Clements C John, Nshimirimanda Deo, Gasasira Alex
Centre for International Health, The Macfarlane Burnet Institute for Medical Research and Public Health Ltd., GPO Box 2284, Commercial Road, Melbourne, VIC 3004, Australia.
Vaccine. 2008 Apr 7;26(16):1926-33. doi: 10.1016/j.vaccine.2008.02.032. Epub 2008 Mar 5.
Integration of health services brings together common functions within and between organizations to solve common problems, developing a commitment to a shared vision and goals, and using common technologies and resources to achieve these goals. Integration has been the frustrated rally call of Primary Health Care for 30 years. This paper discusses the process of integrating child survival strategies and other heath services with immunization in Africa. Immunization is arguably the most successful health programme throughout the continent, making it the logical vehicle for add-on services. Strong health systems are the best way of delivering cost-effective child survival interventions in a most sustainable manner. But the reality in many African countries is that health systems have been weak for a number of reasons. Joining additional cost-effective child survival interventions on to immunization services may provide the needed boost. The unacceptably high childhood mortality in parts of Africa makes it the ideal location to undertake this exercise. The urgency to scale-up child survival interventions that have proven cost-effective is especially important if the Millennium Development Goals (MDGs) are to be met by 2015. Africa has more to loose than most in failing to scale up to meet these goals, bearing as it does the highest burden of childhood mortality in the world. But so far, prospects do not look good for achieving MDG-4 for the countries with the highest mortality rates. The timeliness of this initiative towards integration could not be better. In the last five years, countries in Africa have received massive injections of financial resources for polio eradication and measles control as well as additional funding for a range of immunization-strengthening activities and the introduction of new and under-utilized vaccines. While the data to support integration are limited, the information to hand suggests the effectiveness of the strategy. Where immunization performance is strong, immunization contacts may be excellent vehicles for additional interventions such as de-worming or Integrated Management of Childhood Illness (IMCI). But where an immunization service is struggling, adding another child survival intervention on to immunization might be the straw that breaks its back. Health managers have a wide range of options for adding on to immunization services, but the best choice will depend very much on local situations.
卫生服务整合将组织内部及组织之间的共同职能汇聚在一起，以解决共同问题，形成对共同愿景和目标的承诺，并利用共同技术和资源来实现这些目标。30年来，整合一直是初级卫生保健令人沮丧的战斗口号。本文讨论了在非洲将儿童生存战略及其他卫生服务与免疫接种相结合的过程。免疫接种可以说是整个非洲大陆最成功的卫生项目，使其成为附加服务的合理载体。强大的卫生系统是以最可持续的方式提供具有成本效益的儿童生存干预措施的最佳途径。但许多非洲国家的现实情况是，由于多种原因，卫生系统一直很薄弱。在免疫接种服务中加入其他具有成本效益的儿童生存干预措施可能会提供所需的推动。非洲部分地区儿童死亡率高得令人无法接受，这使其成为开展此项工作的理想地点。如果要在2015年实现千年发展目标（MDGs），扩大已证明具有成本效益的儿童生存干预措施的紧迫性尤为重要。如果无法扩大规模以实现这些目标，非洲比大多数地区损失更大，因为它承担着世界上最高的儿童死亡率负担。但到目前为止，对于死亡率最高的国家而言，实现千年发展目标4的前景并不乐观。这项整合举措的及时性再好不过了。在过去五年中，非洲国家获得了大量资金用于根除脊髓灰质炎和控制麻疹，以及为一系列加强免疫活动和引入新的及未充分利用的疫苗提供额外资金。虽然支持整合的数据有限，但手头的信息表明了该战略的有效性。在免疫接种工作出色的地方，免疫接种接触可能是进行其他干预措施（如驱虫或儿童疾病综合管理（IMCI））的绝佳载体。但在免疫接种服务举步维艰的地方，在免疫接种基础上增加另一项儿童生存干预措施可能会成为压垮骆驼的最后一根稻草。卫生管理人员在为免疫接种服务增加内容方面有多种选择，但最佳选择在很大程度上取决于当地情况。
