Satia J K, Mavalankar D V, Sharma B
Indian Institute of Management, Ahmedabad, India.
Health Policy Plan. 1994 Sep;9(3):318-30. doi: 10.1093/heapol/9.3.318.
This paper describes the use of a rapid assessment technique in micro-level planning for primary health care services which has been developed in India. This methodology involves collecting household-level data through a quick sample survey to estimate client needs, coverage of services and unmet need, and using this data to formulate micro-level plans aimed at improving service coverage and quality for a primary health centre area. Analysis of the data helps to identify village level variations in unmet need and develop village profiles from which general interventions for overall improvement of service coverage and targeted interventions for selected villages are identified. A PHC area plan is developed based on such interventions. This system was tried out in 113 villages of three PHC centres of a district in Gujarat state of India. It demonstrated the feasibility and utility of this approach. However, it also revealed the barriers in the institutionalization of the system on a wider scale. The proposed micro-level planning methodology using rapid assessment would improve client-responsiveness of the health care system and provide a basis for increased decentralization. By focusing attention on under-served areas, it would promote equity in the use of health services. It would also help improve efficiency by making it possible to focus efforts on a small group of villages which account for most of the unmet need for services in an area. Thus the proposed methodology seems to be a feasible and an attractive alternative to the current top-down, target-based health planning in India.
本文描述了一种在印度开发的用于初级卫生保健服务微观层面规划的快速评估技术。该方法包括通过快速抽样调查收集家庭层面的数据，以估计客户需求、服务覆盖范围和未满足的需求，并利用这些数据制定微观层面的计划，旨在提高初级卫生保健中心区域的服务覆盖范围和质量。对数据的分析有助于识别未满足需求在村庄层面的差异，并形成村庄概况，据此确定全面改善服务覆盖范围的一般干预措施以及针对选定村庄的针对性干预措施。基于此类干预措施制定初级卫生保健区域计划。该系统在印度古吉拉特邦一个地区的三个初级卫生保健中心的113个村庄进行了试验。它证明了这种方法的可行性和实用性。然而，它也揭示了该系统在更广泛范围内制度化的障碍。所提议的使用快速评估的微观层面规划方法将提高医疗保健系统对客户的响应能力，并为加强权力下放提供依据。通过关注服务不足的地区，它将促进卫生服务利用的公平性。它还将有助于提高效率，因为可以将工作重点放在一小部分村庄上，这些村庄占该地区大部分未满足的服务需求。因此，所提议的方法似乎是印度目前自上而下、基于目标的卫生规划的一种可行且有吸引力的替代方案。
