Kamuzora P
Institute of Development Studies, University of Dar-es-Salaam, United Republic of Tanzania.
World Hosp Health Serv. 1996;32(2):22-9.
The paper reviews the initiatives made by the Government of Tanzania to develop intersectoral collaboration for the implementation of Primary Health Care(PHC). It explains why there has been little in those directions. A number of shortcomings were identified during the different phases of PHC implementation, these include: misconception of PHC by the MoH as PHC was paradoxically initiated in the MoH (national level) as a vertical programme alongside other vertical programmes which were not coordinated, formation of the PHC coordinating committees alongside development committees existing at village, district and regional levels gave rise to unnecessary multiplication of committees at these levels: a tendency by the MoH to refrain from implementing its past decisions such as dropping the formation of a National Health Council to guide the PHC-oriented policy formulation process at national level; weakening the national level coordinating mechanism by lack of political legitimacy it deserves; and inadequate legal mechanisms proposed in the 1983 PHC guidelines to back up PHC implementation which were made in reference to only the village level PHC committee. Experience of implementing PHC in Tanzania highlights the point that intersectoral collaboration is not simply a technical issue but as influenced by socio-political factors. This article has raised a number of issues which have to be noted in order to improve intersectoral collaboration in Tanzania. First, is the need to place PHC on Tanzania's political agenda. This may taken time but it is a necessary exercise to undertake. Second, effective mechanisms to foster policy coordination at national level should be developed. Third, intersectoral coordination processes at national level should guide similar processes at subnational levels. Fourth, is always to be aware of an counteract the problems presented by the medical model in health programmes implementation processes.
该论文回顾了坦桑尼亚政府为开展部门间合作以实施初级卫生保健（PHC）所采取的举措。它解释了为何在这些方面进展甚微。在初级卫生保健实施的不同阶段发现了一些不足之处，其中包括：卫生部对初级卫生保健存在误解，因为初级卫生保健自相矛盾地是在卫生部（国家层面）作为一项垂直项目启动的，与其他未协调的垂直项目并行；在村庄、地区和区域层面设立初级卫生保健协调委员会以及现有的发展委员会，导致这些层面的委员会不必要地增多；卫生部倾向于不执行其过去的决定，比如放弃成立国家卫生委员会以指导国家层面以初级卫生保健为导向的政策制定过程；由于缺乏应有的政治合法性，国家层面的协调机制被削弱；1983年初级卫生保健指南中提出的法律机制不足，无法支持初级卫生保健的实施，这些机制仅涉及村级初级卫生保健委员会。坦桑尼亚实施初级卫生保健的经验凸显了这样一个观点，即部门间合作不仅仅是一个技术问题，还受到社会政治因素的影响。本文提出了一些为改善坦桑尼亚部门间合作而必须注意的问题。首先，需要将初级卫生保健提上坦桑尼亚的政治议程。这可能需要时间，但却是一项必要的工作。其次，应建立有效的国家层面政策协调机制。第三，国家层面的部门间协调进程应指导次国家层面的类似进程。第四，始终要意识到并应对卫生项目实施过程中医疗模式带来的问题。
