Cavender A, Albán M
Department of Sociology and Anthropology, East Tennessee State University, Johnson City 37614, USA.
Soc Sci Med. 1998 Dec;47(12):1937-46. doi: 10.1016/s0277-9536(98)00335-9.
Compulsory medical service programs for physicians and other health care professionals have been installed in developing countries around the world. The underlying assumption for the creation of these programs is that the increased presence of physicians will improve the health status of rural populations which exhibit higher rates of morbidity and mortality compared to urban populations. This assumption, however, has been challenged by recent evaluative studies of compulsory service programs in Latin America. This paper reports on the physician's perspective of Ecuador's compulsory service program, known as medicatura rural. Based on responses to a self-administered questionnaire completed by 127 physicians who had fulfilled or were currently fulfilling their medicatura rural requirement, in-depth interviews with physicians and other officials, and visits to several rural placement sites, the paper examines some of the fundamental programmatic and logistical problems that have impeded the successful implementation of the program since its inception in 1970. While the majority of the physicians reported that the medicatura rural experience was both professionally and personally rewarding, many view the program as conceptually flawed with respect to its goal of improving the health status of rural communities. The physicians' suggestions for improving the medicatura rural, which elucidate some of the program's basic conceptual flaws and reflect the criticisms of compulsory medical programs in other Latin American countries, are discussed. Finally, Ugalde's (1988) recommendation for replacing compulsory medical service programs with a "rural health corps" is considered.
世界上许多发展中国家都实施了针对医生和其他医疗保健专业人员的义务医疗服务项目。设立这些项目的基本假设是，增加医生的数量将改善农村人口的健康状况，与城市人口相比，农村人口的发病率和死亡率更高。然而，最近对拉丁美洲义务医疗服务项目的评估研究对这一假设提出了挑战。本文报告了医生对厄瓜多尔义务医疗服务项目（称为农村医疗服务）的看法。基于对127名已完成或正在履行农村医疗服务要求的医生填写的自填式问卷的回复、对医生和其他官员的深入访谈以及对几个农村服务地点的访问，本文研究了自1970年该项目启动以来阻碍其成功实施的一些基本的项目和后勤问题。虽然大多数医生报告说农村医疗服务经历在职业和个人方面都很有收获，但许多人认为该项目在改善农村社区健康状况的目标方面存在概念上的缺陷。讨论了医生们对改进农村医疗服务的建议，这些建议阐明了该项目的一些基本概念缺陷，并反映了其他拉丁美洲国家对义务医疗项目的批评。最后，考虑了乌加尔德（1988年）提出的用“农村卫生 corps”取代义务医疗服务项目的建议。
