Ambegaokar Maia, Lush Louisiana
Health Policy Unit, London School of Hygiene, UK.
Health Policy Plan. 2004 Oct;19 Suppl 1:i22-i30. doi: 10.1093/heapol/czh042.
Advocates of health system reform are calling for, among other things, decentralized, autonomous managerial and financial control, use of contracting and incentives, and a greater reliance on market mechanisms in the delivery of health services. The family planning and sexual health (FP&SH) sector already has experience of these. In this paper, we set forth three typical means of service provision within the FP&SH sector since the mid-1900s: independent not-for-profit providers, vertical government programmes and social marketing programmes. In each case, we present the context within which the service delivery mechanism evolved, the management techniques that characterize it and the lessons learned in FP&SH that are applicable to the wider debate about improving health sector management. We conclude that the FP&SH sector can provide both positive and negative lessons in the areas of autonomous management, use of incentives to providers and acceptors, balancing of centralization against decentralization, and employing private sector marketing and distribution techniques for delivering health services. This experience has not been adequately acknowledged in the debates about how to improve the quality and quantity of health services for the poor in developing countries. Health sector reform advocates and FP&SH advocates should collaborate within countries and regions to apply these management lessons.
卫生系统改革的倡导者们呼吁进行多项改革，其中包括权力下放、自主管理和财务控制，采用合同制和激励措施，以及在提供卫生服务方面更多地依赖市场机制。计划生育与性健康（FP&SH）部门已经有了这方面的经验。在本文中，我们阐述了自20世纪中叶以来FP&SH部门内三种典型的服务提供方式：独立的非营利性提供者、垂直的政府项目和社会营销项目。在每种情况下，我们都介绍了服务提供机制演变的背景、其特点的管理技术以及在FP&SH领域所吸取的、适用于关于改善卫生部门管理的更广泛辩论的经验教训。我们得出结论，FP&SH部门在自主管理、对提供者和接受者使用激励措施、集权与分权的平衡以及采用私营部门营销和分销技术来提供卫生服务等方面，既可以提供正面经验，也可以提供负面教训。在关于如何提高发展中国家穷人的卫生服务质量和数量的辩论中，这一经验尚未得到充分认可。卫生部门改革倡导者和FP&SH倡导者应在国家和地区层面进行合作，以应用这些管理经验。
