Eyre Rachel, Gauld Robin
Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
Health Promot Int. 2003 Sep;18(3):189-97. doi: 10.1093/heapro/dag014.
Since the mid-1980s, the New Zealand health sector has been in a state of continual change. The most radical changes were in the early-1990s, with the creation of an internal market system for public health care delivery. Rural health services, seen to be unviable, were given the option of establishing themselves as 'community trusts', owning and running their own services. Community trusts have since become a feature of rural health care in New Zealand. An expectation was that community trusts would facilitate community participation. This article reports on a study of participation in a rural community health trust. The 'pentagram model' of Rifkin and coworkers, with its five dimensions of participation-needs assessment, leadership, resource mobilization, management and organization-was applied. High levels of participation were found across each of these dimensions. The research revealed additional dimensions that could be added to the framework, including 'sustainability of participation', 'equity in participation' and 'the dynamic socio-political context'. In this regard, it supports recent theoretical work by Laverack (2001) and Laverack and Wallerstein (2001). Finally, the article comments on the future of rural health trusts in the current round of health sector restructuring.
自20世纪80年代中期以来，新西兰卫生部门一直处于持续变革的状态。最激进的变革发生在20世纪90年代初，当时建立了公共医疗服务的内部市场体系。农村卫生服务被认为不可行，它们可以选择将自己确立为“社区信托机构”，拥有并运营自己的服务。自那以后，社区信托机构已成为新西兰农村医疗保健的一个特色。人们期望社区信托机构能促进社区参与。本文报道了一项关于参与农村社区卫生信托机构的研究。采用了里夫金及其同事的“五角星模型”，该模型有参与的五个维度——需求评估、领导力、资源调动、管理和组织。在这些维度的每一个方面都发现了高水平的参与。研究还揭示了可以添加到该框架中的其他维度，包括“参与的可持续性”、“参与的公平性”和“动态的社会政治背景”。在这方面，它支持了拉韦拉克（2001年）以及拉韦拉克和沃勒斯坦（2001年）最近的理论研究。最后，本文对当前一轮卫生部门重组中农村卫生信托机构的未来发表了评论。
