Cervantes S, Raabe C
Instituto Costarricense de Investigación y Ensenanza en Nutrición y Salúd (INCIENSA), San José, Costa Rica.
Scand J Soc Med Suppl. 1991;46:43-52.
The objective of the present project is to evaluate the relative importance of different governmental social programmes for health development during the 1970's. National statistics available for the whole period and disaggregated to district level were analyzed with particular regard to three indicators of infant health status when the infant mortality rate was used, increased access to secondary care and improved socio-economic status were related to improvement in infant health status. When the percentage of neonatal deaths or the percentage of deceased live births per woman was used, neither the socio-economic improvement nor the assess to secondary did explain the improvement. Moreover, the primary health programme did not seem to be of importance in explaining the changes in the three indicators of infant health status. A second phase of the project, currently ongoing, is aimed at the evaluation of other factors such as the degree of efficiency of some of the health programmes. This study is based on directly collected information, quantitative as well as qualitative. Structured interviews have been used together with anthropological information from in-depth interviews with individuals and groups. The preliminary results of this second phase indicate that the contradictions observed in the first phase might be due to shortcomings in the national registers. In one of the study areas the coverage of PHC developed earlier than indicated by the official information. In other areas it was found that different obstacles as access problems, lack of health centers, socio-economical problems and lack of cultural knowledge reduced the effectiveness and impact of the primary health programmes.
本项目的目标是评估20世纪70年代不同政府社会健康发展项目的相对重要性。分析了整个时期可获得的、按地区分类的国家统计数据，特别关注婴儿健康状况的三个指标，即婴儿死亡率、二级医疗服务可及性的提高以及社会经济状况的改善与婴儿健康状况改善之间的关系。当使用新生儿死亡百分比或每名妇女死产活产百分比时，社会经济改善和二级医疗服务可及性均无法解释这种改善情况。此外，初级卫生保健项目似乎对解释婴儿健康状况的三个指标的变化并不重要。该项目目前正在进行的第二阶段旨在评估其他因素，如一些卫生项目的效率程度。本研究基于直接收集的信息，包括定量和定性信息。已将结构化访谈与来自对个人和群体进行深入访谈的人类学信息结合使用。第二阶段的初步结果表明，第一阶段观察到的矛盾可能是由于国家登记册存在缺陷。在其中一个研究地区，初级卫生保健的覆盖范围比官方信息显示的发展得更早。在其他地区发现，诸如获得医疗服务的问题、缺乏卫生中心、社会经济问题以及缺乏文化知识等不同障碍降低了初级卫生保健项目的有效性和影响力。
