Smith D L, Bryant J H
Division of Strengthening of Health Services, World Health Organization, Geneva, Switzerland.
Soc Sci Med. 1988;26(9):909-17. doi: 10.1016/0277-9536(88)90411-x.
In the past four decades there has been a succession of different approaches to the development of infrastructure for the delivery of health services. There have been striking similarities among these approaches in both direction and timing in many different countries, particularly in the developing world. While the general trend has been strongly in the direction of a more comprehensive, integrated health infrastructure, there have been important regressions from this path. It is suggested that the recent attention given to the delivery of 'selective' packages of interventions has often diverted energy and resources from the essential task of developing comprehensive, efficient and effective health services. This paper begins with an historical review of trends in the development of health services infrastructure in recent decades. It proceeds to analyse the implications for the organization of health services and for resource allocation when the health services infrastructure is viewed as part of a health system based on primary health care. Finally, we maintain that district health systems based on primary health care provide an excellent practical model for health development, including an appropriate health system infrastructure. Within this model the concerns with accelerating the application of known and effective technologies and the concerns with strengthening of community involvement and intersectoral action for health are both accommodated. The district health system provides a realistic setting for dialogue and planning involving both professionals and non-professionals concerned with health and social development.
在过去的四十年里，为提供卫生服务而发展基础设施出现了一系列不同的方法。在许多不同的国家，尤其是在发展中世界，这些方法在方向和时间上存在着显著的相似之处。虽然总体趋势一直强烈地朝着更全面、综合的卫生基础设施发展，但也出现了从这条道路上的重要倒退。有人认为，最近对提供“选择性”干预措施包的关注常常将精力和资源从发展全面、高效和有效的卫生服务这一基本任务上转移开。本文首先对近几十年来卫生服务基础设施发展趋势进行历史回顾。接着分析当把卫生服务基础设施视为基于初级卫生保健的卫生系统的一部分时，对卫生服务组织和资源分配的影响。最后，我们认为基于初级卫生保健的地区卫生系统为卫生发展提供了一个极好的实践模式，包括适当的卫生系统基础设施。在这个模式中，既考虑了加速应用已知有效技术的问题，也考虑了加强社区参与和卫生领域部门间行动的问题。地区卫生系统为涉及专业人员和关注卫生与社会发展的非专业人员的对话和规划提供了一个现实的环境。
