Alma-Ata: Rebirth and revision 5 - Community participation: lessons for maternal, newborn, and child health
Alma-Ata: Rebirth and revision 5 - Community participation: lessons for maternal, newborn, and child health
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DOI：
10.1016/s0140-6736(08)61406-3
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发表时间：
2008-09-13
期刊：
影响因子：
168.9
通讯作者：
Costello, Anthony
中科院分区：
文献类型：
--
作者：
Rosato, Mikey;Laverack, Glenn;Costello, Anthony
1978年，初级卫生保健被批准为世卫组织成员国的卫生政策。(1)参与保健是《阿拉木图宣言》的一项关键原则。在发展中国家，妇女的产前、分娩和产后体验通常发生在社区，而不是卫生设施。因此，改善孕产妇和儿童健康的战略应使社区参与进来，作为任何以设施为基础的组成部分的补充。宣言“第四条指出，”人民有权利和义务单独和集体参与规划和实施其保健工作“，第七条规定，初级保健”要求并促进社区和个人最大限度地自力更生，参与初级保健的规划、组织、运作和控制“。但是，社区参与是更好的健康结果的基本前提，还是仅仅是提供治疗和预防性健康教育的有用但非必要的伙伴？它是否只是一种过渡性战略：对最贫穷和最贫困的人口至关重要，但一旦建立医疗保健体系，基本上就无关紧要了？或者，未能将社区参与纳入大规模初级保健方案是我们未能实现降低孕产妇和儿童死亡率的千年发展目标4和5的主要原因？
Primary health care was ratified as the health policy of WHO member states in 1978.(1) Participation in health care was a key principle in the Alma-Ata Declaration. In developing countries, antenatal, delivery, and postnatal experiences for women usually take place in communities rather than health facilities. Strategies to improve maternal and child health should therefore involve the community as a complement to any facility-based component. The fourth article of the Declaration stated that, "people have the right and duty to participate individually and collectively in the planning and implementation of their health care", and the seventh article stated that primary health care "requires and promotes maximum community and individual self-reliance and participation in the planning, organization, operation and control of primary health care". But is community participation an essential prerequisite for better health outcomes or simply a useful but non-essential companion to the delivery of treatments and preventive health education? Might it be essential only as a transitional strategy: crucial for the poorest and most deprived populations but largely irrelevant once health care systems are established? Or is the failure to incorporate community participation into large-scale primary health care programmes a major reason for why we are failing to achieve Millennium Development Goals (MDGs) 4 and 5 for reduction of maternal and child mortality?