Rohde Jon, Cousens Simon, Chopra Mickey, Tangcharoensathien Viroj, Black Robert, Bhutta Zulfiqar A, Lawn Joy E
Management Sciences for Health, Boston, MA, USA; James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
Lancet. 2008 Sep 13;372(9642):950-61. doi: 10.1016/S0140-6736(08)61405-1.
We assessed progress for primary health care in countries since Alma-Ata. First we analysed life expectancy relative to national income and HIV prevalence to identify overachieving and underachieving countries. Then we focused on the 30 low-income and middle-income countries with the highest average yearly reduction of mortality among children less than 5 years of age, describing coverage and equity of primary health care as well as non-health sector actions. These 30 countries have scaled up selective primary health care (eg, immunisation, family planning), and 14 have progressed to comprehensive primary health care, marked by high coverage of skilled attendance at birth. Good governance and progress in non-health sectors are seen in almost all of the 14 countries identified with a comprehensive primary health care system. However, these 30 countries include those that are making progress despite very low income per person, political instability, and high HIV/AIDS prevalence. Thailand has the highest average yearly reduction in mortality among children less than 5 years of age (8.5%) and has achieved universal coverage of immunisation and skilled birth attendance, with low inequity. Lessons learned from all these countries include the need for a nationally agreed package of prioritised and phased primary health care that all stakeholders are committed to implementing, attention to district management systems, and consistent investment in primary health-care extension workers linked to the health system. More detailed analysis and evaluation within and across countries would be invaluable in guiding investments for primary health care, and expediting progress towards the Millennium Development Goals and "health for all".
自《阿拉木图宣言》发布以来，我们评估了各国在初级卫生保健方面取得的进展。首先，我们分析了预期寿命与国民收入及艾滋病毒流行率的关系，以确定表现优异和表现欠佳的国家。然后，我们聚焦于5岁以下儿童死亡率年平均降幅最高的30个低收入和中等收入国家，描述了初级卫生保健的覆盖范围和公平性以及非卫生部门的行动。这30个国家扩大了选择性初级卫生保健（如免疫接种、计划生育）的规模，其中14个国家已迈向全面初级卫生保健，其标志是熟练接生服务的高覆盖率。在确定拥有全面初级卫生保健系统的14个国家中，几乎所有国家都具备良好治理且非卫生部门取得了进展。然而，这30个国家包括了那些尽管人均收入很低、政治不稳定且艾滋病毒/艾滋病流行率很高但仍取得进展的国家。泰国5岁以下儿童死亡率的年平均降幅最高（8.5%），并实现了免疫接种和熟练接生服务的全民覆盖，不公平现象较少。从所有这些国家吸取的经验教训包括，需要有一个全国商定的、分阶段实施的优先初级卫生保健包，所有利益攸关方都致力于实施，关注地区管理系统，以及持续投资于与卫生系统挂钩的初级卫生保健推广工作者。在国家内部和国家之间进行更详细的分析和评估，对于指导初级卫生保健投资以及加快实现千年发展目标和“人人享有健康”将非常宝贵。
