Oswald I H
Soc Sci Med. 1983;17(5):255-7. doi: 10.1016/0277-9536(83)90327-1.
In the last two decades the great expansion of Primary Health Care (PHC) in the rural areas of developing countries has not been matched by significant improvements in health standards. Nepal is no exception. This study explores the view that some of these failures derive from the communication difficulties that exist between the rural health services and the client population. In other parts of the world traditional healers have been used as go-betweens to overcome these difficulties. In this study a group of 22 Traditional Medical Practitioners in a district of North Eastern Nepal were trained as TB and Leprosy referral agents. Ways of integrating them into existing rural health services were explored by discussion between themselves and local government health workers. Our results suggest that they are interested in participating in PHC delivery. Their specific task of referring patients proved more successful for leprosy than for TB. While their most important influence was a general effect of improving attendance at rural health facilities. This improved attendance is likely to be their chief success at raising health standards. By improving the communication between the health facilities and the people; the confidence of local people in PHC is raised, this brings more people into contact with the services and thereby raises health standards.
在过去二十年中，发展中国家农村地区初级卫生保健（PHC）的大幅扩张并未带来健康标准的显著改善。尼泊尔也不例外。本研究探讨了这样一种观点，即这些失败部分源于农村卫生服务机构与服务对象之间存在的沟通困难。在世界其他地区，传统治疗师被用作中间人来克服这些困难。在本研究中，尼泊尔东北部一个地区的22名传统医学从业者接受了结核病和麻风病转诊代理培训。通过他们与当地政府卫生工作者之间的讨论，探索了将他们纳入现有农村卫生服务的方法。我们的结果表明，他们有兴趣参与初级卫生保健服务的提供。他们转诊患者的具体任务在麻风病方面比在结核病方面更成功。而他们最重要的影响是对提高农村卫生机构就诊率产生了普遍作用。这种就诊率的提高可能是他们在提高健康标准方面的主要成功之处。通过改善卫生机构与民众之间的沟通，增强了当地民众对初级卫生保健的信心，这使更多人能够接触到这些服务，从而提高了健康标准。
