Chopra Mickey, Ford Neil
Health Systems Research Unit, Medical Research Council, South Africa.
Health Promot Int. 2005 Dec;20(4):383-90. doi: 10.1093/heapro/dai018. Epub 2005 Aug 1.
A sustained scaled up response to global public health challenges such as HIV/AIDS will require a functioning and efficient health system, based on the foundation of strong primary health care. Whilst this is necessary, it is not sufficient. Health promotion strategies need to be put into place to better engage and support families and communities in preventing disease, optimize caring, creating the demand for services and holding service providers to account. There will have to be a move away from the traditional model whereby the problem of HIV/TB/malaria is to be solved by merely increasing resources to a centralized bureaucracy that tries to increase the supply of services including health promotion messages. Development projects and programs that succeed are based on understanding of local practice and preferences, rather than on internationally 'generalized models' of how people or villages should behave and what they should want. This paper will first briefly review different approaches to scaling up health promotion interventions, some of the key obstacles in scaling up and then suggest some possible solutions with a focus on a human rights based approach. This approach changes the emphasis from the content of the message to the characteristics of a community's organisations and institutions. Scaling up occurs as a process of association between state actors and civil society that is planned strategically and involves a sharing of experience and a strong learning process among the association partners. A human rights-based approach can facilitate such an approach through developing a common vision, delineating roles and responsibility and facilitating communication channels for the most vulnerable. But this will require health development agencies to pursue a more overt political agenda.
要持续扩大对诸如艾滋病毒/艾滋病等全球公共卫生挑战的应对规模，就需要一个基于强大初级卫生保健基础之上、运转良好且高效的卫生系统。虽然这是必要的，但还不够。需要实施健康促进战略，以便更好地促使和支持家庭及社区预防疾病、优化护理、创造对服务的需求并促使服务提供者负责。必须摒弃传统模式，即仅通过增加资源给试图增加包括健康促进信息在内的服务供应的中央官僚机构来解决艾滋病毒/结核病/疟疾问题。成功的发展项目和计划基于对当地做法和偏好的了解，而非基于关于人们或村庄应如何行事以及他们应想要什么的国际 “通用模式”。本文将首先简要回顾扩大健康促进干预措施的不同方法、扩大过程中的一些关键障碍，然后提出一些可能的解决方案，重点是基于人权的方法。这种方法将重点从信息内容转向社区组织和机构的特征。扩大规模是国家行为体与民间社会之间的一种关联过程，这一过程经过战略规划，涉及关联伙伴之间的经验分享和强大的学习过程。基于人权的方法可以通过制定共同愿景、界定角色和责任以及为最弱势群体促进沟通渠道来推动这种方法。但这将要求卫生发展机构推行更公开的政治议程。
