PDF(Pubmed)
Abstract：
Primary Health Care (PHC), based on the Alma Ata declaration, calls for the movement of responsibility, resources, and control away from medical systems and curative measures toward health promotion. However, PHC implementation in practice appears to be heavily influenced by medical systems with its own attendant effects on the attainment of PHC goals. This study therefore examines the extent and effects of medical systems influence on PHC implementation in Ghana. The study uses the thematic framework approach to qualitative data analysis to analyze data collected from PHC managers through interviews. Ethical clearance for the study was obtained from the Noguchi Memorial Institute for Medical Research. Findings suggest that PHC in practice is tied to the apron-strings of medical systems. While this has catalyzed successes in disease control programs and other medicine-based interventions, it has swayed PHC from its intended shift toward health promotion. Community ownership, participation, and empowerment in PHC is therefore lost in the maze of medical systems which reserves power over PHC decision making and implementation to medical professionals while focusing attention on treatment and curative services. Ultimately, PHC has gradually metamorphosed into mini-clinics instead of the revolutionary community-driven promotive services espoused by Alma Ata with concomitant effects on the attainment of Universal Health Coverage. Further, findings show how gradually, the primary in PHC is being used as a descriptor of the first or basic level of hospital-based care instead of a first point of addressing existing health problems using preventive, promotive, and other community driven approaches. Without a reorientation of health systems, significant efforts and resources are channeled toward empowering health workers instead of local communities with significant effects on the long term sustainability of health efforts and the attainment of UHC. The study recommends further studies toward practical means of reducing the influence of medical systems.
摘要：
初级卫生保健（PHC），根据《阿拉木图宣言》，呼吁责任的转移，资源,远离医疗系统和健康促进的治疗措施。然而,PHC在实践中的实施似乎受到医疗系统的严重影响，其自身对实现PHC目标的影响也很大。因此，本研究考察了医疗系统对加纳实施PHC的影响程度和影响。该研究使用主题框架方法进行定性数据分析，以分析通过访谈从PHC经理收集的数据。这项研究的伦理许可是从野口纪念医学研究所获得的。研究结果表明，PHC在实践中与医疗系统的围裙有关。虽然这促进了疾病控制计划和其他基于医学的干预措施的成功，它已经动摇了PHC从其预期的向健康促进的转变。社区所有权，参与,因此，在医疗系统的迷宫中失去了PHC的授权，这些系统将PHC决策和实施的权力保留给医疗专业人员，同时将注意力集中在治疗和治疗服务上。最终,PHC已逐渐转变为小型诊所，而不是AlmaAta支持的革命性社区驱动的促进服务，并对实现全民健康覆盖产生了影响。Further,研究结果表明，PHC的初级被用作医院护理的第一或基本水平的描述符，而不是使用预防性方法解决现有健康问题的第一点，促进,和其他社区驱动的方法。如果没有卫生系统的重新定位，大量的努力和资源被用于增强卫生工作者的能力，而不是当地社区，这对卫生工作的长期可持续性和UHC的实现产生了重大影响。该研究建议进一步研究减少医疗系统影响的实用方法。
