BACKGROUND Access to qualitative and equitable healthcare is a major challenge in Mauritania. In order to support the country's efforts, a health sector strengthening programme was set up with participatory action research at its core. Reinforcing a health system requires a customised and comprehensive approach to face the complexity inherent to health systems. Yet, limited knowledge is available on how policies could enhance the performance of the system and how multi-stakeholder efforts could give rise to changes in health policy. We aimed to analyse the ongoing participatory action research and, more specifically, see in how far action research as an embedded research approach could contribute to strengthening health systems. METHODS We adopted a single-case study design, based on two subunits of analysis, i.e., two selected districts. Qualitative data were collected by analysing country and programme documents, conducting 12 semi-structured interviews and performing participatory observations. Interviewees were selected based on their current position and participation in the programme. The data analysis was designed to address the objectives of the study, but evolved according to emerging insights and through triangulation and identification of emergent and/or recurrent themes along the process. RESULTS An evaluation of the progress made in the two districts indicates that continuous capacity-building and empowerment efforts through a participative approach have been key elements to enhance dialogue between, and ownership of, the actors at the local health system level. However, the strong hierarchical structure of the Mauritanian health system and its low level of decentralisation constituted substantial barriers to innovation. Other constraints were sociocultural and organisational in nature. Poor work ethics due to a weak environmental support system played an important role. While aiming for an alignment between the flexible iterative approach of action research and the prevailing national linear planning process is quite challenging, effects on policy formulation and implementation were not observed. An adequate time frame, the engagement of proactive leaders, maintenance of a sustained dialogue and a pragmatic, flexible approach could further facilitate the process of change. CONCLUSION Our study showcases that the action research approach used in Mauritania can usher local and national actors towards change within the health system strengthening programme when certain conditions are met. An inclusive, participatory approach generates dynamics of engagement that can facilitate ownership and strengthen capacity. Continuous evaluation is needed to measure how these processes can further develop and presume a possible effect at policy level.

中文翻译：

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行动研究和卫生系统加强：西非毛里塔尼亚的卫生部门支助方案。

背景技术在毛里塔尼亚，获得定性和公平的医疗保健是一项重大挑战。为了支持该国的努力，制定了一项以参与性行动研究为核心的加强卫生部门计划。加强卫生系统需要采用定制的综合方法来应对卫生系统固有的复杂性。然而，关于政策如何能够提高系统性能以及多方利益相关者的努力如何引起卫生政策变化的知识还很少。我们旨在分析正在进行的参与式行动研究，更具体地说，是将行动研究作为一种嵌入式研究方法，可以在多大程度上有助于加强卫生系统。方法我们基于两个分析子单元（即两个选定的地区），采用了单案例研究设计。通过分析国家和计划文件，进行12次半结构化访谈并进行参与性观察来收集定性数据。根据受访者的当前职位和参与计划选择他们。数据分析旨在解决研究的目标，但根据新兴的见解并通过三角剖分和识别过程中出现的和/或经常出现的主题而发展。结果对两个地区取得的进展进行的评估表明，通过参与性方法进行的持续能力建设和赋权工作已成为在地方卫生系统一级加强行动者之间对话和主人翁意识的关键要素。然而，毛里塔尼亚卫生系统强大的等级结构和较低的权力下放构成了创新的重大障碍。其他限制因素是社会文化和组织性质。由于薄弱的环境支持体系，不良的职业道德起了重要作用。尽管要使行动研究的灵活迭代方法与现行的国家线性规划过程保持一致是非常具有挑战性的，但并未观察到对政策制定和实施的影响。适当的时限，积极的领导者参与，保持持续的对话以及务实，灵活的做法可以进一步促进变革进程。结论我们的研究表明，毛里塔尼亚使用的行动研究方法可以在满足某些条件的情况下，促使地方和国家行为者在卫生系统加强计划内进行变革。包容性，参与性方法产生了参与的动力，可以促进主人翁意识和增强能力。需要进行持续评估，以衡量这些流程如何进一步发展并假定可能在政策层面产生影响。