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Primary health care in a developing economy: Issues of job autonomy, resources, quality of care at the district level in Zimbabwe

机译：发展中经济体的初级卫生保健：津巴布韦地区一级的工作自治，资源，医疗质量问题

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摘要

Primary Health Care (PHC) is a structural expression of an alternative form of health-care provision whose central philosophy is equity. Since the appearance of this institution of the scene in the late 1970s, numerous developing countries have embraced its tenets in a bid to either replace or counteract the curative approach characteristic of Western biomedicine with varying degrees of success. Concomitant with this is the proliferation of studies, most of which have focused on the cultural acceptability of PHC technologies; the unequitable distribution of health resources; accessibility of health care facilities, etc.--all of which are germane and laudable attempts to make health a basic human right. However, such research foci neglect some organisational structures upon which the effectiveness of PHC programmes is contigent. Furthermore, the personal experiences of both providers and consumers are often neglected.;The purpose of this exploratory and qualitative study is to investigate the relationship between job autonomy/participation in policy decision making and (a) the quality of health care provision and (b) the effectiveness of the PHC programme, with burnout and job satisfaction/dissatisfaction ad the intermediate variables. Empirical research was undertaken in the district of Mutoko (Zimbabwe), with Mutoko District Hospital as the primary site. Data were collected through unstructured interviews, observation and government records.;Analysis of the data reveals that, apart from those with supervisory and managerial responsibilities, most personnel do not show much desire for greater job autonomy/participation in policy decision making. However, the analysis shows that job autonomy/participation in policy decision making and resources have both a direct and an indirect (through the intermediate variables) effect on the quality of health care and the effectiveness of the PHC programme. Furthermore, the analysis indicates that lack of resources, personnel shortages (which lead to work/role overload) and low salaries are the major causes of job burnout and job dissatisfaction in the district health system.;Analysis of consumers' situations and experiences to determine quality of care suggests that the effectiveness of PHC and the utilisation of health services cannot be simply assumed by encouraging people to use them. Therefore, addressing the major concerns noted above is essential to ensure geographical, economic, intellectual and psychological accessibility and that primary health care services become effective in practice.
机译：初级卫生保健（PHC）是另一种形式的卫生保健提供的结构性表达，其核心理念是公平。自从1970年代后期这个机构出现以来，许多发展中国家已经采纳了其宗旨，力图以不同程度的成功取代或抵消西方生物医学的治疗方法特征。与此相伴的是，研究的泛滥，其中大多数集中在PHC技术的文化接受性上。卫生资源分配不均；医疗设施的可及性等-所有这些都是与健康相关的，值得称赞的尝试。但是，这样的研究焦点忽略了某些组织结构，而在这些组织结构上，PHC计划的有效性是连续的。此外，医疗服务提供者和消费者的个人经验经常被忽略。;这项探索性和定性研究的目的是调查工作自主性/参与政策决策与（a）医疗保健质量和（b）之间的关系。 ）PHC计划的有效性，职业倦怠和工作满意度/不满意感是中间变量。在穆托科（津巴布韦）地区进行了实证研究，以穆托科地区医院为主要研究对象。通过非结构化的访谈，观察和政府记录收集数据；对数据的分析表明，除了那些负有监督和管理职责的人员外，大多数人员对提高工作自主性/参与政策决策的渴望不大。但是，分析表明，工作自主权/参与政策决策和资源（通过中间变量）对卫生保健质量和初级卫生保健计划的有效性都有直接和间接的影响。此外，分析表明，资源不足，人员短缺（导致工作/角色超负荷）和薪水低是造成区域卫生系统工作倦怠和工作不满的主要原因。;分析消费者的情况和经验以确定护理质量表明，不能仅仅通过鼓励人们使用初级保健来假设初级保健的有效性和利用卫生服务。因此，解决上述主要问题对于确保地理，经济，智力和心理上的可及性以及基本医疗保健服务在实践中变得有效至关重要。

著录项

  • 作者

    Makwarimba, Edward.;

  • 作者单位

    McMaster University (Canada).;

  • 授予单位 McMaster University (Canada).;
  • 学科 Sociology.;Economics.;Public health.;Health care management.
  • 学位 Ph.D.
  • 年度 1996
  • 页码 401 p.
  • 总页数 401
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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