社区卫生服务机构公共卫生人员培训需求分析

目的：了解浙江省社区卫生服务机构公共卫生人员培训需求,为制定培训政策提供依据。方法：采用自填式调查问卷,在浙江省340个社区卫生服务机构中调查1186人,回收率91．2％。结果：95．2％的调查对象有外出参加培训的需求;76．10％的人认为业务培训是比较适合的培训方式;57．72％的人认为每次培训时间2～3天较为合适,83．48％的人认为需要到上级疾控中心去进修;技能培训中以现场调查和处理的需求最大,专业培训中以传染病预防控制的需求最大;不同专业之间的培训需求存在差异。结论：社区卫生服务中心公共卫生人员培训需求较大,但需进一步提高培训内容的针对性。     

The Return of the Pholela Experiment: Medical History and Primary Health Care in Post-Apartheid South Africa

I examine why South Africa’s pioneering Pholela model of primary health care, dating from the 1940s, held such appeal for the country’s new policymakers after 1994, and why those policymakers have failed to make it the basis of an effective public health care system since then. In the 1940s, the innovative Pholela experiment had served as such a model, to be replicated gradually throughout the country until a new health care system in its image was finally in place. However, this vision was dashed by the hostility of the mainstream medical profession and, after 1948, even more so by the new apartheid government, causing the idea to wither and become no more than a vanishing memory. In the 1990s, the model resurfaced as part of the country’s transition to democracy, eliciting great enthusiasm among a new generation of health policymakers. I conclude by looking at the fate to date of this second coming of the Pholela experiment.In April 1990, just two months after the release of Nelson Mandela from an apartheid prison and the unbanning of the African National Congress (ANC), its chief representative in Mozambique told an upbeat international conference on health in southern Africa that the party’s aim was to establish “a national health service in South Africa, based on the principles of primary health care and geared towards a programme of health for all by the year 2000.”1During the next 4 years of South Africa’s transition to a democratic political order, this goal was elaborated on by both the ANC and progressive public health specialists who shared its vision. In giving their enthusiastic support to the idea, several of the latter pointed out that this would not be the first time that the country had sought to mold its health system around primary health care; 50 years earlier, an official attempt to create a national health system based on primary health care–style health centers had briefly flourished.Between 1945 and 1948, following the innovative model of Sidney and Emily Kark’s Pholela Health Centre in deep rural Natal, 44 such health centers had been set up around the country by the national Department of Public Health as the foundation of a wholly new national health system. In the words of the National Health Services Commission (the Gluckman Commission), whose grand vision this was, such a system would provide the basis for “an organized National Health Service in conformity with the modern conception of ‘Health’ which will ensure adequate medical, dental, nursing and hospital services for all sections of the people of the Union of South Africa.”2That this ambitious scheme to reshape the country’s health system around an entirely novel principle had been cut short by a combination of medical, racial, and state politics in the years after 1948 only boosted the sense of triumph and joy that the ANC’s commitment to primary health care received from progressive health workers in the 1990s. As 2 of them, Steve Tollman and Derek Yach, wrote in the American Journal of Public Health in 1993, “As South Africa undergoes rapid social, economic, and political change, the rich heritage of public health and primary health care is being rediscovered. . . . The work at Pholela is now recognized as a highly effective example of a rural health center applying (indeed initiating) principles that are today seen as key to primary health care.”3 It seemed that, after 45 years of neglect under apartheid, the time had at last come for their resurrection.Doctors who had worked at Pholela as students in the 1950s now waxed lyrical about the lessons it held for the new, democratic South Africa. “Good ideas and concepts . . . may be rediscovered or re-invented—and may even flourish—in the face of urgent need, political upheaval, or both,” wrote one in 1993. “In South Africa, as the accession of the ANC approaches, the work of the Karks and their successors is now recalled, and the relevance of community health centers is appreciated as a possible centrepiece of the new national health care system that must soon emerge.”4 Even more glowing was the tribute of the editor of the American Journal of Public Health, Mervyn Susser, an ex-South African who had spent several months at Pholela in about 1950. In his eyes, the Karks’ innovations at Pholela were even more significant beyond South Africa, for he believed that “[Sidney] Kark assembled the girders on which, at some remove, the famous declaration of Alma Ata rests.”5Not surprisingly, therefore, when the aged Sidney and Emily Kark visited South Africa in 1992, they were fêted by progressive-minded health workers. The ANC’s shadow minister of health, Nkosazana Dlamini-Zuma (who had herself grown up near Pholela, cherishing “the African health workers and medical students” there as role models6), held lengthy consultations with them; medical school professors jostled to tell them of their own fledgling community-oriented primary care units, and even that old foe of primary health care, the South African Nursing Council, sought a meeting to discuss the role of community health nurses in a community-oriented primary care–based dispensation.7 “Wherever we went,” mused Sidney Kark, “there was a major interest in translating the concept of primary health care into practice.”8 The editor of the South African Medical Journal exuberantly declared in 1994, “The Pholela Health Centre was one of two spectacular attempts at health care innovation that surfaced in the early 1940s, well ahead of their time. The other was the report of the Gluckman Commission. . . . Today’s policy-makers need look no further for a model on which to base a sensible and effective primary health care network.”9Nor did they. Given its noble pedigree and the urgent need to extend health care equitably to all in the new South Africa, primary health care naturally formed the foundation of the ANC government’s National Health Bill, which aimed to transform the country’s health sector comprehensively. Through its many drafts between 1998 and 2003, when it was finally passed, the bill’s primary health care core remained unchallenged. Primary health care is “the basic ‘plank’ of our [new] health system,” explained James Ngculu, the chair of Parliament’s Portfolio Committee on Health,10 and the minister of health insisted that the new health system would be “based on primary health care. . . . It is our responsibility, nationally and provincially, to always protect the principle of primary health care in our country.”11 “As did Moses,” rhapsodized Ngculu, the act would “take the health system of our country to the promised land of equity and equality, efficiency and quality, and accelerate the long road to a better life for all.”12     

庆阳市基层社区卫生服务中心院前急救能力及影响因素分析

目的 分析影响基层社区卫生服务中心院前急救能力的主要因素,提出针对性的改进策略。方法 整群随机抽取庆阳市某主城区3个社区卫生服务中心的127名卫技人员进行现场问卷调查,了解卫技人员院前急救能力、培训学习情况等;召集社区卫生服务中心负责填写本单位的基本情况。采用有序多分类logistic回归模型分析院前急救能力的影响因素。结果 3家社区卫生服务中心的建设规模尚未完全达标。3家服务中心均未设急诊科,一些常规急救设备尚未充分配备。针对卫技人员的调查,收回有效问卷122份,有效回收率96.06%。122名卫技人员中以护理人员为主（占59.1%）,学历构成以大专为主（占61.5%）,初级职称人数最多（占63.1%）。3家社区卫生服务中心卫技人员的学历、职称、年龄、工龄比较,差异均无统计学意义（P> 0.05）。参加过急救专业知识培训的卫技人员占95.0%;所参与的各类培训中,含有急救知识的比率介于86.7%～96.6%。卫技人员对不同急救知识技能的掌握程度的自评结果不同（P <0.05）：对生命体征检测、心肺复苏技术和伤口处理表示“完全掌握”的人数占比相对较多,分别为57.4%、40...     

Assessing the professional development needs of public health professionals.

This article describes the major activities associated with designing and implementing a comprehensive, professional development needs assessment of public health professionals in four states of the South Central region of the United States. The instrumentation, research design, and summary results of the needs assessment described in this article may facilitate similar efforts by interested researchers and program developers to assess the public health professional workforce training needs. Results of needs assessments can be useful in designing and evaluating professional development curricula and activities to strengthen public health services in the United States.     

Interdisciplinary Collaborative Training for School-Based Health Professionals

ABSTRACT: Changes in the nation's health and education systems have mandated that disciplines work together in a coordinated and collaborative manner to meet the complex health and educational needs of children and adolescents. This need for interdisciplinary collaborative training becomes even more of an issue for professionals providing services in school-based health centers. Although several foundation projects have focused on training health care professionals and other service disciplines, there are relatively few reports of interdisciplinary training of school health professionals. Two projects — the California State University Interprofessional Collaboration Training Project and the Catholic University of America School Nurse Practitioner Program — are reviewed and suggestions are presented for expanding interdisciplinary training of school-based health professionals in academic institutions     

滨州市滨城区公共卫生服务体系建设现况调查及发展趋势探讨

[目的]为进一步了解公共卫生服务体系建设状况,探索可持续发展的基层公共卫生服务模式,保障广大人民群众的身体健康和生命安全。[方法]于2007年7月至2008年6月对山东省滨州市滨城区公共卫生机构从业人员、服务范围、基础设施建设、经费投入等情况进行现况调查,并对该区2000年以来的卫生统计资料进行了调查。[结果]医疗机构526家,社区卫生服务中心（站）20个,疾控中心、卫生监督所、结防所、妇幼保健站各1个,基本建立了单位、部门之间的密切协作、社会参与、齐抓共管的公共卫生服务模式;乡镇卫生院、社区、中心卫生室公共卫生人员的学历构成和技术职称较低,本科、专科、中专学历分别占4．7％、12．6％和77．1％,副高、中级、初级职称分别占0．7％、10．5％和84．4％;乡镇级医疗卫生机构、社区卫生服务中心（站）财政拨款只有人员工资的30％～40％;存在人才缺乏、经费不到位、体制不建全等制约因素,居民就医双向转诊模式尚未真正形成。[结论]加强管理,加大财政投入,逐步完善公共卫生服务体系建设。     

VIOLENCE AGAINST WOMEN: AN EDUCATION PROGRAM FOR RURAL COMMUNITY HEALTH WORKERS

ABSTRACT: This study aimed to identify the educational needs of community-based rural health professionals regarding violence against women, and was funded under the Rural Health Support, Education and Training (RHSET) program. Focus groups and teleconferences were conducted with health workers, organisations and key individuals in the Wide Bay Region, Queensland, Australia. As a result, an education package has been designed that will provide specific training in violence against women for rural and remote health professionals working in the field. Rural health community workers identified the need to enhance their intervention skills and understanding on the issue of violence against women. A distance education framework based on adult and guided learning principles has been developed to meet this need. Six areas were identified as important learning needs and included: (i) violence against women as a public health concern; (ii) The role of the community health worker; (iii) How the community health worker can empower women experiencing violence in their lives; (iv) Enhancing and developing supportive networks; (v) Building on community development action; and (vi) Where to next for community health workers.     

深圳市区域公共卫生应急队伍现状及岗位培训需求调查分析

目的了解深圳市区域公共卫生应急队伍现状及其对岗位培训的需求,分析影响公共卫生应急岗位培训的因素,对培训模式及效果的研究提供科学依据。方法整群抽取区属疾病预防控制中心、卫生监督所及随机抽取区属医疗机构及社康中心从事公共卫生应急工作的技术人员,共对47名人员进行问卷调查。结果 47名人员中参加工作年限平均为12年;中高级以上职称36名,占76.6%;本科以上学历43名,占91.5%;有45人(占95.7%)从事过公共卫生应急工作;需要参加培训的前三位原因:岗位工作需要、个人兴趣、晋升需要;影响参加培训的前三位原因:工作离不开、不知道培训信息和内容不合适;培训方法选择,分别为小讲课(78.7%)、情景教学(72.3%)、示教(63.8%)及小组讨论(57.4%);在培训形式上函授、学历/学位教育、进修和培训项目是最受欢迎的形式;培训内容的需求,超过78%的被调查者认为应以疾病监测理论与方法,现场调查和处理能力,专业技术方案等事项为主。结论基层公共卫生应急队伍的培训应从专业人员学历、职称等特点出发,通盘考虑影响因素,加强培训前期准备工作,合理安排培训形式和内容。     

安庆市社区健康教育现状分析

目的分析社区健康教育现状,为更有效地实施国家基本公共卫生服务提供理论依据。方法随机抽取安庆市32所乡镇卫生院和11所社区卫生服务中心,针对《国家基本公共卫生服务规范2011》规定的社区健康教育的内容、形式和服务要求,自行设计调查表开展现状调查,运用EpiData3．02、SPSS13．0软件进行数据库的建立和统计处理。结果社区健康教育内容不全面、形式较单一、缺乏健康教育的专职人员和专业指导。结论要重视社区健康教育,内容要针对性、形式要多样化,并加强评估和考核工作。     

Public health skills in primary care in South West England--a survey of training needs, obstacles and solutions.

The UK government is moving primary care towards a more health needs led service. This will require a greater awareness of public health skills among primary care staff. We therefore sent a postal questionnaire to the chairmen of primary care groups (general practitioners), the chief officers of primary care groups, directors of public health, nurse advisors of health authorities, directors of community nursing and directors of midwifery in the South West region of England. Respondents were asked about skills in health needs assessment, health service planning and other public health skills among general practitioners, health visitors and midwives. The survey also covered perceived obstacles to the acquisition of such skills and possible solutions. The response rate was 67% (96/143). Eighty percent of primary care groups returned at least one reply. Sixty-four percent had either not considered the problem or considered it but not acted. Fifty percent of directors of public health felt that they could not provide more training to non-specialist staff. Most organisations provided little training in public health skills to non-specialist staff despite a perceived skill shortage particularly in health promotion, advocacy and the evaluation of the effectiveness and efficiency of services. We conclude that primary care groups and public health departments need to agree how to access public health advice. Primary care groups need to identify individuals with an interest in strategic working and service planning, identify their skill deficits and seek appropriate training.     

Nutrition in an ethnically diverse society: what are some of the key challenges?

The role of nutrition is especially important in certain 'lifestyle' diseases that impact disproportionately on ethnic minority populations. The aim of this paper is to review the evidence of risk, health outcomes and interventions for certain diseases that affect the UK's largest ethnic minority group (South Asians) in order to help professionals better address the needs of this diverse population. Research evidence is presented on factors influencing access to services by ethnic minority populations and the changing UK policy background for public health and preventive care. The available research base on obesity, diabetes and CVD is discussed. Conditions such as type 2 diabetes, which are more prevalent among the South Asian population, are associated with poorer health outcomes and appear to exhibit links to diet and nutrition that start in childhood or even before birth; all making preventive care important. Obesity is a major risk factor and it appears that BMI thresholds may need to be lower for South Asians. Targeted interventions to improve diet and outcomes in the South Asian population also appear promising. Recent moves to promote access to evidence of ethnicity and health and to improve the cultural competence of organisations are discussed. Health professionals will increasingly need to promote lifestyle changes in a manner that meets the needs of a diverse population in order to address future public health challenges. Nutritionists and other professionals will need to ensure that interventions are culturally appropriate and involve engagement with extended family members and communities.     

Community Medicine in India — Which Way Forward?

Today, the Community Medicine professionals in India feel both “confused” and “threatened” by the mushrooming of schools of public health and departments of family medicine. The phenomenon of identity crisis and low-self esteem is not a recent one, nor is it restricted to India. The disciplines of community medicine and public health have evolved differently and despite some overlaps have differences especially in the need for clinical training. The core of the issue is that while the community medicine fraternity is keen to retain its clinical tag, what differentiates it from clinicians is the use of public health approach. I believe the strength of community medicine is that it bridges the gap between traditional fields of public health and clinical medicine and brings community perspective into health. The perceived threat from non-medical persons led public health is largely a result of us undervaluing our strength and our inability to foster partnership on equal footing with non-clinicians. While departments of community medicine have a fully functional rural or urban field practice area used for training at primary level care, these can serve as an excellent platform for training in secondary level care required for family medicine. National needs dictate that all three disciplines are required for improvement of population health, whether these are housed together or separately can be left to individual institutions to decide as long as they enable collaborations between them. We need to strengthen community medicine and market it appropriately to ministries of health.     

Barriers to Medical Research Participation as Perceived by Clinical Trial Investigators: Communicating with Rural and African American Communities

Clinical trials help advance public health and medical research on prevention, diagnosis, screening, treatment, and quality of life. Despite the need for access to quality care in medically underserved areas, clinical trial participation remains low among individuals in rural and African American communities. This study assessed clinical trial research in South Carolina's five main academic medical centers, focusing specifically on clinical trial investigators' perceived barriers to recruitment in the general population and in rural and African American communities. Online survey responses (N = 119) revealed that it was most difficult for investigators to recruit from rural areas and that rural residents were least likely to be represented in medical research, behind both the general public and African Americans. Barriers focusing on communication or awareness proved to be the biggest hurdles to finding potential participants in both the general public and rural communities. Psychological barriers to recruitment were perceived to be most prevalent in African American communities. Study findings provide important insights from the perspective of the clinical trial investigator that will aid in the development of effective communication and education strategies for reaching rural and African American residents with information about clinical trials.     

社区卫生服务机构医务人员从业培训状况调查及分析

目的通过对社区卫生服务机构医务人员的调查,探讨社区医疗全科医学教育的合理方案和模式。方法采用调查问卷方式,对广州市越秀区部分社区医疗医务人员进行调查,包括基本信息、工作状况、培训教育状况等。结果社区卫生服务机构医务人员构成以大学本科、大专学历为主,职称构成以初级为主。对工作满意程度一般的占44.4%,认为工作压力很大的占44.1%。进行全科医生规范培训前有61.9%的人员没有获得过进修机会。大部分人愿意参加全科医生规范培训,并认为业务水平有一定程度提高。结论全科医生规范培训是提高社区卫生服务机构医务人员业务和服务水平有效途径。对于存在一些问题,需要加强政府管理,加以改善。     

甘肃省社区卫生服务提供及财政状况调查研究

目的了解甘肃省社区卫生服务机构服务提供及财政状况基本现状,为发展甘肃省社区卫生服务提供决策依据。方法采用统一问卷,调查分析甘肃省98所城市社区卫生服务中心和264所社区卫生服务站的服务提供情况及财政状况。结果甘肃省城市社区卫生服务机构医疗服务利用率较低,公共卫生服务不完善且质量较差。40.01%的社区卫生服务中心和26.07%的社区卫生服务站财政支出大于收入,政府财政对社区卫生服务机构的投入不足。结论建议转变服务模式,加强公共卫生服务能力培训,加大政府投入,建立收支两条线的财务政策。     

Engaging communities to improve mental health in African and African Caribbean groups: a qualitative study evaluating the role of community well‐being champions

Over the last decade, Britain has undergone reforms to promote engagement in local structures of governance. These reforms have encouraged the promotion of active citizenship and have been central to the government's public service modernisation agenda. This article presents the findings from a study evaluating a pilot outreach intervention which adopted a community engagement model to address the mental health needs of African and African Caribbean groups, which entailed a partnership between faith‐based organisations, local public services and community organisations to co‐produce the pilot project. Lay people were trained to raise awareness about mental health among these communities in South London. Between 2012 and 2013, a qualitative participatory approach was used to evaluate the pilot project, which enabled a researcher to take part in the engagement phase of the pilot project, and the project co‐ordinators to be involved in the research process. Semi‐structured, one‐to‐one interviews were carried out with 13 community and well‐being champions (CWBCs) recruited from African and African Caribbean communities (seven male and six female). This study examines the impact of the relationship between the intervention and community through the participants’ engagement in the pilot outreach project and the action undertaken as champions. We found that although CWBCs used circles of influence to share ideas about mental health and well‐being and to encourage change, they encountered resistance on the part of the people they engaged with, which resulted from a lack of knowledge about mental health, taboos and ascribed stigma. We argue that CWBCs acted as healthy examples to communicate mental health knowledge to those approached, but that they needed to be equipped with bespoke communication skills to be able to talk about such sensitive issues as mental health.     

Caring for children with specialized health care needs in the community: the challenges for primary care

People needing intensive and specialized health care are being cared for now in community settings; this has implications for both primary health care professionals and family carers. This paper draws on research investigating how services can be developed to support families caring for children with complex health care needs, to consider the challenges facing professionals working in the primary health care sector. Interviews conducted with parents, professionals and those who fund and commission specialized health services reveal particular problems in relation to the purchasing and provision of short-term care and specialist equipment/therapies in the community. These problems need to be addressed if people with specialized needs are to be cared for outside hospitals. The new Primary Care Groups (PCGs) will have the opportunity to enhance the provision of these services. Primary care professionals will also need to work in partnership with other sectors of the health service and with local authority services, at both strategic and operational levels, to develop integrated and coordinated services for this growing group of people.     

山东省部分社区医护人员肿瘤防治知识的调查研究

目的了解山东省某社区医护人员对肿瘤防治知识的掌握情况,旨在为今后加强肿瘤防治知识培训提供依据。方法发放问卷调查表对山东省三家社区卫生服务中心的180名医护人员进行肿瘤防治相关知识的调查。结果学历和职称越高,年龄越小,得分越高,肿瘤防治知识掌握程度越好。护士的平均得分在性别、学历、职称、年龄方面均低于临床医生与防保医生。结论社区医护人员对肿瘤防治知识的认知不足,尤其是护士更为明显。应加强社区医护人员的教育和培训,提高肿瘤防治的社区服务水平,普及社区肿瘤防治知识,增强社区群众的肿瘤防护意识。     

新医改以来我国社区卫生服务中心卫生人力资源配置现状分析

目的 了解新医改以来我国社区卫生服务中心卫生人力资源配置现状和问题,为我国合理配置社区卫生人力资源提供依据。方法 运用描述性分析方法分析我国社区卫生服务中心人力资源的数量、结构,利用洛伦兹曲线和基尼系数分析我国社区卫生服务中心人力资源分布的公平性。结果 2009－2015年,我国社区卫生服务中心卫生人员以省为单位的东、中、西部地区卫生服务中心卫生技术人员Gini系数从0.331 1下降到0.294 6;社区卫生人员数量有所增加,新增卫生人员291.24万人,其中社区卫生人员20.97万人,占新增卫生人员的7.2%;2015年社区卫生服务中心执业(助理)医师本科及以上学历占比为39.8%,医护比从2009年的1.4改善为2015年的1.2。结论 新医改以来,我国社区卫生服务中心人才队伍总的来说向好的趋势变化,我国东、中、西部社区卫生服务中心的卫生人员分布公平上存在的差异在逐步缩小,但仍存在人员数量不足、学历、职称、医护比结构失衡问题。     

Health workforce development: a needs assessment study in French speaking African countries

In 2006, WHO alerted the world to a global health workforce crisis, demonstrated through critical shortages of health workers, primarily in Sub-Saharan Africa (WHO in World Health Report, 2006). The objective of our study was to assess, in a participative way, the educational needs for public health and health workforce development among potential trainees and training institutions in nine French-speaking African countries. A needs assessment was conducted in the target countries according to four approaches: (1) Review at national level of health challenges. (2) Semi-directed interviews with heads of relevant training institutions. (3) Focus group discussions with key-informants. (4) A questionnaire-based study targeting health professionals identified as potential trainees. A needs assessment showed important public health challenges in the field of health workforce development among the target countries (e.g. unequal HRH distribution in the country, ageing of HRH, lack of adequate training). It also showed a demand for education and training institutions that are able to offer a training programme in health workforce development, and identified training objectives and core competencies useful to potential employers and future trainees (e.g. leadership, planning/evaluation, management, research skill). In combining various approaches our study was able to show a general demand for health managers who are able to plan, develop and manage a nation’s health workforce. It also identified specific competencies that should be developed through an education and training program in public health with a focus on health workforce development.