De Brouwere V, Van Lerberghe W, Criel B, Van Dormael M
Institut de Médecine Tropicale, Unité de Recherche et d'Enseignement en Santé Publique, Anvers, Belgique.
Cah Sociol Demogr Med. 1996 Apr-Jun;36(2):141-70.
A Primary Health Care (PHC) system may be effective and efficient to the extent that essential drugs are available in health services and financially accessible to the population. In developing countries, besides the difficulties related to supplying health services with adequate amounts of drugs, the control of drug consumption is one of the frequent problems encountered by health authorities. Literature is relatively abundant in the field of rationalization of the diagnosis and drug prescription processes, and also in the field of drug financing mechanisms; publications are however rather scarce when topics related to corruption or drug misappropriation are concerned. The case study submitted hereafter reports a drug overconsumption problem in the health centres (HC) of the Kasongo district (Zaire). Despite the existence of direct control mechanisms as well as indirect ones (monitoring of drug consumption by HC), the problem has been identified belatedly. The district staff then used a step-by-step analysis of the HC drug consumption profiles; this analysis allowed to demonstrate that misappropriation would be the most plausible hypothesis. In order to solve the misappropriation problem-the consequences of which jeopardized the functioning of the very health system-the district staff chose to involve the nurses, in charge of the HC, in the entire problem-solving process. This participative approach, involving different actors as partners, allowed to deepen the situation analysis and to elaborate solutions congruent with PHC principles and acceptable to all concerned.
初级卫生保健（PHC）系统要达到有效且高效，就必须在卫生服务中提供基本药物，并且民众在经济上能够获取这些药物。在发展中国家，除了在为卫生服务提供充足药物供应方面存在困难外，控制药物消费也是卫生当局经常遇到的问题之一。在诊断和药物处方流程合理化领域以及药物筹资机制领域，文献相对丰富；然而，当涉及到腐败或药物挪用相关主题时，出版物却相当稀少。以下提交的案例研究报告了扎伊尔卡松戈区卫生中心（HC）的药物过度消费问题。尽管存在直接控制机制以及间接控制机制（对卫生中心药物消费的监测），但该问题却被发现得很晚。随后，该地区工作人员对卫生中心的药物消费情况进行了逐步分析；这一分析表明挪用药物是最有可能的假设。为了解决挪用药物问题（其后果危及了整个卫生系统的运作），该地区工作人员选择让负责卫生中心的护士参与到整个问题解决过程中。这种让不同行为体作为合作伙伴参与的方法，有助于深入进行情况分析，并制定出符合初级卫生保健原则且为所有相关方所接受的解决方案。
