Chetty K S
Department of Community Health, University of Cape Town.
S Afr Med J. 1995 Apr;85(4):245-50.
The development of a comprehensive national health plan must take into account an analysis of the provision and distribution of health facilities. This study collected and verified data from a number of different sources, on the number and types of hospital beds, the number of fixed clinics, and the population sizes in each of the nine new provinces of South Africa. A comprehensive database of these figures was compiled for the years 1988 and 1993. Integrated analyses were made of the distribution and types of health facilities in South Africa by using population/facility ratios. Notable disparities were found to exist between provinces in the total (public and private) distribution of hospital beds per 1,000 population, but the distribution of acute hospital beds between provinces is more even. In provinces where there is more than one medical school, there is a marked imbalance between the levels of care, with greater emphasis placed on tertiary care, at the expense of the secondary level. Given the World Health Organisation recommendation of 10,000 people per clinic, there is a shortfall in most provinces. Recommendations are made with regard to the rationalisation of academic and referral beds, and the factors to be considered in the addressing of shortages of clinic facilities. However, the limitations of a resource-based planning approach must be recognised, and it is recommended that comprehensive analyses be carried out at regional and sub-regional levels to determine the appropriate delivery of health care.
制定全面的国家卫生计划必须考虑对卫生设施的提供和分布进行分析。本研究从多个不同来源收集并核实了有关南非九个新省份的医院病床数量和类型、固定诊所数量以及人口规模的数据。针对1988年和1993年编制了这些数据的综合数据库。通过使用人口/设施比率，对南非卫生设施的分布和类型进行了综合分析。结果发现，各省之间每千人口的医院病床总数（公立和私立）分布存在显著差异，但各省之间急性医院病床的分布更为均衡。在有不止一所医学院的省份，医疗水平之间存在明显失衡，更侧重于三级护理，而牺牲了二级护理。鉴于世界卫生组织建议每个诊所服务10000人，大多数省份都存在短缺。针对学术病床和转诊病床的合理化以及解决诊所设施短缺问题时应考虑的因素提出了建议。然而，必须认识到基于资源的规划方法的局限性，建议在区域和次区域层面进行全面分析，以确定适当的医疗服务提供方式。
