实施有效措施:振兴东帝汶综合初级保健的案例研究。

Q1 Medicine Asia Pacific Family Medicine Pub Date : 2014-02-24 DOI:10.1186/1447-056X-13-5
Nelson Martins, Lyndal J Trevena
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引用次数: 13

摘要

背景:振兴初级卫生保健和实现千年发展目标的必要性要求发展中国家根据当地情况调整有关有效卫生系统的现有证据。东帝汶是世界上最新的发展中国家之一,孕产妇和儿童死亡率高,疟疾,结核病和营养不良。多山的地形和缺乏交通对获得保健服务和实施预防性保健战略构成严重挑战。方法:我们对文献进行了非系统回顾,并确定了有效PHC系统的六个组成部分。它们被映射到三个国家的初级保健系统,并展示了一个来自东帝汶的以千年发展目标为重点的沙特综合服务(SISCa)的案例研究。在当地收集的卫生系统数据显示了将这些措施付诸实践所面临的一些挑战。结果:一个有效的初级保健体系包括:1)强有力的健康人权领导和政府;2)优先考虑具有成本效益的干预措施;3)建立互动、融合的社区参与文化;4)在社区一级提供综合连续护理;5)支持各级卫生系统熟练和装备精良的卫生工作者;6)利用数据为卫生保健提供信息,创建一个反馈的系统循环。来自东帝汶(人口100万)的实施案例研究表明,在实施的第三年,已经收集了有限的全国数据,SISCa方案在村一级提供了50多万次卫生互动。然而,全国只有一半的SISCa诊所在运作。参加者不仅包括孕妇和儿童,也包括成人和老年社区成员。发展伙伴在支持这一执行进程方面发挥了关键作用。结论:SISCa项目是一种初级保健模式,在新兴发展中国家实施当前的最佳实践,以覆盖偏远社区。尽管资源有限,但可以实现村一级的保健和参与,但需要长期的承诺和伙伴关系。
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Implementing what works: a case study of integrated primary health care revitalisation in Timor-Leste.

Background: Revitalising primary health care (PHC) and the need to reach MDG targets requires developing countries to adapt current evidence about effective health systems to their local context. Timor-Leste in one of the world's newest developing nations, with high maternal and child mortality rates, malaria, TB and malnutrition. Mountainous terrain and lack of transport pose serious challenges for accessing health services and implementing preventive health strategies.

Methods: We conducted a non-systematic review of the literature and identified six components of an effective PHC system. These were mapped onto three countries' PHC systems and present a case study from Timor-Leste's Servisu Integrado du Saude Comunidade (SISCa) focussing on MDGs. Some of the challenges of implementing these into practice are shown through locally collected health system data.

Results: An effective PHC system comprises 1) Strong leadership and government in human rights for health; 2) Prioritisation of cost-effective interventions; 3) Establishing an interactive and integrated culture of community engagement; 4) Providing an integrated continuum of care at the community level; 5) Supporting skilled and equipped health workers at all levels of the health system; 6) Creating a systems cycle of feedback using data to inform health care. The implementation case study from Timor-Leste (population 1 million) shows that in its third year, limited country-wide data had been collected and the SISCa program provided over half a million health interactions at the village level. However, only half of SISCa clinics were functional across the country. Attendances included not only pregnant women and children, but also adults and older community members. Development partners have played a key role in supporting this implementation process.

Conclusion: The SISCa program is a PHC model implementing current best practice to reach remote communities in a new developing country. Despite limited resources, village level healthcare and engagement can be achieved but takes a long-term commitment and partnership.

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Asia Pacific Family Medicine
Asia Pacific Family Medicine Medicine-Family Practice
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