Grodos D, de Béthune X
Collaborateurs de l'Unité de Recherche et d'Enseignement en Santé Publique, Institut de Médecine Tropicale, Antwerpen, Belgique.
Soc Sci Med. 1988;26(9):879-89. doi: 10.1016/0277-9536(88)90406-6.
The authors examine the evolution of the PHC approach in historical perspective, present definitions and criteria of what PHC actually means, look upon deviations of conceptual content and practice of PHC and end up with a socio-political as well as a technical critique of the so-called 'selective' PHC. Modern health systems evolved in developing countries modelled on the 'western' biomedical health care systems. Yet even colonial medical services contained also progressive elements, as e.g. the acceptance of the need to de-centralise hospital care to peripheral health posts, or the stress on more rational distribution and utilisation of drugs. The vertical programmes developed under this approach showed clearly their limitations and the conference of Alma-Ata can be looked at as a turning point, where a new model of health care, i.e. PHC, was designed. Though there exists a widespread resistance in industrialised countries against adopting this new model, it was not at all limited only to developing countries. As with every innovative idea, the PHC strategy provoked contradictory views and large differences in interpretation. But, the authors stress, PHC is neither a doctrine, or a theory but the outcome of decades of field-experience of concerned scientists and practitioners. The essential criteria of PHC include: Accessibility: need for improved first contact with the health care system, demanding efforts of decentralising the existing health system without neglecting the quality of care on higher-level medical services. PHC is essentially an action-programme designed around the well-known eight PHC elements, designed to meet effective demand and to rationalise medical offer. The eight elements rather underline the multiplicity of health action required--they are not considered to serve as 'chapters' of PHC policy. PHC is a strategy for re-organising health services. The hospitals should serve the peripheral health centres and not the other way round. At the same time, curative preventive and promotive actions have to be integrated. This necessitates community participation, as the global health problems cannot be solved by the health services alone. PHC in so far re-defines the role of medicine and looks at health in a holistic way. Medicine is being de-mystified and individuals and communities are encouraged to take over responsibility for their own health. This is not at all the consequence of an idealistic view, but derived from field experiences in various circumstances. PHC as a new philosophy of health services delivery therefore, stresses: holistic action for global health issues, equity, participation, and cost/efficiency.(ABSTRACT TRUNCATED AT 400 WORDS)
作者从历史角度审视了初级卫生保健方法的演变，给出了初级卫生保健实际含义的定义和标准，审视了初级卫生保健概念内容与实践的偏差，最后对所谓的“选择性”初级卫生保健进行了社会政治和技术批判。发展中国家的现代卫生系统是仿照“西方”生物医学卫生保健系统发展而来的。然而，即使是殖民时期的医疗服务也包含一些进步元素，例如，接受将医院护理分散到周边卫生站的必要性，或强调更合理地分配和使用药物。在这种方法下制定的垂直项目清楚地显示了其局限性，而阿拉木图会议可被视为一个转折点，在那里设计了一种新的卫生保健模式，即初级卫生保健。尽管工业化国家普遍抵制采用这种新模式，但它并不局限于发展中国家。与每一个创新理念一样，初级卫生保健战略引发了相互矛盾的观点和很大的解释差异。但是，作者强调，初级卫生保健既不是一种学说，也不是一种理论，而是相关科学家和从业者数十年实地经验的结果。初级卫生保健的基本标准包括：可及性：需要改善与卫生保健系统的首次接触，要求努力使现有卫生系统去中心化，同时不忽视高级别医疗服务的护理质量。初级卫生保健本质上是一个围绕著名的八项初级卫生保健要素设计的行动计划，旨在满足有效需求并使医疗服务合理化。这八项要素更强调所需卫生行动的多样性——它们不被视为初级卫生保健政策的“章节”。初级卫生保健是一种重组卫生服务的战略。医院应该为周边卫生中心服务，而不是相反。同时，治疗、预防和促进行动必须整合。这需要社区参与，因为全球卫生问题不能仅靠卫生服务来解决。就此而言，初级卫生保健重新定义了医学的角色，并以整体方式看待健康。医学正在祛魅，鼓励个人和社区对自身健康负责。这绝不是理想主义观点的结果，而是源于各种情况下的实地经验。因此，作为一种新的卫生服务提供理念，初级卫生保健强调：针对全球卫生问题的整体行动、公平、参与以及成本/效率。（摘要截选至400字）
