Health sector reform in South Asia: new challenges and constraints
Health sector reform in South Asia: new challenges and constraints
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DOI：
10.1016/s0168-8510(01)00211-1
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发表时间：
2002-05-01
期刊：
影响因子：
3.3
通讯作者：
Tahir, MZ
中科院分区：
文献类型：
--
作者：
Islam, A;Tahir, MZ
上世纪90年代初。贾米森、莫斯利和其他人的结论是，发展中国家正在发生深刻的人口结构和随之而来的流行病学转变。根据这一经典模型，到2015年。随着慢性病变得更加明显，传染病将只占发展中国家死亡人数的20%左右。这些迫在眉睫的人口和流行病学转变将主导发展中国家的卫生部门改革议程。在对南亚和其他发展中国家的生育率、死亡率和其他人口和流行病学数据进行分析后，文章认为经典模型需要重新评估。一些新的“挑战”使人口统计学和流行病学因素之间的传统相互作用变得更加复杂。这些新的挑战包括一些国家的人口持续增长、计划外的快速城市化、撒哈拉以南非洲的艾滋病毒/艾滋病大流行(及其在南亚的迫在眉睫的威胁)以及全球化和发展中国家日益边缘化。然而，传统上缺乏对人类发展的投资使发展中国家更容易受到全球化变迁的影响。他们的政府经济日益疲软，迫使他们进一步退出社会部门。因此，贫困和匮乏的地区。这些问题持续存在，给南亚和许多其他发展中世界带来了三个同时的负担：传染性疾病持续存在、慢性病负担日益加重以及对初级和三级保健服务的需求日益增加。虽然这些复杂因素一方面强调了卫生部门改革的必要性，但另一方面也使这项任务更加困难和具有挑战性。文章强调有必要重温人口和流行病学转变的经典模型。有人认为，发展中国家的卫生部门必须意识到并有效地应对这些“新挑战”。尽管它包含了来自许多发展中国家的数据。重点主要放在南亚。(C)2002爱思唯尔科学爱尔兰有限公司。保留所有权利。
In early 1990s. Jamison, Mosley and others concluded that a profound demographic and consequent epidemiological transition is taking place in developing countries. According to this classical model, by the year 2015. infectious diseases will account for only about 20% of deaths in developing countries as chronic diseases become more pronounced. These impending demographic and epidemiological transitions were to dominate the health sector reform agenda in developing countries. Following an analysis of fertility, mortality and other demographic and epidemiological data from South Asian and other developing countries, the paper argues that the classical model is in need of re-evaluation. A number of new 'challenges' have complicated the classical interplay of demographic and epidemiological factors. These new challenges include continuing population growth in Some Countries, rapid unplanned urbanization, the HIV/AIDS pandemic in Sub-Saharan Africa (and its impending threat in South Asia), and globalization and increasing marginalisation of developing countries. While the traditional lack of investment in human development makes the developing countries more vulnerable to the vicissitudes of globalization. increasing economic weakness of their governments forces them to retreat further from the social sector. Pockets of poverty and deprivation, therefore. persist giving rise to three simultaneous burdens for South Asia and much of the rest of the developing world: continuing communicable diseases, increasing burden of chronic diseases, and increasing demand for both primary and tertiary levels of health care services. While these complex factors, on the one hand, underscore the need for health sector reform, on the other, they make the task much more difficult and challenging. The paper emphasizes the need to revisit the classical model of demographic and epidemiological transition. It is argued that the health sector in developing countries must be aware of and effectively address these 'new challenges'. Although it has included data from many developing countries. the focus is primarily on South Asia. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.