BRIDGING THE GAP - THE VILLAGE HEALTH WORKER AS THE CORNERSTONE OF THE PRIMARY HEALTH-CARE MODEL
BRIDGING THE GAP - THE VILLAGE HEALTH WORKER AS THE CORNERSTONE OF THE PRIMARY HEALTH-CARE MODEL
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DOI：
10.1016/0277-9536(87)90341-8
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发表时间：
1987-01-01
影响因子：
5.4
通讯作者：
PITKIN, K
中科院分区：
文献类型：
--
作者：
BENDER, DE;PITKIN, K
1978年阿拉木图会议重申了“到2000年人人享有卫生保健”的目标，并宣布初级卫生保健是实现这一崇高目标的手段。各国政府被认为是制定和实施初级保健计划的负责任的机构。强调以社区为导向的保健服务非常重视村卫生工作者，他们是正规卫生保健系统与社区之间的“接口”。尽管VHW角色的重要性得到公认，但以VHW为基石的PHC模式能否在没有“财富和权力的根本转移”（Sidel）的情况下有效实施的问题仍在继续。本文考察了哥斯达黎加、尼加拉瓜和哥伦比亚这三个采用初级保健模式的拉丁美洲国家VHW角色的演变和现状。作者讨论了PHC模式在每个国家的演变，并特别参考了社会发生或未发生根本性变化的情况。结论是，成功实施初级保健的主要决定因素是国家对初级保健的承诺，包括承认社区参与的重要性，而社区参与的最佳实现方式是依靠村卫生工作者。
The Alma-Ata Conference in 1978 reiterated the goal of ‘Health for All by the Year 2000’ and declared primary health care (PHC) the vehicle through which this lofty goal was to be achieved. National governments were recognized as responsible agents for developing and implementing PHC plans. The emphasis on community-oriented delivery of care places great importance on the village health worker (VHW), the individual who serves as the ‘interface’ between the formal health care system and the community. Despite the acknowledged importance of the VHW role, the question of whether the PHC model, with the VHW as the cornerstone can be effectively implemented without a “fundamental shift of wealth and power” (Sidel) continues to be asked.This paper examines the evolution and current status of the VHW role in Costa Rica, Nicaragua and Colombia, three Latin American nations which have adopted the PHC model. The authors discuss the evolution of the PHC model in each country with particular reference to the occurence or non-occurence of fundamental changes in the society. The conclude that the primary determiner of successful implementation of PHC is a national commitment to PHC including recognition of the importance of community participation which is best achieved through reliance on the village health worker.