治理视阈下公民参与“健康中国2030”战略的实施路径

2016年10月,中共中央国务院印发《"健康中国2030"规划纲要》,提出了把健康融入所有政策(Hi AP)及坚持共建共享、动员全社会参与两大原则。文章基于这一战略规划,分析我国健康领域社会治理中存在的主要矛盾,指出社会治理的协同性设计、全社会共同治理是我国卫生政策得以落实的关键。文章试图构建"以健康为中心"的社会治理机制,提出注重开辟公民个人参与健康治理的渠道、形成统一的健康共同价值观、深入探索建立社区医养结合健康服务模式参与健康中国建设。     

中国全球健康相关非政府组织的发展策略浅析

国际非政府组织在全球健康治理中发挥了重要作用,也是各国发挥国际影响力的重要渠道,但中国非政府组织目前参与全球健康治理甚少。本文旨在分析中国非政府组织发展的社会政策环境、健康类非政府组织的发展现状并借鉴国外新兴的全球健康相关非政府组织的经验,为中国扶持非政府组织参与全球健康治理提供策略建议。本文发现,中国参与全球健康治理有较好国际机遇;国内社会组织发展环境趋势向好,但具有依附行政体系、政策定向发展等特点。因为专业性、公共服务属性以及与公共治理相关性小,非政府组织参与全球健康可以得到政府的全力支持。健康类非政府组织数量较少、基础较差、参与国际合作少。不同类型健康类社会组织各有长短,国际经验提示新兴机构主要依靠政府力量扶持非政府组织参与全球健康。建议我国政府采取"重点扶持,整体改善"的策略,制定中国全球健康发展战略,以政府附属与社会精英创办的大型非营利机构为重点扶持对象,引导和资助健康类非营利机构走向国际舞台。     

大型公立医院参与主动健康的路径探讨

大型公立医院是健康中国战略下参与主动健康的关键主体，其参与主动健康既是高质量发展的内在要求，也是医学科技创新发展的战略需要，然而当前存在主动健康理念缺乏系统认知、资源亟待有效整合、协作广度深度不足和技术应用水平较低等问题。大型公立医院在积极参与主动健康过程中，应完善功能定位，创新医院发展理念；整合院内资源，建立主动健康体系；加强外部协作，发挥引领带动作用；强化技术支撑，提升健康治理效能。     

全球健康领域的国际合作者分析——以在中国开展卫生合作的机构为例

在全球化背景下,健康影响因素与公共卫生治理已超越国界,而促进全球健康目标的实现需要多方协调和努力。在全球健康这一相对新兴的领域内,有越来越多的国际参与者,包括国家政府、联合国、其他国际组织、双边机构以及非国际组织、基金会等。本文主要通过查阅我国卫生合作项目的相关资料,对在中国开展合作的主要国际卫生机构及合作项目、重点合作领域进行总结,并对其特点进行比较分析,认为应完善以世界卫生组织为主导,其他国际组织、双边机构、非国际组织等为行动主体的多重治理,并提出加强顶层协调、促进非卫生领域参与卫生治理,以及建设多方沟通机制等建议,以促进国际合作者进一步参与中国全球健康领域国际合作。     

老年慢性病健康治理网络研究

采用文献研究法，查阅老年慢性病健康治理相关文献，了解到老年慢性病健康治理存在治理网络结构松散、卫生资源条块分割、健康服务内容有待改进、难以跨越老年数字鸿沟等难题，亟需构建起健康治理新网络。提出了注重宏观指导元治理、促进“互联网+”在老年人慢性病中的应用技术串联、加强家庭医生签约服务在老年慢性病治疗中的基础性作用、重视老年慢性病患者心理健康干预等特殊性需求、注重医养结合对老年慢性病诊疗护理的支持作用等应对策略，以期达成多主体交融互动、精准防治的老年慢性病健康治理局面。     

治理视角下的城市社区健康教育供给分析

随着我国经济体制的转型，公共管理也在不断变化。最新治理理论的出现催生了对政府职能转变的更高要求：公共物品的供给主体、供给机制如何顺应治理理念的需求。本文以城市社区健康教育为例，系统分析治理视角下健康教育的供给机制，提出健康教育的多元供给，明确公共部门在健康教育供给中的职责，并倡导社会力量参与健康教育供给行为。     

国际非政府组织参与全球健康治理的工具研究

非政府组织在全球健康治理中发挥着日益重要的作用。本研究筛选了10家在全球健康事务中有重要作用的关键非政府组织,总结非政府组织参与全球健康治理的工具,包括:"产生知识和证据"、"合作"、"参与"、"协商一致"、"透明性"、"组织建设"、"制定政策或战略方向"、"责任"和"规制"九个维度。实施型、倡导型、支持型和综合型非政府组织在参与全球健康治理的工具选择上具有共性和各自侧重点。中国应努力培育本土非政府组织,同时应注重其"透明性"、"参与"与"合作"。     

加强健康促进中的儿童参与促进儿童身心健康发展

为了不断提高居民健康水平 ,健康促进活动已在世界范围内广泛开展 ,作为提高其效果的手段之一———“社区参与”已被运用于许多健康促进活动中 ,但健康促进中的“儿童参与”却没有引起足够的重视。文章阐述了加强健康促进活动中的“儿童参与”对儿童身心健康发展和对社会发展的重要性 ,并通过其他国家成功的例子说明了健康促进活动中“儿童参与”不仅必要 ,而且可行。     

枝江市村庄清洁行动现状与对策——基于健康治理视角

在《健康中国2030规划纲》提出要持续推进城乡环境卫生整洁行动并完善城乡环境卫生基础设施和长效机制的背景下，枝江市村庄清洁行动通过健康治理积极提升农村人居环境，改变群众卫生习惯，作为健康中国行动典型经验在全国推介。枝江市村庄清洁行动在健康治理过程中通过各种措施提升全体社会成员的健康水平，实现了多元主体在多领域多维度的协同治理，并表现出了健康治理全过程、可持续、常态化的特点，但是在推行村庄清洁行动的过程中存在治理主体间互动程度不足、相关配套机制不完善、治理过程缺乏动态弹性的局限，可以通过探索优化主体间的协同方式、建立完善相应治理机制、形成多元治理联动体系几方面路径来破解当前的困境。     

健康教育在儿童保健门诊的应用

目的通过健康教育,让家长掌握正确的喂养、护理、预防疾病等知识,以促进儿童健康成长。方法将儿童从出生到学龄前期的健康教育,纳入到常规的儿童保健工作内容中,分别在门诊、家庭、托幼园所对儿童不同时期进行相应的健康教育。结果通过各种形式的健康教育,普及了儿童保健知识,对儿童常见病、多发病的检测起到了早发现、早治疗的作用,同时建立了良好的医患关系,提高了医院的经济效益。结论健康教育的系统干预,是促进儿童保健实施的关键,可以改善儿童及其家长的健康行为。     

浅析医学社团助力中国参与全球卫生治理特点、路径及启示

目的 深入分析医学社团在全球卫生治理进程中的特点,参与路径;思考医学社团助力中国参与全球卫生治理带来的启示。 方法 本文通过文献检索,总结医学社团的特点,理解在全球卫生进程中发挥的作用;通过案例分析法,回顾中华预防医学会疫情期间国际交流工作实践,探索医学社团助力中国参与全球卫生治理的路径。 结果 医学社团利用专业性、灵活性和协同性等特点,在全球重大公共卫生问题应对、推动全球卫生倡议、促进全球卫生合作中发挥重要作用。医学社团通过组织学术交流会议、分享抗疫经验、搭建权威信息平台及争取国际组织任职等路径,帮助中国参与全球卫生治理进程。 结论 医学社团应提升能力,配合政府开展工作,主动将国际交流工作主动纳入中国参与全球卫生治理工作大局。     

社区卫生服务管理体制面临的挑战分析——基于六城区的抽样调查

目的：分析我国社区卫生服务管理体制面临的挑战。方法：运用焦点组访谈和个人深入访谈的方法收集六城区有关社区卫生服务管理体制的资料,并运用归纳总结的方法对定性资料进行分析。结果：区级政府作为举办主体理顺社区卫生服务管理体制存在困难;各级政府的事权与财力不相适应;卫生部门与其他部门的跨部门合作机制有待加强;社管中心成立的必要性与功能定位仍然悬而未决;如何管理社会资本举办的社区卫生机构有待进一步探索;缺乏居民参与管理的有效途径。建议：理顺政府相关部门之间的关系,促进财力与事权相匹配;建立有效的跨部门合作机制;制定和完善鼓励社会资本发展社区卫生的相关政策;进一步探索成立社管中心的可行性与必要性;探索和完善居民参与管理的有效途径。     

Governance,public participation and accountability: To whom are regional health authorities accountable?

The discourse of health reform has emphasized the need to increase public participation in decision-making as a way to enhance accountability. Despite recent gains in public participation in health care – primarily through citizen governance of regional health authorities – a clearly articulated accountability framework remains elusive in the Canadian context. If citizen participation is to be effective and meaningful, governing boards and politicians need to adopt an accountability framework that clearly delineates roles and responsibilities.     

Citizens’ participation in the Italian health‐care system: the experience of the Mixed Advisory Committees

Background In 1994, the region of Emilia‐Romagna recognized the importance of citizens’ participation in the regional health‐care system and recommended the institution of Mixed Advisory Committees in the health districts and hospitals with the objective of monitoring and assessing health‐care quality from the users’ perspective. Design This paper reports findings from a qualitatively based evaluation involving direct observations of the committees and 39 semi‐structured interviews: 20 with representatives of patients and users’ associations and 19 with health professionals and managers involved in the activities of the committees. Results The Mixed Advisory Committees introduced for the first time in the Italian health system an ongoing deliberative approach that gave patients and users’ representatives the opportunity to be involved in health service governance. The committees enabled the creation of a method of collective participation that overcame the reductive individualistic ‘approach’ to health‐care participation. MAC participants evaluated the committees positively for their mixed composition, which integrated different cultures, experiences and professional profiles with the potential to contribute to solving health‐care problems, in a consultative role. Although patients and users’ representatives were able to exert some form of influence, their expectations were greater than the results obtained. The study illuminated some weak points of public consultation, such as a decline in participation by citizen representatives and a weak influence on decision making. Discussion and conclusions MACs developed a mechanism of participation that provides health‐care users’ representatives with the opportunity to contribute to the identification and analysis of critical points of the health‐care system. A strength of the MACs is their level of institutionalization within the health system in the region of Emilia‐Romagna. However, they contain a problem of representativeness, lacking a formal system of determining a representative composition from among patients and users’ associations. The case study also illustrates that participation without the cooperation of the health service, and financial and organizational support, will result in a decline in citizen participation, given the resources required of these volunteer citizens in return for limited results.     

Primary Health Care: Hope and Challenges for Public Health in Maldives

The government of Maldives considers that the enjoyment of the highest attainable level of health is a basic right of every citizen. Thus it lays emphasis on the accessibility and affordability of health care services. In order to achieve these objectives, it is very important to expand curative services as well as preventive services in the country. The major hurdles faced by the country are result of the inherent structural problem faced by the county which leads to sever diseconomies of scale in the provision of healthcare services. Community and individual involvement and self-reliance are very important to achieve Health for All by the Year 200 AD. Community participation is one of the domains of community capacity building in a small island country. It is one of the mechanisms to empower people to take part in community development. In this paper, the nature, the dimensions of community participation, and its role and scope in implementation of different components of primary health care have been described. The health services in public and curative care have been briefed. Some of the achievements in health sector have also been briefly presented.     

宁波市县域医共体治理机制改革实践及优化策略分析:基于新公共服务理论视角

对宁波市县域医共体治理策略进行了梳理,并结合新公共服务理论认为,当前宁波市县域医共体治理机制改革中存在着政府角色有待进一步转变、内部事务决策机制尚有待开发、监督机制尚缺乏系统性设计、激励机制仍需优化等主要障碍,进而提出宁波市在推进县域医共体治理机制改革中应探索政府监管、专业团队执行的医共体外部治理结构,公民参与的医共体社区健康治理机制,法人治理结构下的内部事务决策机制,公共健康利益的医共体内外监督机制以及基于系统化责任分担的考核与激励机制。优化策略可为推进宁波市县域医共体治理机制改革提供参考。     

Community participation and empowerment in primary health care in Emilia-Romagna: A document analysis study

Community participation and empowerment are seen as fundamental for achieving equitable, people-centred primary health care. Emilia-Romagna region introduced the Casa della Salute aiming to foster comprehensive primary health care and support community participation. Since the 1990s, community involvement has been promoted to improve the regional health system. The pivotal role of third sector organisations as service providers and advocates for users’ rights has been underlined. This contribution explores the evolution of the meaning and conceptualisation of community participation and empowerment in policies addressing the Casa della Salute. A qualitative document analysis study was undertaken. Three national and twelve regional documents dated between 2006 and 2019 were evaluated. The policies continuously address community participation. The Casa della Salute is seen as a designated place to promote participation and empowerment. The documents point to the need for democratic practice and shared decision-making power; third sector organisations are seen as salient community representatives and mediators. However, the policies show only a vague conceptualisation of how to empower communities; moreover, strategies to promote participation of vulnerable groups are lacking. Policies that consider the ambiguous role of the third sector, specify community empowerment, identify strategies to facilitate it and collaborate with vulnerable groups could be beneficial for further progress.     

Citizen participation in health decision-making: past experience and future prospects

Every couple of decades governments decide that they need to involve citizens more in public decision-making processes. The significant changes that have occurred over the past decade, including a growing loss of faith in the traditional institutions of government, have once again prompted political decision-makers to explore options for enhanced citizen participation. In the health care sector, reforms occurring during the 1990s were couched in terms such as "enhanced responsiveness," "improved accountability," and "increased citizen participation." In the new millennium, governments and regional health authorities have been relatively silent on this issue. As has been the case in the past, a wide range of opinions exist about what citizen participation is and how governments should proceed. Without either conceptual clarity or practical direction, governments have been slow to articulate what they hope to achieve or how they intend to get there. The purpose of this paper is to examine the concept of citizen participation within the context of a series of basic questions from which decision-makers might draw some policy relevance. Rather than taking a particular disciplinary perspective (i.e. health promotion), the authors have chosen to review a broad spectrum of existing literature to provide a better understanding of what is known about citizen participation, both good and bad. As such, the paper is meant to be a point of departure for an informed discussion of the possibilities for improved citizen participation in health (care) decision-making.     

金砖国家卫生外交政策及其参与全球卫生治理的经验

全球化进程使各国将全球卫生治理作为重要战略关切,作为新兴国家代表的巴西、俄罗斯、印度、中国、南非这五个金砖国家(BRICS)在全球卫生治理领域发挥着日益重要的作用。本文比较和分析了金砖国家的卫生外交政策及其参与全球卫生治理的行动,总结了金砖国家参与全球卫生治理的特点及可供中国借鉴的经验,同时提出了作为多边合作机制的金砖国家在全球卫生领域中所面临的挑战。     

泰国参与全球和区域卫生安全治理的经验和启示

泰国通过参与全球和区域卫生安全治理不仅改善了本国的卫生和经济状况，而且提高了泰国在东亚地区乃至全球范围内卫生安全领域的影响力和话语权。中国和泰国同属东亚地区发展中国家，泰国参与全球和区域卫生安全治理的经验和途径对中国具有借鉴价值。本文分析泰国在宏观、中观和微观层面如何主动参与全球和区域卫生安全治理，对于提高中国在卫生安全治理领域的参与度和影响力有重要启发，同时为中国加强与联合国系统机构和东南亚国家的卫生安全合作提供案例。