Mbeva Jean Bosco Kahindo, Karemere Hermès, Schirvel Carole, Porignon Denis
Sante Publique. 2014 Sep-Oct;26(5):685-93.
Intermediate health care structures in the DRC were designed during the setting-up of primary health care in a perspective of health district support. This study was designed to describe stakeholder representations of the intermediate level of the DRC health system during the first 30 years of the primary health care system.
This case study was based on inductive analysis of data from 27 key informant interviews..
The intermediate level of the health system, lacking sufficient expertise and funding during the 1980s, was confined to inspection and control functions, answering to the central level of the Ministry of health and provincial authorities. Since the 1990s, faced with the pressing demand for support from health district teams, whose self-management had to deal with humanitarian emergencies, the need to integrate vertical programmes, and cope with the logistics of many different actors, the intermediate heath system developed methods and tools to support heath districts. This resulted in a subsidiary model of the intermediate level, the perceived efficacy of which varies according to the province over recent years.
The "subsidiary" model of the intermediary health system level seems a good alternative to the "control" model in DRC.
刚果民主共和国的中级卫生保健结构是在建立初级卫生保健时，从卫生区支持的角度设计的。本研究旨在描述在初级卫生保健系统的头30年里，刚果民主共和国卫生系统中级层面的利益相关者的看法。
本案例研究基于对27次关键 informant访谈数据的归纳分析。
卫生系统的中级层面在20世纪80年代缺乏足够的专业知识和资金，仅限于检查和控制职能，向卫生部中央层面和省级当局负责。自20世纪90年代以来，面对卫生区团队对支持的迫切需求，这些团队的自我管理必须应对人道主义紧急情况、整合垂直项目以及应对众多不同行为体的后勤工作，中级卫生系统开发了支持卫生区的方法和工具。这导致了中级层面的一种附属模式，近年来其实际效果因省份而异。
中级卫生系统层面的“附属”模式似乎是刚果民主共和国“控制”模式的一个很好的替代方案。
