Botha J L, Bradshaw D, Gonin R, Yach D
Institute for Biostatistics, SA Medical Research Council, Tygerberg, South Africa.
Soc Sci Med. 1988;26(8):845-51. doi: 10.1016/0277-9536(88)90177-3.
The authors recognize that social, economic and political factors play a larger role in determining public health policy than do epidemiological principles such as the analysis of needs, demand and supply. Nevertheless, demographic and mortality statistics, information from the 1983 registers of medical and dental practitioners, and that of nurses, as well as information on hospital beds were reviewed to describe health care requirements and resources in South Africa. The maldistribution observed in health needs and services closely parallel the divisions in South African society imposed by the apartheid policy. It is concluded that fundamental political change is required to reduce this maldistribution. The provision of preventive and promotive health services for children in African rural and peri-urban areas was identified as a health care requirement of high priority. It is thought that the need in these geographical regions might best be met by employing primary health care workers at a lower level of training than doctors with an accessible, supporting referral system. In addition, the quality of health care data being collected needs to be improved. It is suggested that both these problems be approached on a regional basis, and preferably under a single health authority, rather than the current fragmented health service.
作者认识到，在决定公共卫生政策方面，社会、经济和政治因素比诸如需求、需求与供应分析等流行病学原则发挥着更大的作用。尽管如此，还是对人口统计和死亡率统计数据、1983年医生、牙医以及护士登记信息，还有医院病床信息进行了审查，以描述南非的医疗保健需求和资源情况。在卫生需求和服务方面观察到的分布不均现象与种族隔离政策给南非社会造成的划分情况极为相似。得出的结论是，需要进行根本性的政治变革以减少这种分布不均。为非洲农村和城市周边地区的儿童提供预防和促进健康服务被确定为一项高度优先的医疗保健需求。有人认为，通过雇用培训水平低于医生的初级卫生保健工作者，并建立一个可及的、支持性的转诊系统，可能最能满足这些地理区域的需求。此外，正在收集的医疗保健数据的质量需要提高。建议在区域基础上处理这两个问题，最好是在单一的卫生当局之下，而不是在当前分散的卫生服务体系下。
