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The governance of local health systems in the era of SustainableDevelopment Goals: reflections on collaborative action to address complexhealth needs in four country contexts

机译:可持续时代的地方卫生系统治理发展目标:对解决复杂问题的协作行动的思考四个国家的卫生需求

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摘要

This analysis reflects on experiences and lessons from four country settings—Zambia, India, Sweden and South Africa—on building collaborations in local health systems in order to respond to complex health needs. These collaborations ranged in scope and formality, from coordinating action in the community health system (Zambia), to a partnership between governmental, non-governmental and academic actors (India), to joint planning and delivery across political and sectoral boundaries (Sweden and South Africa). The four cases are presented and analysed using a common framework of collaborative governance, focusing on the dynamics of the collaboration itself, with respect to principled engagement, shared motivation and joint capacity. The four cases, despite their differences, illustrate the considerable challenges and the specific dynamics involved in developing collaborative action in local health systems. These include the coconstruction of solutions (and in some instances the problem itself) through engagement, the importance of trust, both interpersonal and institutional, as a condition for collaborative arrangements, and the role of openly accessible information in building shared understanding. Ultimately, collaborative action takes time and difficulty needs to be anticipated. If discovery, joint learning and developing shared perspectives are presented as goals in themselves, this may offset internal and external expectations that collaborations deliver results in the short term.
机译:该分析反映了赞比亚,印度,瑞典和南非四个国家在建立地方卫生系统中的合作以应对复杂卫生需求方面的经验和教训。这些合作的范围和形式繁多,从协调社区卫生体系中的行动(赞比亚)到政府,非政府和学术机构之间的伙伴关系(印度),再到跨政治和部门边界的联合计划和交付(瑞典和南方)。非洲)。这四个案例是使用协作治理的通用框架进行介绍和分析的,重点放在协作本身的动态方面,包括有原则的参与,共享的动机和联合能力。尽管这四个案例存在差异,但它们说明了在地方卫生系统中开展协作行动所面临的巨大挑战和具体动态。这些包括通过参与来共同构建解决方案(在某些情况下是问题本身),作为合作安排的条件的人际和机构信任的重要性,以及公开获取的信息在建立共同理解中的作用。最终,协作行动需要时间,并且需要预见困难。如果发现,共同学习和发展共同的观点本身作为目标提出,这可能会抵消内部和外部对合作在短期内交付成果的期望。

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