ABSTRACT
Definitions of health systems strengthening (HSS) have been limited in their inclusion of communities, despite evidence that community involvement improves program effectiveness for many health interventions. We review 15 frameworks for HSS, highlighting how communities are represented and find few delineated roles for community members or organizations. This review raises the need for a cohesive definition of community involvement in HSS and well-described activities that communities can play in the process. We discuss how communities can engage with HSS in four different areas-planning and priority-setting; program implementation; monitoring, evaluation, and quality improvement; and advocacy-and how these activities could be better incorporated into key HSS frameworks. We argue for more carefully designed interactions between health systems policies and structures, planned health systems improvements, and local communities. These interactions should consider local community inputs, strengths, cultural and social assets, as well as limitations in and opportunities for increasing capacity for better health outcomes.
Subject(s)
Community Participation/methods , Global Health , Health Care Reform/organization & administration , Health Policy , Health Priorities/organization & administration , Humans , Quality Improvement/organization & administrationABSTRACT
Emergency Medicine (EM) is a developing specialty in Peru, as is the case in many other countries around the world. The nation's first residency training program was started in 1993 at the Universidad Nacional Mayor de San Marcos (UNMSM). This description of the development, organization, challenges, and goals of the EM specialty in Peru is based on personal experience and communication with other specialists in the country.
