加快立法进程推动初保实施

1 农村初级卫生保健工作概况 农村初级卫生保健是农村居民应该人人享有的、与农村经济社会发展相适应的基本卫生保健服务。我国自20世纪80年代初开始进行初保试点工作。1990年,卫生部、国家计委、农业部、国家环保局、全国爱卫会在总结建国40年农村卫生工作经验和初保试点经验的基础上,制定下发了《关于我国农村实现“2000年人人享有卫生保健”的规划目标》(简称《规划目标》),提出13项指标,涵盖了农村卫生工作的重点内容。在各级党委、政府的领导下,农村初级卫生保健工作取得了一定成绩。虽然20世纪90年代末期,国家取消了达标评审,使各地初保工作受到一定影响,但到2000年年底,全国已有95％的农业     

"首届21世纪初级卫生保健论坛"宣言

以人为本,健康是根。健康是中华民族伟大复兴的基石。人民健康是国家发展的永恒主题。由中国初级卫生保健基金会、中国农村卫生协会、广东省卫生厅、广东省中山市人民政府主办的“首届21世纪初级卫生保健论坛”于2003年11月29日在广东省中山市举办。这次论坛的主题是:“人人享有初级卫生保健与我国全面建设小康社会进程中的健康促进策略”。“论坛”认为,根据世界卫生组织提出的21世纪前20年“人人享有卫生保健”的全球性目标确定的我国本世纪前20年农村初级卫生保健的总目标和实施策略,是“2000年人人享有初级卫生保健”目标的继续和发展,…     

北京市初级卫生保健工作的回顾与展望

实施初级卫生保健是实现“2000年人人享有卫生保健”的基本途径和策略。我国是发展中国家,我国政府对“初级卫生保健”工作非常重视。北京作为我国的首都,初级卫生保健工作起步比较早,也取得了一定的成效。一、北京市初级卫生保健工作的总结与回顾北京的初级卫生保健事业起步于五十年代初期。三十多年来,各级政府动员和组织全体市民有目的、有计划地推行“初级卫生保健”,取得了初步成效。 (一)树立“大卫生的观念”。建国     

农村社区初级卫生保健未来发展必须遵循的几条原则

对农村社区初级卫生保健未来5年发展的研究,是我国农村实现2000年人人享有卫生保健的重要课题。本文仅就农村初级卫生保健未来发展必须遵循的几条原则作一雏议。1 初级卫生保健的发展必须与国民经济、社会发展同步 经济与社会发展的目标是提高人民的生活质量,包括人民的健康质量。也就是说,健康是经济与社会发展的有机组成部分。初级卫生保健的目标是“人人享有卫生保健”、“人人健康”。因此,初级卫生保健又是国民     

初级卫生保健与健康教育

“2000年人人享有卫生保健”是全球的社会目标,是卫生发展的总战略。初级卫生保健(PHC)是实现“2000年人人享有卫生保健”的关键和基础。健康教育是初级卫生保健的第一个内容、可见健康教育在初级卫生保健中具有举足轻重的地位。     

“首届21世纪初级卫生保健论坛”宣言

以人为本 ,健康是根。健康是中华民族伟大复兴的基石。人民健康是国家发展的永恒主题。由中国初级卫生保健基金会、中国农村卫生协会、广东省卫生厅、广东省中山市人民政府主办的“首届 2 1世纪初级卫生保健论坛”于 2 0 0 3年11月 2 9日在广东省中山市举办。这次论坛的主题是“人人享有初级卫生保健与我国全面建设小康社会进程中的健康促进策略”。“论坛”认为 ,根据世界卫生组织提出的 2 1世纪前2 0年人人享有卫生保健的全球性目标 ,确定的我国本世纪前 2 0年农村初级卫生保健的总目标和实施策略是 2 0 0 0年人人享有初级卫生保健目标的…     

几个发达国家和我国的初级卫生保健状况

初级卫生保健（primaryhealthcare,简称PHC）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。PHC是全球性的战略行动,不论是发展中国家还是发达国家,不论是农村还是城市普遍适用。其核心价值观是社会公平,所信奉的理论是“健康是人类的基本权利”,所追求的目标是“人人享有健康”。2008年10月14日世界卫生报告题为《初级卫生保健一过去重要,现在更重要》,世卫组织总干事陈冯富珍指出：“从目前的趋势来看,初级卫生保健越来越是重返卫生发展正确轨道的明智之举”。     

围绕初级卫生保健目标 开展社区卫生服务工作

1 初级卫生保健与社区卫生服务关系1·1 目标一致 1977年第30届世界卫生大会通过的WHO·30·43号决议中指出:“到2000年,使世界上所有的人都达到在社会和经济生活两方面富有成效的那样一种健康水平”,这就是著名的“2000年人人健康”、在我国被译为“2000年人人享有卫生保健”的全球卫生战略目标。1978年国际初级卫生保健会议通过的《阿拉木图宣言》明确指出:初级卫生保健是实现“2000年人人享有卫生保健”目标的关键和基本途径,从而确定了两者之间目标和手段的关系以及这种手段的重要地位。     

找准人人享有卫生保健的突破口——栖霞县加强妇幼卫生保健的调查

栖霞县紧紧围绕世界卫生组织提出的“2000年人人享有卫生保健”这一目标,狠抓妇幼卫生保健,取得显著成绩。各项初级卫生保健指标达到或接近达到省政府制定的2000年初级卫生保健最低限标准,妇幼保健成为全国先进单位,初级卫生保健被列为山东省实施初级卫生保健试点县。一、把妇幼卫生保健作为实现2000年人人事有初级卫生保健的突破口 1977年,世界卫生组织提出了“2000年人人享有卫生保健”的全球性目标,1986年,我国政府明确表示了对这一目标的承诺。要实现这一战略目标,搞好占社会人口     

云南省初级卫生保健实施方案(摘要)

第30届世界卫生大会提出世界卫生组织和各国政府卫生工作的主要目标,是“2000年人人健康”(即人人享有卫生保健)。由联合国儿童基金会和世界卫生组织在苏联阿拉木图召开的国际初级卫生保健会议上进一步指出,初级卫生保健是实现“人人健康”的关键。     

21世纪全面开展初级卫生保健的思考与建议

从我国当前的国力和国际经验来看,我国在21世纪仍然特别需要采取低成本、广覆盖与高产出的卫生发展战略,需要富有远见和创新精神的卫生制度设计。通过立法保障和普及初级卫生保健,保证城乡居民公平享有基本卫生服务,保障全体公民的基本健康权利,是解决当前广大群众“看病难、看病贵”问题的可行策略,是符合我国国情、尽快改善卫生公平性、控制医疗费用过快上涨和提高人民健康水平的最佳制度选择,也是推动卫生改革和体制创新的关键举措。建议通过立法构建我国21世纪初级卫生保健体系,将卫生工作的重点从医疗服务转到疾病预防,将卫生资源从过度的医院服务转向普及基层的初级卫生保健服务,并对相关的社会、环境、行为和心理等健康危险因素进行干预。在大力控制传染病、地方病的同时,尽快建立控制慢性非传染性疾病的能力,防止国家、社会和家庭在未来付出更高的健康损失和经济代价;建议我国未来的卫生服务大体上由“两层服务体系”提供,即初级卫生保健层次和转诊服务层次,逐步实现居民人人享有的“双重健康保障”,即:所有公民享有基本卫生服务和基本医疗保险。     

Health for all: the way ahead

The attainment of health for all requires that a complex range of political, social, managerial and technical problems be overcome. To this end it is necessary to produce a sufficient number of health-for-all leaders throughout the world, possessing the conviction and knowledge that will allow them to galvanize the masses into taking action on their own behalf. This article outlines the importance of leadership in the future of WHO. The most important managerial obstacle to the attainment of health for all in many developing countries is the absence or poor development of a health system infrastructure. There is no universal blueprint for a health-for-all strategy but there can be broad understanding of what health for all means. The fundamental resource of all health work is the community itself and full community involvement should form the basis for the expansion of health care systems. Leadership potential can be encouraged, enhanced and strengthened by means other than formal educational activities. Some examples of this are given.     

Primary health care in China: problems and challenges]

The World Health Organization (WHO) put forward a global strategy goal of "Health for All by year 2000" and pointed out the task of achieving this based on the primary health care (PHC) during the Alma-Ate Conference in 1978. The government of China have endorsed the WHO agreement and performed much work toward it. However, the gap between urban areas and rural areas is widening. The accomplishment of the goal of "Health for All by the year 2000" is still a critical task in China. In this study, main health problems, government policies and measures on the framework of quality of life, health status, lifestyle and health-supporting environment, medical, health and welfare system and health policies in PHC of China were diagnosed and evaluated according to the "diagnosis and evaluation for health promotion" by Green and Kreuter (1991). Japanese experiences in a combined medical, health and welfare system, elderly care, environmental protection and health education are very helpful to strengthen PHC in China. A new partnership for "Health for All" between Japan and China to achieve the goal of "Health for All by the year 2000" is imperative.     

Is primary health care progressing in Europe?

Primary health care (PHC) is the key to attaining the goal of health for all (HFA) by the year 2000. Also the European countries have accepted the declarations and WHO resolutions related to global and European HFA strategies. However, the implementation of regional and national strategies has met with many obstacles, caused by reluctant attitudes and poor planning and management systems. In this review the objective of PHC in industrialized countries, the evaluation process of HFA strategy, and progress in PHC in Europe in the 1980s are discussed. Lack of defined national objectives, and health information systems which are not adopted to purposes of monitoring progress in PHC are causing most of the problems in evaluation. There is a clear positive development in PHC resources and organization in the Nordic countries. Generally speaking PHC is progressing very slowly in Europe, if there is any progress at all. This can be said both about organization of health care, planning and management systems and about application of PHC principles like community participation and intersectoral collaboration. The national health information systems should be quickly revised to allow more exact monitoring of progress towards the 38 European targets and additional national targets.     

The second round of monitoring the health-for-all strategy: the experience of the Americas.

The WHO Region of the Americas comprises 34 Member States and a number of other countries and territories. For the 1988 monitoring of the health-for-all strategy (HFA), 27 Member States which included almost 100% of the population of the Region submitted reports. Data from other sources were used by the Regional Office to supplement these reports and to compile reports for all the countries of the Region for inclusion in the regional monitoring report. It was noted that sometimes data were available from outside sources on items that had not been reported on by the countries themselves. The common framework for monitoring (CFM) was used by the countries to prepare these reports. A number of problems were found with this instrument. A conflict was perceived between the assessment of the value of the global indicator for a given country, and its value in terms of the goal set for that indicator. It is also suggested that a number of more qualitative indicators be eliminated, and case studies substituted. A new indicator on coverage by vital registration is proposed, since it is argued that coverage with birth and death registration is directly correlated with coverage by primary health care (PHC). Regarding the availability, quality and comparability of the data provided by the countries, the results of the monitoring process showed great variability. Immunization data were generally available, but several countries reported on fewer doses or different target ages than those recommended by the global Expanded Programme on Immunization.(ABSTRACT TRUNCATED AT 250 WORDS)     

Primary health care in the Philippines: banking on the barangays?

Primary health care has been hailed by some countries as the only practical means of providing any form of health care for expanding populations in poor economies. This is particularly true in Third World countries where the cost explosion of technology-oriented health care has been a major problem in extending services. Therefore, the PHC package of education, nutrition, preventive medicine and treatment of the most common diseases and injuries is sometimes regarded as the most beneficial application of scarce resources. The Philippines claims to be one of the first (perhaps the first) countries to have adopted PHC as a national strategy for health care and, since 1981, impressive achievements have been attained in this sector by contrast with reversals in many other sectors of the economy. PHC has not challenged the pre-eminence of Metro-Manila in the provision of hospital and specialist facilities but it has extended some basic care particularly to rural regions of the country. This paper reviews the background to health care in the Philippines and it then examines the implementation of PHC in Negros Oriental, where PHC has taken on the additional feature of special use of indigenous materials and resources. The administrative, financial and legal bases and some geographical facets of PHC are highlighted in this province. The campaign relies heavily on local (barangay) initiatives and community participation, in part to minimise resources which have to be devoted to health in a very troubled national economy. In spite of local skills and enthusiasm, this arguably still involves the abrogation of a degree of government responsibility for health care. As a result, the Philippines strategy may be said to be "banking on the barangays."     

WHO: reaching out to all

This article explains how the concept of health for all developed within the context of the history of the World Health Organization (WHO). By the early 1970s a new idea was taking shape in WHO. Medical services were failing to reach vast numbers. Health would have to emerge from the people themselves. In the heat of discussion the new strategy was clarified and given a name--primary health care (PHC). An ambitious target was set for it--no less than health for all by the year 2000. It was decided that the community itself had to be involved in planning and implementing its own health care. A new type of health worker was called for, chosen by the people from among themselves and responsible to the community but supported by the entire health system. In virtually all countries, the emphasis on curative care would have to be balanced by an equal emphasis on prevention. Almost 90% of WHO's Member States were prepared to share with one another detailed information about the problems facing their health systems. Industrial countries were beginning to realize that sophisticated medical technology was no guarantee of good health and that health for all through PHC offered an alternative. Millions of health workers have been trained, extending services to low-income groups that had no access to modern health care. Among health professionals, lack of understanding of the PHC concept and insufficient concern for social equity remain the principal constraints. Another problem is that expenditure on health care tends to be viewed as a drain on scarce resources rather than as an investment in the nation's future. The mommentum of health for all can be sustained only by governments implementing at home the policies they have collectively agreed on at The World Health Assembly in Geneva.     

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)     

在PHC中妇幼指标的达标要求

根据国家五部委下发的《我国农村实现“2000年人人享有卫生保健”的规划目标》,对规划中所涉及到的妇幼保健指标及达标要求进行了剖析,分析了目前国内妇幼保健现状,从局部地区情况出发,提出了达标差距及达标措施,并论述了评价方法。     

Transition to family practice in Turkey

INTRODUCTION: Turkey's primary health care (PHC) system was established in the beginning of the 1960s and provides preventive and curative basic medical services to the population. This article describes the experience of the Turkish health system, as it tries to adapt to the European health system. It describes the current organization of primary health care and the family medicine model that is in the process of implementation and discusses implications of the transition for family physicians and the challenges faced in meeting the needs for health care staff. In Turkey a trend toward urbanization is evident and more staff positions in rural PHC centers are vacant. Shortages of physicians and an ineffective distribution of doctors are seen as a major problem. Family medicine gained popularity at the beginning of the 1990s, as a specialty with a 3-year postgraduate training program. Medical practitioners who are graduates of a 6-year medical training program and are already working in the PHC system are offered retraining courses. Better working conditions and higher salaries may be important incentives for medical practitioners to sign a contract with the social security institution of Turkey. DISCUSSION: The lack of well-trained primary care staff is an ongoing challenge. Attempts to retrain medical practitioners to act as family physicians show promising results. Shortness of physician and health professionals and lack of time and resources in primary health care are problems to overcome during this process.