Negin Joel, Roberts Graham, Lingam Dharam
Sydney School of Public Health and Menzies Centre for Health Policy, University of Sydney.
Pac Health Dialog. 2010 Sep;16(2):13-23.
Health policy initiatives are under-analysed in the Pacific region. Understanding how health policies develop and evolve is a first step towards improving their quality and contextual appropriateness. Through a document review and key informant interviews, this paper examines the evolution of primary health care in Fiji from 1975 to 2009 focusing on priority-setting, funding, implementation, political economy, the cultural context and interactions among communities, government and donors. Lessons learned from more than 30 years of experience with community health in Fiji are highlighted and reveal high levels of contestation over health policy processes. The paper identifies factors for consideration in renewed primary health interventions and calls for greater government ownership of priority-setting processes, more clarity on the links between policy and funding, more focus on evidence-based policy, greater awareness by development partners of the risks of policy imposition, and a deeper analysis of political economy and culture in relation to health sector policies.
太平洋地区对卫生政策倡议的分析不足。了解卫生政策如何制定和演变是提高其质量和与具体情况适配性的第一步。通过文献回顾和关键信息人访谈，本文考察了1975年至2009年斐济初级卫生保健的演变，重点关注优先事项设定、资金、实施、政治经济、文化背景以及社区、政府和捐助方之间的互动。文中强调了从斐济30多年社区卫生经验中汲取的教训，这些教训揭示了卫生政策过程中存在的高度争议性。本文确定了在重新开展初级卫生干预措施时需考虑的因素，并呼吁政府在优先事项设定过程中发挥更大的主导作用，进一步明确政策与资金之间的联系，更加注重循证政策，发展伙伴要更清楚认识到强行推行政策的风险，以及更深入地分析与卫生部门政策相关的政治经济和文化。
