Bryant J H, Zuberi R W, Thaver I H
Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
Infect Dis Clin North Am. 1991 Jun;5(2):403-16.
The title of this article raises a complex set of questions. To begin, what happened at Alma Ata and the goal that emanated from it-Health for All by the Year 2000--are themselves controversial matters. At least there are some who are strongly critical of those events and ideas. Even without linking academic institutions with Alma Ata and HFA/2000, a controversy is spawned when one asks about the roles of such institutions in dealing with societal problems--which problems should a university address, and how deeply does a university become engaged in them, particularly if it carries the university out of the cloister into the trenches of societal conflict? Linking academic institutions with Alma Ata and HFA/2000 deepens the controversy but also provides a framework for examining the basic principles on which each is based, and for testing those principles against the realities of real world problems of health development. This article draws on recent critical assessments of both sides of the equation: a recent Consultative Committee to the Director General of WHO that analyzes the successes and failures of PHC development to date, and lays out conditions for greater effectiveness in the future; and the Technical Discussions of WHO on the Roles of Universities in the Strategy for Health for All that review traditional and progressive arguments about the roles of universities in their societies, and how HFA can be seen as fitting into that debate. The thinking contained in these documents provides ample opportunity to examine whether or not academic institutions should have a role that relates to Alma Ata and Health for All, and, in the end, takes the position that, indeed, this is an appropriate role for those universities prepared to make the commitment. The point is also made that such involvement cannot be effective if the scale of the institutional commitment is marginal--it must be substantial and institution-wide. An example is given of the Aga Khan University in Karachi, Pakistan, an institution avowedly committed to a community orientation and to health services development. The Network of Community-Oriented Educational Institutions for Health Sciences can be considered a movement of educational institutions in this direction. It is functioning with considerable creative initiative in addressing issues having to do with problem-based teaching methods, community orientation, and partnerships with governmental health services.(ABSTRACT TRUNCATED AT 400 WORDS)
本文的标题引发了一系列复杂的问题。首先，在阿拉木图发生的事情以及由此产生的目标——到2000年实现全民健康——本身就是有争议的问题。至少有一些人对这些事件和理念提出了强烈批评。即使不将学术机构与阿拉木图及2000年全民健康目标联系起来，当人们问及这些机构在处理社会问题时的作用时——大学应该解决哪些问题，以及大学在这些问题上参与的深度如何，尤其是如果这使大学走出象牙塔，投身到社会冲突的前沿时，也会引发一场争议。将学术机构与阿拉木图及2000年全民健康目标联系起来，不仅加深了争议，还提供了一个框架，用于审视它们各自所基于的基本原则，并根据健康发展实际问题的现实情况来检验这些原则。本文借鉴了对这一问题双方的近期批判性评估：世界卫生组织总干事最近的一个协商委员会，该委员会分析了迄今为止初级卫生保健发展的成败，并为未来提高成效制定了条件；以及世界卫生组织关于大学在全民健康战略中的作用的技术讨论，该讨论回顾了关于大学在其社会中的作用的传统和进步观点，以及全民健康如何融入这场辩论。这些文件中的思想提供了充分的机会来审视学术机构是否应该在与阿拉木图及全民健康相关的方面发挥作用，最终得出的立场是，对于那些准备做出承诺的大学来说，这确实是一个合适的角色。文中还指出，如果机构承诺的规模微不足道，这种参与就不会有效——它必须是实质性的且涵盖整个机构。文中举了巴基斯坦卡拉奇的阿迦汗大学的例子，该机构公然致力于以社区为导向并发展卫生服务。面向社区的健康科学教育机构网络可以被视为教育机构朝着这个方向发展的一个举措。它在解决与基于问题的教学方法、社区导向以及与政府卫生服务的伙伴关系相关的问题时，发挥着相当大的创造性主动性。（摘要截取自400字）
