Dugbatey K
Saint Louis University School of Public Health, MO 63108, USA.
Soc Sci Med. 1999 Jul;49(2):223-39. doi: 10.1016/s0277-9536(99)00110-0.
Four countries, Botswana, Cote d'Ivoire, Ghana and Zimbabwe, were chosen as cases to study the impact of national health policies on national health status in sub-Saharan Africa. Through a conceptual framework that covers health problem identification, policy formulation and implementation procedures, the study examined national translations of Primary Health Care (PHC) and Health for All by the Year 2000 (HFA/2000) strategies. A series of government measures, taken between 1980-1986 for health policy development and implementation in these countries, were treated as policy determinants of national health outcomes for the period ending 1990. The impact of these determinants on national health status was then analyzed through a comparative description and documentation of observable patterns and trends in infant mortality rates (IMR), under-5 mortality rates (U5MR) and life expectancy. Policy guidelines from PHC and HFA/2000 were used in conjunction with the respective per capita Gross National Products to categorize the four cases. Based on these guidelines, Botswana was ranked high, both in terms of policy development and the level of economic development, while Zimbabwe ranked high in terms of policy development but relatively low in economic terms. Cote d'Ivoire ranked high on economic development but low with regard to its policy framework. Ghana was at the other end of the spectrum, ranking low both in terms of its policy development and its economic performance. The comparative analysis revealed that Botswana and Zimbabwe performed better than Cote d'Ivoire and Ghana on the three outcome indicators. Despite Cote d'Ivoire's superior level of economic development, its health status fell behind that of Zimbabwe and even Ghana. The study concluded that policies formulated and implemented in accordance with key PHC principles could account for improvements in national health status. Since the end of the study period (1990), there have been significant political changes in the sub-Saharan African region as a whole and in some of the case countries in particular. Political leadership has changed in Ghana and Cote d'Ivoire with some course corrections in Ghana's health plans. Health sector financing in the region has become more dependent on external donors. The World Bank leads the external donor community in promoting policy-based lending. The complexity of a number of health problems has changed while the problems themselves remain the same as before. Essentially, building viable public health infrastructures to address basic public health needs must still be high on the agenda of action for most governments in the region. Thus, notwithstanding some course corrections and reasonable shifts in priorities, all the PHC principles are still applicable, indeed, much needed in the sub-Saharan African region. This study's findings, underscoring the fact that significant improvements in health are possible even where financial resources are limited, still hold true.
博茨瓦纳、科特迪瓦、加纳和津巴布韦这四个国家被选为案例，以研究撒哈拉以南非洲国家卫生政策对国家健康状况的影响。通过一个涵盖健康问题识别、政策制定和实施程序的概念框架，该研究考察了初级卫生保健（PHC）和“2000年人人健康”（HFA/2000）战略在各国的转化情况。1980年至1986年间，这些国家为制定和实施卫生政策采取了一系列政府措施，这些措施被视为截至1990年该时期国家健康结果的政策决定因素。然后，通过对婴儿死亡率（IMR）、五岁以下儿童死亡率（U5MR）和预期寿命的可观察模式及趋势进行比较描述和记录，分析了这些决定因素对国家健康状况的影响。PHC和HFA/2000的政策指南与各国人均国民生产总值相结合，对这四个案例进行分类。根据这些指南，博茨瓦纳在政策制定和经济发展水平方面均排名靠前，而津巴布韦在政策制定方面排名靠前，但经济方面相对较低。科特迪瓦在经济发展方面排名较高，但政策框架方面排名较低。加纳则处于另一端，在政策制定和经济表现方面均排名较低。比较分析表明，在三项结果指标上，博茨瓦纳和津巴布韦的表现优于科特迪瓦和加纳。尽管科特迪瓦经济发展水平较高，但其健康状况却落后于津巴布韦，甚至落后于加纳。该研究得出结论，按照初级卫生保健的关键原则制定和实施的政策能够解释国家健康状况的改善。自研究期结束（1990年）以来，撒哈拉以南非洲地区整体以及一些案例国家，尤其是发生了重大政治变革。加纳和科特迪瓦的政治领导层发生了变化，加纳的卫生计划也进行了一些调整。该地区的卫生部门融资变得更加依赖外部捐助者。世界银行在促进基于政策的贷款方面引领着外部捐助界。一些健康问题的复杂性发生了变化，但问题本身与以前相同。从本质上讲，建立可行的公共卫生基础设施以满足基本公共卫生需求，仍然必须是该地区大多数政府行动议程上的重要事项。因此，尽管进行了一些调整和优先事项的合理转变，但所有初级卫生保健原则仍然适用，实际上，在撒哈拉以南非洲地区非常必要。这项研究的结果强调，即使在财政资源有限的情况下，健康状况也有可能大幅改善，这一点仍然成立。
