Maclure R
Faculty of Education, University of Ottawa, Canada.
Int J Health Serv. 1995;25(3):539-58. doi: 10.2190/X4E7-P8LN-3NHR-B6GF.
Primary health care assistance has become prominent in the rural development programs of many nongovernment organizations throughout sub-Saharan Africa. By emphasizing education and the promotion of new participatory health systems, most such programs aim to enhance the conditions of women as principal community care givers. Yet village-level health assistance in Africa is not without shortcomings. This is exemplified in a case study of two nongovernment programs in Burkina Faso's Namentenga Province. Although both programs have contributed to maternal health and infant survival, they have also induced new ties of donor dependency. This appears to present a conundrum for the sponsoring agencies which espouse self-reliance as a development assistance goal. In fact, however, where the intervention of nongovernment organizations helps to improve rural health, new dimensions of dependency may prove to be a positive first stage in the mobilization of women and the development of locally managed health systems. For this to be so, much is contingent on the capacity of these organizations to integrate local participation in their own planning and management processes, and to augment the professional status of indigenous health workers.
在撒哈拉以南非洲的许多非政府组织的农村发展项目中，初级卫生保健援助已变得十分突出。通过强调教育以及推广新的参与式卫生系统，大多数此类项目旨在改善作为主要社区护理提供者的妇女的状况。然而，非洲的村级卫生援助并非没有缺点。布基纳法索纳门滕加省的两个非政府项目的案例研究就例证了这一点。尽管这两个项目都对孕产妇健康和婴儿存活做出了贡献，但它们也引发了新的对捐助者的依赖关系。这似乎给支持将自力更生作为发展援助目标的赞助机构带来了一个难题。然而，事实上，在非政府组织的干预有助于改善农村卫生状况的地方，新的依赖层面可能被证明是动员妇女和发展地方管理的卫生系统的积极的第一阶段。要做到这一点，很大程度上取决于这些组织将地方参与纳入其自身规划和管理过程以及提高本土卫生工作者专业地位的能力。
