纪念《阿拉木图宣言》发表40周年:全球基本医疗卫生服务发展经验及中国医疗卫生人才队伍建设
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摘要
《阿拉木图宣言》的发表具有里程碑式的意义,基本医疗卫生服务(PHC)概念的提出为发展现代高质量的国家医疗卫生体制体系奠定了基础。中国赤脚医生-农村合作医疗制度(BD-RCMS)的开展经验在PHC概念的形成和发展中发挥了关键作用。《阿拉木图宣言》发表后的40多年里,世界上多数发达国家/地区以及发展中国家古巴等建立了较为成熟的PHC体系,但多数发展中国家/地区的开展成效并不理想。中国大陆自2009年开始实行新医改,已取得了多项重要成就,但目前的PHC体系建设仍处于初级阶段。本文回顾并分析了《阿拉木图宣言》发表40多年里,全球发展PHC的现状及经验。认为中国PHC体系建设仍处于初级阶段的原因包括:未在战略上充分重视高质量的医学教育和专业培训、尚未建立起一支有活力的高素质医疗卫生人才队伍以提供高质量的医疗卫生服务。在此基础上,提出建设高质量PHC体系的双中心(双轮)驱动模式,即同时建设以居民为中心的PHC体制体系和以医疗卫生人才队伍为中心的医疗卫生服务系统,希望这一模式的提出可以为中国新医改以及PHC体系建设提供思路。
The publication of the Alma-Ata Declaration at the International Primary Health Care Conference in 1978 is a milestone in global health history.The concept of primary health care(PHC) proposed at the meeting 40 years ago laid the foundation for the development of a modern,high-quality national health system.China has played a key role in the formation and development of the original concept of PHC by introducing its implementation experience of the barefoot doctor system and Rural Cooperative Medical Scheme.Since the adoption of the Alma-Ata Declaration,most developed countries and regions in the world,as well as Cuba,a developing country,have successfully established relatively mature PHC systems,but also witnessed failure of achievements in most developing countries.Since 2009,China has started a new round of health reform in Chinese mainland and has obtained many achievements,but its PHC system development is still in the initial phase.This paper reviews and analyzes the history,results and experience of the global development of PHC over the past 40 years,and puts forward that the unsatisfied development of a PHC system in China is due to the failure of strategic emphasis on contemporary high-quality health education and professional training,and lack of government requirements on the establishment of a vigorous high-quality health workforce for delivering high-quality health care services.On this basis,the concept of a dual-center construction(two-wheel drive) for the development of a national high-quality PHC system was proposed,that is,simultaneously building a peoplecentered basic health care system and a health workforce-centered health care system.It is hoped that this concept can provide a new way of thinking and strategic choice for the ongoing health reform and PHC system establishment in China.
The publication of the Alma-Ata Declaration at the International Primary Health Care Conference in 1978 is a milestone in global health history.The concept of primary health care(PHC) proposed at the meeting 40 years ago laid the foundation for the development of a modern,high-quality national health system.China has played a key role in the formation and development of the original concept of PHC by introducing its implementation experience of the barefoot doctor system and Rural Cooperative Medical Scheme.Since the adoption of the Alma-Ata Declaration,most developed countries and regions in the world,as well as Cuba,a developing country,have successfully established relatively mature PHC systems,but also witnessed failure of achievements in most developing countries.Since 2009,China has started a new round of health reform in Chinese mainland and has obtained many achievements,but its PHC system development is still in the initial phase.This paper reviews and analyzes the history,results and experience of the global development of PHC over the past 40 years,and puts forward that the unsatisfied development of a PHC system in China is due to the failure of strategic emphasis on contemporary high-quality health education and professional training,and lack of government requirements on the establishment of a vigorous high-quality health workforce for delivering high-quality health care services.On this basis,the concept of a dual-center construction(two-wheel drive) for the development of a national high-quality PHC system was proposed,that is,simultaneously building a peoplecentered basic health care system and a health workforce-centered health care system.It is hoped that this concept can provide a new way of thinking and strategic choice for the ongoing health reform and PHC system establishment in China.
引文
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