Yassoub Rami, Hashimi Suha, Awada Siham, El-Jardali Fadi
Department of Health Management and Policy, American University of Beirut, Lebanon.
Int J Health Plann Manage. 2014 Oct-Dec;29(4):407-21. doi: 10.1002/hpm.2192. Epub 2013 Jun 3.
Lebanon currently faces a rise in non-communicable diseases (NCD) that is stressing the population's health and financial well-being. Preventive care is recognized as the optimal health equitable, cost-effective solution. The study aims to assess the responsiveness of primary health care centers (PHCs) to NCD, and identify the needed health arrangements and responsibilities of PHCs, the Ministry Of Public Health and other healthcare system entities, for PHCs to purse a more preventive role against NCD. Single and group interviews were conducted via a semi-structured questionnaire with 10 PHCs from Lebanon's primary health care network that have undergone recent pilot accreditation and are recognized for having quality services and facilities. This manifested administrative aspects and NCD-related services of PHCs and generated information regarding the centers' deficiencies, strengths and areas needing improvement for fulfilling a more preventive role. Administrative features of PHCs varied according to number and type of health personnel employed. Variations and deficiencies within and among PHCs were manifested specifically at the level of cardiovascular and respiratory diseases and cancer. PHCs identified the pilot accreditation as beneficial at the administrative and clinical levels; however, various financial and non-financial resources, in addition to establishing a strong referral system with secondary care settings and further arrangements with MOPH, are necessary for PHCs to pursue a stronger preventive role. The generated results denote needed changes within the healthcare system's governance, financing and delivery. They involve empowering PHCs and increasing their breadth of services, allocating a greater portion of national budget to health and preventive care, and equipping PHCs with personnel skilled in conducting community-wide preventive activities.
黎巴嫩目前面临非传染性疾病（NCD）的增加，这给民众的健康和经济福祉带来了压力。预防保健被认为是最佳的健康公平、具有成本效益的解决方案。该研究旨在评估初级卫生保健中心（PHC）对非传染性疾病的应对能力，并确定初级卫生保健中心、公共卫生部和其他医疗系统实体所需的卫生安排和责任，以使初级卫生保健中心在预防非传染性疾病方面发挥更大作用。通过半结构化问卷对黎巴嫩初级卫生保健网络中的10家初级卫生保健中心进行了单人访谈和小组访谈，这些中心最近通过了试点认证，并以优质的服务和设施而闻名。这体现了初级卫生保健中心的行政方面和与非传染性疾病相关的服务，并产生了有关这些中心在履行更大预防作用方面的不足、优势和需要改进的领域的信息。初级卫生保健中心的行政特点因所雇用的卫生人员数量和类型而异。初级卫生保健中心内部和之间的差异和不足尤其体现在心血管疾病、呼吸系统疾病和癌症方面。初级卫生保健中心认为试点认证在行政和临床层面都有益；然而，除了与二级医疗机构建立强大的转诊系统以及与公共卫生部进一步安排外，初级卫生保健中心还需要各种财政和非财政资源，以发挥更强的预防作用。所产生的结果表明医疗系统在治理、融资和服务提供方面需要变革。这些变革包括赋予初级卫生保健中心权力并增加其服务范围，将国家预算中更大的一部分分配给卫生和预防保健，并为初级卫生保健中心配备有能力开展全社区预防活动的人员。
