一党制国家的权力下放和免疫计划:老挝人民民主共和国的案例。

IF 3.6 Q1 TROPICAL MEDICINE Tropical Medicine and Health Pub Date : 2024-05-07 DOI:10.1186/s41182-024-00601-8
Phonevilay Viphonephom, Sengchanh Kounnavong, Daniel Reinharz
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引用次数: 0

摘要

背景:老挝人民民主共和国(老挝)是一个中低收入国家,在两岁以下儿童免疫接种覆盖率方面落后于其他东南亚国家。保健服务的组织是免疫接种计划能否发挥作用的关键决定因素。然而,对这一方面,特别是医疗保健系统的权力下放部分,却从未进行过研究:方法:采用基于新制度理论的概念框架,对老挝国家免疫计划进行了案例研究,突出强调了支持免疫计划开展的医疗保健系统权力下放状态的结构(规则、法律、资源等)和解释方案(主导信念和观念)。我们在四个省对各级政府、外部捐助者和民间社会的代表人物进行了 22 次半结构式访谈。从相关文件中获取的信息对数据进行了补充:老挝的医疗保健系统采用了分散的权力下放形式。尽管采取了一些措施促进免疫接种计划的权力下放,但其结构基本上是中央集权。所提供的免疫接种服务的集中状态所依据的结构与共同的主导解释方案是一致的。然而,影响该国的经济、技术和教育的快速变化表明,结构和解释方案之间的一致性必然会发生变化:在老挝人民民主共和国,获得优质高等教育的机会前所未有,社会网络的使用也是可能影响各级政府在国家免疫计划等公共卫生计划中的责任分配的因素。
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Decentralization and immunization program in a single-party state: the case of the Lao People's Democratic Republic.

Background: The Lao People's Democratic Republic (Lao PDR), a lower-middle-income country, lags behind other Southeast Asian countries in immunization coverage for children under two years of age. The organization of health services is a key determinant of the functionality of immunization programs. However, this aspect, and in particular its decentralization component of the healthcare system, has never been studied.

Methods: A case study in the Lao National Immunization Program was performed using a neo-institutional theory-based conceptual framework, highlighting the structure (rules, laws, resources, etc.) and interpretative schemes (dominant beliefs and ideas) that underlie the state of decentralization of the healthcare system that support the conduct of the immunization program. Twenty-two semi-structured interviews were conducted with representative actors from various government levels, external donors, and civil society, in four provinces. Data were complemented with information retrieved from relevant documents.

Results: The Lao healthcare system has a deconcentrated form of decentralization. It has a largely centralized structure, albeit with certain measures promoting the decentralization of its immunization programs. The structure underlying the state of centralization of immunization services provided is coherent with a shared dominant interpretive scheme. However, the rapid economic, technical, and educational changes affecting the country suggest that the coherence between structure and interpretative schemes is bound to change.

Conclusion: Unprecedented opportunities to access quality higher education and the use of social networks are factors in Lao PDR that could affect the distribution of responsibilities of the different levels of government for public health programs such as the National Immunization Program.

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来源期刊
Tropical Medicine and Health
Tropical Medicine and Health TROPICAL MEDICINE-
CiteScore
7.00
自引率
2.20%
发文量
90
审稿时长
11 weeks
期刊最新文献
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