卫生系统复原力的学习分析。

IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Health policy and planning Pub Date : 2025-03-07 DOI:10.1093/heapol/czae113
Kyaw Myat Thu, Sarah Bernays, Seye Abimbola
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引用次数: 0

摘要

复原力 "作为分析卫生系统(尤其是中低收入国家的卫生系统)的一个概念,其出现伴随着关于 "复原力 "是过程还是结果的争论。这场辩论带来了方法论上的挑战。对 "卫生系统复原力 "的理解决定了对其进行分析的方法。为了应对这一方法论上的挑战,我们提出了 "学习 "这一概念,这一概念的多样性足以应对 "过程与结果 "之间的矛盾。我们认为,"学习"--被定义为 "洞察力、知识的发展,以及过去行动、这些行动的有效性和未来行动之间的联系"--可以激发在复原力分析中往往被忽略的特征。与学习一样,复原力所涉及的过程也是循环往复的:从吸收到适应,到转变,再到预测未来的破坏。学习揭示了复原力是如何在复杂系统中以互动和迭代的方式发生或未能发生的,同时承认了个人、团队和组织在环境、认知和行为方面的能力,这些能力有助于系统从冲击/压力中脱颖而出或不断发展。学习分析有助于抵制将抗灾能力作为一种结果的做法,因为抗灾能力通常被用来表示或暗示一种状态或属性,而不是一个展开的过程,无论结果是否被认为是积极的。将抗灾能力作为一个学习过程来分析,可以帮助卫生系统研究人员更好地系统地理解卫生系统对当前和未来压力/冲击的反应。在定性或定量分析中,将需要分析的内容视为 "学习",而不是更模糊的 "复原力",可以重新聚焦于需要测量、解释和如何测量的内容--前提是理解一个有学习能力的卫生系统就是一个有复原力的系统,无论这一过程的结果如何。
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Learning analysis of health system resilience.

The emergence of 'resilience' as a concept for analysing health systems-especially in low- and middle-income countries-has been trailed by debates on whether 'resilience' is a process or an outcome. This debate poses a methodological challenge. What 'health system resilience' is interpreted to mean shapes the approach taken to its analysis. To address this methodological challenge, we propose 'learning' as a concept versatile enough to navigate the 'process versus outcome' tension. Learning-defined as 'the development of insights, knowledge, and associations between past actions, the effectiveness of those actions, and future actions'-we argue, can animate features that tend to be silenced in analyses of resilience. As with learning, the processes involved in resilience are cyclical: from absorption to adaptation, to transformation, and then to anticipation of future disruption. Learning illuminates how resilience occurs-or fails to occur-interactively and iteratively within complex systems while acknowledging the contextual, cognitive, and behavioural capabilities of individuals, teams, and organizations that contribute to a system's emergence from or evolution given shocks/stress. Learning analysis can help to resist the pull towards framing resilience as an outcome-as resilience is commonly used to mean or suggest a state or an attribute, rather than a process that unfolds, whether the outcomes are deemed positive or not. Analysing resilience as a learning process can help health systems researchers better systematically make sense of health system responses to present and future stress/shocks. In qualitative or quantitative analyses, seeing what is to be analysed as 'learning' rather than the more nebulous 'resilience' can refocus attention on what is to be measured, explained, and how-premised on the understanding that a health system with the ability to learn is the one with the ability to be resilient, regardless of the outcome of such a process.

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来源期刊
Health policy and planning
Health policy and planning 医学-卫生保健
CiteScore
6.00
自引率
3.10%
发文量
98
审稿时长
6 months
期刊介绍: Health Policy and Planning publishes health policy and systems research focusing on low- and middle-income countries. Our journal provides an international forum for publishing original and high-quality research that addresses questions pertinent to policy-makers, public health researchers and practitioners. Health Policy and Planning is published 10 times a year.
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