Dohn Anita L, Chávez Andrea, Dohn Michael N, Saturria Luis, Pimentel Carlos
La Iglesia Episcopal Dominicana, La Clínica Esperanza y Caridad, San Pedro de Macorís, San Pedro de Macorís, Dominican Republic.
Rev Panam Salud Publica. 2004 Mar;15(3):185-93. doi: 10.1590/s1020-49892004000300007.
To assess the impact of health promotion programs and microcredit programs on three communities in the Dominican Republic. One community had only the health promotion program, one community had only the microcredit program, and one community had both a health promotion program and a microcredit program. This pilot project examined the hypothesis that the largest changes in 11 health indicators that were studied would be in the community with both a health promotion program and a microcredit program, that there would be intermediate changes in the community with only a health promotion program, and that the smallest changes would be in the community with only a microcredit program.
The health promotion programs used community volunteers to address two major concerns: (1) the prevalent causes of mortality among children under 5 years of age and (2) women's health (specifically breast and cervical cancer screening). The microcredit program made small loans to individuals to start or expand small businesses. Outcome measures were based on comparisons for 11 health indicators from baseline community surveys (27 households surveyed in each of the three communities, done in December 2000 and January 2001) and from follow-up surveys (also 27 households surveyed in each of the three communities, in June and July 2002, after the health promotion program had been operating for about 13 months). Households were randomly chosen during both the baseline and follow-up surveys, without regard to their involvement in the microcredit or health promotion programs.
The health indicators improved in all three communities. However, the degree of change was different among the communities (P < 0.001). The community with parallel microcredit and health promotion programs had the largest changes for 10 of the 11 health indicators.
Multisector development is known to be important on a macroeconomic scale. The results of this pilot project support the view that multisector development is also important on a microeconomic level, given that the parallel microcredit and health promotion programs resulted in greater change in the measured health indicators than either program alone. As far as we authors know, this is the first published study to quantify changes in health indicators related to parallel health promotion and microcredit programs as compared to control communities with only a health promotion program or a microcredit program.
评估健康促进项目和小额信贷项目对多米尼加共和国三个社区的影响。一个社区仅有健康促进项目，一个社区仅有小额信贷项目，还有一个社区既有健康促进项目又有小额信贷项目。该试点项目检验了以下假设：在所研究的11项健康指标中，变化最大的将是既有健康促进项目又有小额信贷项目的社区，仅有健康促进项目的社区变化程度中等，而仅有小额信贷项目的社区变化最小。
健康促进项目利用社区志愿者解决两个主要问题：（1）5岁以下儿童死亡的常见原因；（2）妇女健康（特别是乳腺癌和宫颈癌筛查）。小额信贷项目向个人提供小额贷款以启动或扩大小企业。结果指标基于对2000年12月和2001年1月进行的基线社区调查（三个社区各调查27户家庭）以及后续调查（2002年6月和7月，在健康促进项目运行约13个月后，三个社区同样各调查27户家庭）中11项健康指标的比较。在基线调查和后续调查中，家庭都是随机选取的，不考虑其是否参与小额信贷或健康促进项目。
所有三个社区的健康指标都有所改善。然而，各社区的变化程度不同（P<0.001）。在11项健康指标中的10项上，同时开展小额信贷和健康促进项目的社区变化最大。
众所周知，多部门发展在宏观经济层面很重要。该试点项目的结果支持了这样一种观点，即多部门发展在微观经济层面也很重要，因为同时开展小额信贷和健康促进项目比单独开展任何一个项目在测量的健康指标上带来的变化更大。据我们作者所知，这是第一项发表的研究，量化了与同时开展健康促进和小额信贷项目的社区相比，仅有健康促进项目或小额信贷项目的对照社区健康指标的变化情况。
