van Bergen J E
Trop Geogr Med. 1995;47(1):23-9.
A tension exists between objectives of health policy makers to achieve high quality standards of care on one hand, and district multi-crisis reality in sub-Saharan Africa on the other hand where sheer survival of the (public) health system is questioned. The collapsing health services as well as the deteriorating living conditions affect the health status of the population and contribute to an increase in (health) inequalities both nationally and internationally. Constraints and some examples of achievements in district health management in two districts in Northern Province, Zambia, are presented. A strong focus on community-based health care, partnership with communities and accelerated health-system support via strengthening of on-site supervision is advocated. Decentralization and self-reliance are potential tools in flexible crisis management, but require continuity in human resource development and appropriate 'care for the carers'. In order to increase operational efficiency, the need is expressed to conceptualize a practical approach of 'minimum primary health care'.
一方面，卫生政策制定者的目标是实现高质量的医疗服务标准；另一方面，撒哈拉以南非洲地区面临着多方面的危机现实，（公共）卫生系统的生存本身都受到质疑，这两者之间存在着矛盾。不断崩溃的卫生服务以及日益恶化的生活条件影响着民众的健康状况，导致国内和国际上（健康）不平等现象加剧。本文介绍了赞比亚北部省份两个地区在地区卫生管理方面的制约因素和一些成就实例。提倡大力关注社区卫生保健、与社区建立伙伴关系以及通过加强现场监督加快卫生系统支持。权力下放和自力更生是灵活应对危机管理的潜在手段，但需要在人力资源开发方面保持连续性，并对“照顾者给予适当照顾”。为了提高运营效率，有人表示需要构思一种“最低限度初级卫生保健”的实用方法。
