A renewed focus on primary health care: revitalize or reframe?
A renewed focus on primary health care: revitalize or reframe?
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DOI：
10.1186/1744-8603-6-13
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发表时间：
2010-01-01
影响因子：
10.8
通讯作者：
Rifkin, Susan
中科院分区：
文献类型：
--
作者：
Bhatia, Mrigesh;Rifkin, Susan
2008年是《阿尔马宣言》产生的初级保健政策30周年，发表了两份重要报告，即《2008年世界卫生报告》和《健康问题社会决定因素委员会的报告》。这两份报告都重申了初级保健在当今世界的愿景和价值观方面的相关性。然而，在定义初级保健，公平和赋权方面的重要挑战需要解决。本文采取评论的形式回顾了过去30年的发展，并讨论了这一政策的未来。提出了三项挑战供讨论：㈠从狭隘的技术性生物医学保健模式转向更广泛的社会决定因素办法的挑战，以及将初级保健与初级保健区分开来的必要性; ㈡处理面向市场的改革所涉公平问题和确保国家在提供福利服务方面的作用不被进一步削弱的挑战;以及（iii）寻找方法，特别是在赋予权力方面，发展地方社区承诺的挑战。如果初级保健要在今天的背景下保持相关性，就必须应对这些挑战。本文件的结论是，仅仅振兴《阿尔马宣言》中的初级保健是不够的，必须根据上述讨论重新制定。
The year 2008 celebrated 30 years of Primary Health Care (PHC) policy emerging from the Alma Ata Declaration with publication of two key reports, the World Health Report 2008 and the Report of the Commission on the Social Determinants of Health. Both reports reaffirmed the relevance of PHC in terms of its vision and values in today's world. However, important challenges in terms of defining PHC, equity and empowerment need to be addressed.This article takes the form of a commentary reviewing developments in the last 30 years and discusses the future of this policy. Three challenges are put forward for discussion (i) the challenge of moving away from a narrow technical bio-medical paradigm of health to a broader social determinants approach and the need to differentiate primary care from primary health care; (ii) The challenge of tackling the equity implications of the market oriented reforms and ensuring that the role of the State in the provision of welfare services is not further weakened; and (iii) the challenge of finding ways to develop local community commitments especially in terms of empowerment. These challenges need to be addressed if PHC is to remain relevant in today's context. The paper concludes that it is not sufficient to revitalize PHC of the Alma Ata Declaration but it must be reframed in light of the above discussion.