Frenk J, Bobadilla J L, Sepúlveda J, Rosenthal J, Ruelas E, González-Block M A, Urrusti J
J Health Adm Educ. 1986 Summer;4(3):467-81.
This paper presents the conceptual and organizational elements that have guided the development of the Center for Public Health Research (CPHR) in Mexico. The CPHR was established in August 1984, in the midst of the most profound health care reform in Mexico in the last 40 years. The reform has included, among other measures, a Constitutional amendment recognizing the social right to health care, an energetic effort to decentralize the system so that each state will run its own services, an ambitious drive to extend primary health care coverage to all the population, and a strong promotion of research as the basis for strategic planning and for the development of standards of care. The creation of the CPHR is a response to the need for a firm base of epidemiologic and health systems research in Mexico. This need arises from the increasing complexity of the country's organizational arrangements for health care. In addition, the patterns of morbidity and mortality are also becoming more intricate, as Mexico is experiencing an epidemiologic transition whereby chronic diseases, mental ailments, and accidents are on the rise even as the incidence of infectious diseases and malnutrition continues to be high. As a unit of the Ministry of Health, the CPHR must strike a balance between relevance to decision making and excellence in the strict adherence to the norms of scientific research. To do so, it has developed a conceptual framework based on a tridimensional matrix. The dimensions of the matrix include substantive areas (i.e., the phenomena to be researched), knowledge areas (i.e., the disciplines pertinent to public health), and methodological areas (i.e., the methods to be applied in each project). The intersection of these dimensions produces different configurations of "research modules" that can be adapted to changing priorities. Current priorities of the CPHR include epidemiologic studies of the emerging conditions in the transition, migration and health, child survival, social organization and primary health care, health systems management, quality of care, and the development of information systems and quantitative models for public health research. Research projects are undertaken in a matrix type of organization in which academic departments are structured according to problems rather than disciplines. The analysis of Mexico's Center for Public Health Research may contribute to similar endeavors in other countries and also to the wider development of comparative studies on research organizations.
本文介绍了指导墨西哥公共卫生研究中心（CPHR）发展的概念和组织要素。CPHR成立于1984年8月，正值墨西哥过去40年中最深刻的医疗改革时期。改革措施包括，除其他外，一项承认医疗保健社会权利的宪法修正案，一项积极的系统分权努力，以便每个州管理自己的服务，一项将初级医疗保健覆盖范围扩大到全体人口的宏伟举措，以及大力推动将研究作为战略规划和制定护理标准的基础。CPHR的创建是为了满足墨西哥对坚实的流行病学和卫生系统研究基础的需求。这种需求源于该国医疗保健组织安排日益复杂。此外，发病率和死亡率模式也变得更加复杂，因为墨西哥正在经历流行病学转变，即慢性病、精神疾病和事故不断增加，而传染病和营养不良的发病率仍然很高。作为卫生部的一个单位，CPHR必须在与决策的相关性和严格遵守科学研究规范方面的卓越性之间取得平衡。为此，它基于一个三维矩阵开发了一个概念框架。矩阵的维度包括实质性领域（即要研究的现象）、知识领域（即与公共卫生相关的学科）和方法学领域（即每个项目中要应用的方法）。这些维度的交叉产生了不同配置的“研究模块”，可以根据不断变化的优先事项进行调整。CPHR目前的优先事项包括对转型期新出现情况的流行病学研究、移民与健康、儿童生存、社会组织与初级医疗保健、卫生系统管理、护理质量，以及公共卫生研究信息系统和定量模型的开发。研究项目是在一种矩阵式组织中进行的，其中学术部门是根据问题而不是学科来构建的。对墨西哥公共卫生研究中心的分析可能有助于其他国家的类似努力，也有助于更广泛地开展对研究组织的比较研究。
