Bhuyan Khanindra Kumar
London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
BMC Public Health. 2004 Apr 16;4:11. doi: 10.1186/1471-2458-4-11.
The concepts of health promotion, self-care and community participation emerged during 1970s, primarily out of concerns about the limitation of professional health system. Since then there have been rapid growth in these areas in the developed world, and there is evidence of effectiveness of such interventions. These areas are still in infancy in the developing countries. There is a window of opportunity for promoting self care and community participation for health promotion.
A broad outline is proposed for designing a health promotion programme in developing countries, following key strategies of the Ottawa Charter for health promotion and principles of self care and community participation. Supportive policies may be framed. Self care clearinghouses may be set up at provincial level to co-ordinate the programme activities in consultation with district and national teams. Self care may be promoted in the schools and workplaces. For developing personal skills of individuals, self care information, generated through a participatory process, may be disseminated using a wide range of print and audio-visual tools and information technology based tools. One such potential tool may be a personally held self care manual and health record, to be designed jointly by the community and professionals. Its first part may contain basic self care information and the second part may contain outlines of different personally-held health records to be used to record important health and disease related events of an individual. Periodic monitoring and evaluation of the programme may be done. Studies from different parts of the world indicate the effectiveness and cost-effectiveness of self care interventions. The proposed outline has potential for health promotion and cost reduction of health services in the developing countries, and may be adapted in different situations.
Self care, community participation and health promotion are emerging but dominant areas in the developed countries. Elements of a programme for health promotion in the developing countries following key principles of self care and community participation are proposed. Demonstration programmes may be initiated to assess the feasibility and effectiveness of this programme before large scale implementation.
健康促进、自我保健和社区参与的概念于20世纪70年代出现，主要源于对专业卫生系统局限性的担忧。从那时起，这些领域在发达国家迅速发展，并有证据表明此类干预措施是有效的。而这些领域在发展中国家仍处于起步阶段。目前存在一个促进自我保健和社区参与以推动健康促进的机遇之窗。
按照《渥太华健康促进宪章》的关键战略以及自我保健和社区参与的原则，为发展中国家设计健康促进项目提出了一个大致框架。可以制定支持性政策。可在省级设立自我保健信息中心，与地区和国家团队协商以协调项目活动。可在学校和工作场所推广自我保健。为培养个人技能，通过参与式过程生成的自我保健信息可利用各种印刷和视听工具以及基于信息技术的工具进行传播。一种这样的潜在工具可能是由社区和专业人员共同设计的个人持有的自我保健手册和健康记录。其第一部分可能包含基本的自我保健信息，第二部分可能包含不同的个人持有的健康记录大纲，用于记录个人重要的健康和疾病相关事件。可对该项目进行定期监测和评估。来自世界不同地区的研究表明自我保健干预措施的有效性和成本效益。所提议的框架对发展中国家的健康促进和降低卫生服务成本具有潜力，并且可根据不同情况进行调整。
自我保健、社区参与和健康促进在发达国家是新兴但占主导地位的领域。提出了遵循自我保健和社区参与关键原则的发展中国家健康促进项目的要素。在大规模实施之前，可启动示范项目以评估该项目的可行性和有效性。
