A code of best practice for disease control programmes to avoid damaging health care services in developing countries
A code of best practice for disease control programmes to avoid damaging health care services in developing countries
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DOI：
10.1002/hpm.723
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发表时间：
2003-10-01
影响因子：
2.7
通讯作者：
Green, A
中科院分区：
文献类型：
--
作者：
Unger, JP;De Paepe, P;Green, A
我们应该如何实施疾病控制规划，以加强现有的卫生系统？为了回答这个问题，我们从管理的角度重新审查了这些方案的整合。根据文献回顾，我们得出结论，在大多数情况下，整合是必不可少的。我们继续研究了疾病控制活动整合可能危及医疗保健服务的机制，导致服务利用率低、检出率和治愈率低以及患者延误。为此，我们将疾病控制规划分为三类，并评估了每一类对当地卫生保健设施的影响。根据这些结果，我们建议采取一系列措施，帮助援助机构和国家政府支持地方卫生保健基础设施，或者至少避免破坏它们。虽然一些垂直规划永远不应该被整合，但有两个条件对于整合其他规划至关重要：(1)疾病控制需要与提供一般卫生保健相结合——这意味着有可能在面向公众的卫生服务中提供全科/家庭医学护理。(2)业务和行政两方面应同时结合起来。发展中国家任何倾向于将疾病控制方案分配给政府设施而将一般保健分配给私人设施的保健政策都阻碍了它们的整合。它们有可能破坏疾病控制和卫生保健服务所依赖的结构。版权所有：John Wiley Sons， Ltd。
How should we implement disease control programmes so as to strengthen existing health systems? To answer this question, we re-examined the integration of these programmes from a managerial perspective. Based on a literature review, we concluded that integration is essential in the majority of cases. We went on to examine the mechanisms whereby the integration of disease control activities can jeopardize health care delivery, resulting in low service utilization, low detection and cure rates, and patient delays. To do this we clustered disease control programmes into three categories and assessed the impact of each on local health care facilities. From these results, we suggest a series of measures designed to help aid agencies and national governments support local health care infrastructures or, as a minimum, avoid damaging them. Whilst some vertical programmes should never be integrated, two conditions are essential to the integration of others: (1) Disease control needs to be integrated with general health care delivery-which implies the possibility to deliver general practice/family medicine care in publicly oriented health services. (2) Integration of both operational and administrative aspects should take place simultaneously. Any health policies in developing countries tending to allocate disease control programmes to government facilities and general health care to private facilities preclude their integration. They risk unravelling the fabric on which both disease control and health care delivery depend. Copyright (C) 2003 John Wiley Sons, Ltd.