论农村医学对农村社会健全发展的作用──在第七届亚洲农村医学学术会议上的特别讲演

论农村医学对农村社会健全发展的作用──在第七届亚洲农村医学学术会议上的特别讲演张自宽（中华人民共和国卫生部北京１００７２５）人类社会前进的步伐即将跨入２１世纪。中国以及亚洲许多发展中国家正在奋起，投入世界经济和科技竞争的大潮，争取经济全面增长。在此历...     

人口老龄化对农村医疗卫生服务的新要求

在我国未富先老的情况下,农村人口老龄化水平高于全国平均水平和城市水平,大多数农村社会保障制度尚未建全,为老年人提供的医疗卫生保健服务发展严重滞后,现有的农村医疗模式难以满足越来越多的老年人医疗卫生服务需求.为此,提出健全农村基层卫生服务网络体系,大力培养全科医学人才,充分利用中医药,加大健康教育力度、做好预防工作,重视老年医学的教育和科学研究,以满足人口老龄化对农村医疗服务提出的新要求.     

人口老龄化对农村医疗卫生服务的新要求

在我国未富先老的情况下,农村人口老龄化水平高于全国平均水平和城市水平,大多数农村社会保障制度尚未建全,为老年人提供的医疗卫生保健服务发展严重滞后,现有的农村医疗模式难以满足越来越多的老年人医疗卫生服务需求。为此,提出健全农村基层卫生服务网络体系,大力培养全科医学人才,充分利用中医药,加大健康教育力度、做好预防工作,重视老年医学的教育和科学研究,以满足人口老龄化对农村医疗服务提出的新要求。     

稷山县抽调三百余人下乡搞初保

在山西省稷山县农村,到处都能看见县上派来的初级卫生保健工作队。他们中间,有的帮助群众修建街道,疏通下水,大搞卫生基本建设;有的帮助村委会整顿农村卫生所,开展合作医疗,健全和完善农村卫生管理制度;还有一部分医务人员,帮助农村进行儿童体格检查,开展农民健康教育,普及医学卫生知识。     

农村急救医学的若干思考

急救医学是新近发展起来的一门新兴学科，当今世界各国医学界非常广泛地关注这个问题。我国农村急救医学如何发展提高，如何适应市场经济的需要，更好地为经济基础服务，是一个很值得研究的重要课题。就总体而论，目前我国农村的急救医学发展步子缓慢，力量薄弱，体制不健全，抢救水平低下，与其他行业比较、发展滞后。有的地方出现了只能“诊”不能“治”，有的既不能’‘诊”也不能‘贤’”。随着农村改革开放的不断深人，基础农业飞速的发展，乡镇企业的一体化，交通道路的现代化，农村经济的不断腾飞，面对农村的急剧变化，农村劳动卫生…     

疾病资源库建设的重要性及现状分析

疾病资源库是医学发展的重要战略资源,建设一个资料完整、信息共享度高的疾病资源库,将提高医学竞争力,促进转化医学发展.目前我国在疾病资源库的建设方面存在着政府主导力不够、缺乏规范化标准化、共享机制不健全等问题,为此医疗机构应加强疾病资源库的标准化和信息化建设,政府应给予政策支持和引导,保存我国丰富的临床资源,并对其进行整合共享,促进医学发展.     

加强保健网建设 控制传染病流行

最近,笔者对两个农村社区的急性传染病发病情况及医疗保健网的健全程度进行了对比分析,发现在地理环境、经济条件和人口构成基本相同的情况下,医疗保健网健全的社区,急性传染病发病率明显低于不健全的社区。表明健全农村三级医疗保健网,对控制急性传染病的流行有极为重要的意义     

进一步强化医学计量在医学装备质量管理工作中的重要作用

本文针对当前在医疗卫生单位医学计量工作中存在的一些问题,从增强法制观念,完善健全医学计量监督管理体系、抓好医学计量工作落实和建设高素质人才队伍等方面,结合军队认真贯彻计量法规,积极开展医学计量工作情况,对强化医学计量在医学装备质量管理工作中的重要作用进行研究和探讨.     

日本佐久综合医院及农村医学情况介绍

应日本农村医学会的邀请,由卫生部医政司组织的“农村医学及健康管理研修班”一行12人,于1989年7月赴日本长野县,对佐久地区农村医学的发展和现状、区域性健康管理的组织体系及医疗保健活动等进行了为期十天的考察研修。     

日本农村医学的现状给我们的启示

1992年8月,我参加中国农村卫生协会组织的中国农村医学高级研修班赴日研修考察,重点考察了长野县的农村医学。长野县是日本农村医学的发祥地,他们的过去与现状,对于我们发展农村医学,保障农村居民健康和促进农村经济发展是有启示和借鉴意义的。     

Primary health care for whom? Village perspectives from Nepal

Over the last decade, many developing nations have embraced Primary Health Care (PHC) within their national health plans. PHC, in contrast to earlier approaches to national health development, emphasizes community participation and basic health care for the poorer segments of society. The research reported here finds that in the enthusiasm for the PHC concept in Nepal, important sociocultural processes have been overlooked. This paper describes the relationship between certain sociocultural factors and PHC activities in rural Central Nepal. It reveals a contradiction between the stated PHC intentions to address local interests and promote community participation on the one hand, and the actual approach taken on the other hand. Specifically it argues that PHC is encountering problems in Nepal for three reasons: (1) PHC fails to appreciate villagers' values and their own perceived needs. In particular, PHC is organized primarily to provide health education, whereas villagers value modern curative services and feel little need for new health knowledge. (2) PHC views rural Nepali culture only pejoratively as a barrier to health education. Alternatively, local cultural beliefs and practices should be viewed as resources to facilitate dissemination and acceptance of modern health knowledge. (3) In attempting to incorporate Nepal's traditional medical practitioners into the program, PHC has mistakenly assumed that rural clients passively believe in and obey traditional practitioners. In fact, clients play active roles and are themselves in control of the therapeutic process. Thus, instead of attempting to recruit traditional practitioners to do its work, PHC should recognize the precedent for community participation in Nepal's traditional medical system and develop the respect for villagers' own ideas and values that traditional practitioners already possess.     

Where there is no policy: governing the posting and transfer of primary health care workers in Nigeria

The posting and transfer of health workers and managers receives little policy and research attention in global health. In Nigeria, there is no national policy on posting and transfer in the health sector. We sought to examine how the posting and transfer of frontline primary health care (PHC) workers is conducted in four states (Lagos, Benue, Nasarawa and Kaduna) across Nigeria, where public sector PHC facilities are usually the only form of formal health care service providers available in many communities. We conducted in‐depth interviews with PHC workers and managers, and group discussions with community health committee members. The results revealed three mechanisms by which PHC managers conduct posting and transfer: (1) periodically moving PHC workers around as a routine exercise aimed at enhancing their professional experience and preventing them from being corrupted; (2) as a tool for improving health service delivery by assigning high‐performing PHC workers to PHC facilities perceived to be in need, or posting PHC workers nearer their place of residence; and (3) as a response to requests for punishment or favour from PHC workers, political office holders, global health agencies and community health committees. Given that posting and transfer is conducted by discretion, with multiple influences and sometimes competing interests, we identified practices that may lead to unfair treatment and inequities in the distribution of PHC workers. The posting and transfer of PHC workers therefore requires policy measures to codify what is right about existing informal practices and to avert their negative potential. © 2016 The Authors The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd     

Bridging the gap: the village health worker as the cornerstone of the primary health care model

The Alma-Ata Conference in 1978 reiterated the goal of 'Health for All by the Year 2000' and declared primary health care (PHC) the vehicle through which this lofty goal was to be achieved. National governments were recognized as responsible agents for developing and implementing PHC plans. The emphasis on community-oriented delivery of care places great importance on the village health worker (VHW), the individual who serves as the 'interface' between the formal health care system and the community. Despite the acknowledged importance of the VHW role, the question of whether the PHC model, with the VHW as the cornerstone can be effectively implemented without a "fundamental shift of wealth and power" (Sidel) continues to be asked. This paper examines the evolution and current status of the VHW role in Costa Rica, Nicaragua and Columbia, three Latin American nations which have adopted the PHC model. The authors discuss the evolution of the PHC model in each country with particular reference to the occurrence or non-occurrence of fundamental changes in the society. The conclude that the primary determiner of successful implementation of PHC is a national commitment to PHC including recognition of the importance of community participation which is best achieved through reliance on the village health worker.     

Paternalism in Public Health Care

Measures in public health care (PHC) seem vulnerable to chargesof paternalism: their aim is to protect, restore, or promotepeople's health, but the public character of these measuresseems to leave insufficient room for respect for individualautonomy. This paper wants to explore three challenges to thesecharges: (i) Measures in PHC are aimed to protect, restore orpromote ‘deep autonomy’, (ii) Measures in PHC aredirected at the public and, as such, they do show respect forautonomy, and (iii) Some measures in PHC can be justified ongrounds of justice and need not be defended as cases of ‘justifiedpaternalism’. Although charges of unjustified paternalismin PHC might still be relevant, we should at least face thesedifferent challenges.     

Selective health systems: a trap for health politics in the Third World

The authors examine the evolution of the PHC approach in historical perspective, present definitions and criteria of what PHC actually means, look upon deviations of conceptual content and practice of PHC and end up with a socio-political as well as a technical critique of the so-called 'selective' PHC. Modern health systems evolved in developing countries modelled on the 'western' biomedical health care systems. Yet even colonial medical services contained also progressive elements, as e.g. the acceptance of the need to de-centralise hospital care to peripheral health posts, or the stress on more rational distribution and utilisation of drugs. The vertical programmes developed under this approach showed clearly their limitations and the conference of Alma-Ata can be looked at as a turning point, where a new model of health care, i.e. PHC, was designed. Though there exists a widespread resistance in industrialised countries against adopting this new model, it was not at all limited only to developing countries. As with every innovative idea, the PHC strategy provoked contradictory views and large differences in interpretation. But, the authors stress, PHC is neither a doctrine, or a theory but the outcome of decades of field-experience of concerned scientists and practitioners. The essential criteria of PHC include: Accessibility: need for improved first contact with the health care system, demanding efforts of decentralising the existing health system without neglecting the quality of care on higher-level medical services. PHC is essentially an action-programme designed around the well-known eight PHC elements, designed to meet effective demand and to rationalise medical offer. The eight elements rather underline the multiplicity of health action required--they are not considered to serve as 'chapters' of PHC policy. PHC is a strategy for re-organising health services. The hospitals should serve the peripheral health centres and not the other way round. At the same time, curative preventive and promotive actions have to be integrated. This necessitates community participation, as the global health problems cannot be solved by the health services alone. PHC in so far re-defines the role of medicine and looks at health in a holistic way. Medicine is being de-mystified and individuals and communities are encouraged to take over responsibility for their own health. This is not at all the consequence of an idealistic view, but derived from field experiences in various circumstances. PHC as a new philosophy of health services delivery therefore, stresses: holistic action for global health issues, equity, participation, and cost/efficiency.(ABSTRACT TRUNCATED AT 400 WORDS)     

Problems of primary health care in a newly developed society: Reflections on the Hong Kong experience

Hong Kong has emerged as a newly developed society in Asia and its modern scientific health care system has had a substantial expansion. Recently, the rise of medical costs has made the health authority come to stress the development of PHC. This paper focusses on three major aspects of the PHC development in Hong Kong: (1) public health and preventive care; (2) food supply and nutrition; and (3) first-contact medical care and referral network.It is argued that in a newly developed society, the emphasis on developing both the quality and the quantity of PHC in the scientific biomedical stream is justifiable. However, at least two kinds of problems need to be taken into consideration, i.e. the prevalence of traditional beliefs and practices and the ever-rising demands of the public for health services.     

初级卫生保健的内涵及其在我国的发展回顾

由世界卫生组织及其成员国于1978年《阿拉木图宣言》提出的“初级卫生保健”,是指最基本的、人人都能得到的、体现社会平等权利的、人民群众和政府都能负担得起的卫生保健服务。初级卫生保健所反映的核心价值观是社会公平,所信奉的理论是“健康乃人类的基本权利”,所追求的目标是“人人享有健康”,所采用的技术是适宜技术。中国初级卫生保健实践始于建国之初,20世纪50年代初确定的“面向工农兵、预防为主、团结中西医、卫生工作与群众运动相结合”四大方针,已包含了初级卫生保健的基本思想和内容。建国后的前30年取得的成就为国际上形成初级卫生保健策略奠定了实证基础,随后20年是我国初级卫生保健发展阶段,政府承诺实现2000年人人享有卫生保健的目标,但取得的健康效果有限。21世纪以来,政府仍然把初级卫生保健作为农村卫生的中心任务,但是可持续性问题还没有解决。     

初级卫生保健及其发展策略——再论初级卫生保健是卫生发展的重要途径

提出初级卫生保健是卫生发展的重要途径,乃是一个新的概念,是PHC的新发展。PHC方法是以门诊或社区卫生服务中向固定的居民提供的基本卫生服务,如促进健康、预防保健等。PHC的发展策略趋向于面向人群,面向家庭,区域化分权制管理,以及对卫生资源的重新分配和加强领导层的承诺和支持行动,以及加强社区医学教育等。