Cliff Julie, Walt Gill, Nhatave Isabel
Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
J Public Health Policy. 2004;25(1):38-55. doi: 10.1057/palgrave.jphp.3190003.
A common assumption is that international health policies are imposed on developing countries, owing to their high level of dependence on international aid. In reality, the process is likely to be complex. Drawing on analytical frameworks developed to study policy transfer between jurisdictions, this paper explores how far two globally promoted infectious disease policies (DOTS for tuberculosis and syndromic management for sexually transmitted infections) were voluntarily or coercively transferred in one particular setting, Mozambique. The paper suggests that guidelines emanating from these policies were not imposed, but evolved in the 1980s through technical networks of national and international experts. Further, that it was experience at the country level that fed into the globally promoted policies of the 1990s. By the time the policies were transferred by WHO and other international organisations to developing countries in the 1990s, Mozambique had already adopted their guidelines for good practice.
一种常见的假设是，由于发展中国家对国际援助的高度依赖，国际卫生政策是强加给它们的。但实际上，这个过程可能很复杂。本文借鉴为研究不同辖区间政策转移而开发的分析框架，探讨了两项全球推广的传染病政策（结核病直接督导短程化疗和性传播感染的症状管理）在莫桑比克这一特定环境中在多大程度上是自愿或强制转移的。本文表明，这些政策产生的指导方针并非被强加，而是在20世纪80年代通过国家和国际专家的技术网络演变而来。此外，正是国家层面的经验促成了20世纪90年代全球推广的政策。到20世纪90年代世界卫生组织和其他国际组织将这些政策转移到发展中国家时，莫桑比克已经采用了它们的良好实践指导方针。
