私人提供者,以及针对结核病制定的公私混合指南,疟疾,和生殖,母性,新生,孩子,青少年健康帮助增加了卫生设施服务的使用。
结论:可持续性仍然存在一些挑战和威胁,包括公共和私人机构之间脆弱的伙伴关系,资源限制,公共部门和私营部门之间的不信任,对私营部门的激励措施有限,以及对服务质量的监督。为了继续在政策环境中取得进展,服务可访问性,以及卫生系统的其他方面,政府和国际社会必须共同努力,解决可以加强的卫生领域的公私伙伴关系。未来的努力应强调一种机制,以确保私营部门有能力,被激励,并监督交付连续的,高质量和公平的服务。
BACKGROUND: Private health care facilities working in partnership with the public health sector is one option to create sustainable health systems and ensure health and well-being for all in low-income countries. As the second-most populous country in Africa with a rapidly growing economy, demand for health services in Ethiopia is increasing and one-quarter of its health facilities are privately owned. The Private Health Sector Program (PHSP), funded by the United States Agency for International Development, implemented a series of public-private partnership in health projects from 2004 to 2020 to address several public health priorities, including tuberculosis, malaria, HIV/AIDS, and family planning. We assessed PHSP\'s performance in leadership and governance, access to medicines, health management information systems, human resources, service provision, and finance.
METHODS: The World Health Organization\'s health systems strengthening framework, which is organized around six health system building blocks, guided the assessment. We conducted 50 key informant interviews and a health facility assessment at 106 private health facilities supported by the PHSP to evaluate its performance.
RESULTS: All six building blocks were addressed by the program and key informants shared that several policy and strategic changes were conducive to supporting the functioning of private health facilities. The provision of free medicines from the public pharmaceutical logistics system, relaxation of strict regulatory policies that restricted service provision through the private sector, training of private providers, and public-private mix guidelines developed for tuberculosis, malaria, and reproductive, maternal, newborn, child, and adolescent health helped increase the use of services at health facilities.
CONCLUSIONS: Some challenges and threats to sustainability remain, including fragile partnerships between public and private bodies, resource constraints, mistrust between the public and private sectors, limited incentives for the private sector, and oversight of the quality of services. To continue with gains in the policy environment, service accessibility, and other aspects of the health system, the government and international communities must work collaboratively to address public-private partnerships in health areas that can be strengthened. Future efforts should emphasize a mechanism to ensure that the private sector is capable, incentivized, and supervised to deliver continuous, high-quality and equitable services.