基本公共衛(wèi)生服務(wù)項(xiàng)目的實(shí)施效果評(píng)價(jià)研究-以孕產(chǎn)婦健康管理服務(wù)為例

目錄TOC\o"2-5"\f\p""\h\z\t"標(biāo)題1,1,一級(jí),1"常用縮略詞中英文對(duì)照表 基本公共衛(wèi)生服務(wù)項(xiàng)目實(shí)施效果評(píng)價(jià)研究—以孕產(chǎn)婦健康管理服務(wù)為例前言1978年世界衛(wèi)生組織（WorldHealthOrganization,WHO）和聯(lián)合國(guó)兒童基金會(huì)（UnitedNationsChildren'sFund,UNICEF）在哈薩克斯坦的阿拉木圖召開國(guó)際初級(jí)衛(wèi)生保健大會(huì)，并發(fā)表了《阿拉木圖宣言》ADDINEN.CITE<EndNote><Cite><Year>1978</Year><RecNum>2</RecNum><DisplayText>[1]</DisplayText><record><rec-number>2</rec-number><foreign-keys><keyapp="EN"db-id="pfpfz5tt4fzp9qedxzk5wz0v2aeav0z025rz"timestamp="1578917280">2</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors></contributors><titles><title>DeclarationofAlma-Ata</title><secondary-title>Lancet</secondary-title></titles><periodical><full-title>Lancet</full-title></periodical><pages>1040-1</pages><volume>2</volume><number>8098</number><edition>1978/11/11</edition><keywords><keyword>CongressesasTopic</keyword><keyword>InternationalCooperation</keyword><keyword>Kazakhstan</keyword><keyword>*PrimaryHealthCare</keyword></keywords><dates><year>1978</year><pub-dates><date>Nov11</date></pub-dates></dates><isbn>0140-6736(Print) 0140-6736</isbn><accession-num>82047</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[1],宣言明確了“2000年人人享有衛(wèi)生保健（HealthForAllBy2000,HFA）”的全球戰(zhàn)略目標(biāo)，并將初級(jí)衛(wèi)生保?。≒rimaryHealthCare,PHC）確立為實(shí)現(xiàn)這一全球戰(zhàn)略目標(biāo)的基礎(chǔ)與根本途徑ADDINEN.CITE<EndNote><Cite><Author>Frost</Author><Year>2015</Year><RecNum>3</RecNum><DisplayText>[2]</DisplayText><record><rec-number>3</rec-number><foreign-keys><keyapp="EN"db-id="pfpfz5tt4fzp9qedxzk5wz0v2aeav0z025rz"timestamp="1578917534">3</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Frost,J.</author><author>Currie,M.J.</author><author>Cruickshank,M.</author></authors></contributors><auth-address>UniversityofCanberra,Canberra,Australiajane.frost@.au. UniversityofCanberra,Canberra,AustraliaAustralianNationalUniversity,Canberra,Australia. UniversityofCanberra,Canberra,Australia.</auth-address><titles><title>AnIntegrativeReviewofEnablementinPrimaryHealthCare</title><secondary-title>JPrimCareCommunityHealth</secondary-title></titles><periodical><full-title>JPrimCareCommunityHealth</full-title></periodical><pages>264-78</pages><volume>6</volume><number>4</number><edition>2015/08/01</edition><keywords><keyword>Humans</keyword><keyword>PatientSatisfaction</keyword><keyword>Patient-CenteredCare</keyword><keyword>Physician-PatientRelations</keyword><keyword>*PrimaryHealthCare/methods/standards</keyword><keyword>*SelfEfficacy</keyword><keyword>TreatmentOutcome</keyword><keyword>communityhealth</keyword><keyword>healthoutcomes</keyword><keyword>patient-centeredness</keyword><keyword>primarycare</keyword><keyword>qualityimprovement</keyword></keywords><dates><year>2015</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>2150-1319</isbn><accession-num>26229059</accession-num><urls></urls><electronic-resource-num>10.1177/2150131915598373</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[2]。宣言給出初級(jí)衛(wèi)生保健的明確定義ADDINEN.CITE<EndNote><Cite><Author>WHO</Author><Year>1978 </Year><RecNum>160</RecNum><DisplayText>[3]</DisplayText><record><rec-number>160</rec-number><foreign-keys><keyapp="EN"db-id="pfpfz5tt4fzp9qedxzk5wz0v2aeav0z025rz"timestamp="1583824821">160</key><keyapp="ENWeb"db-id="">0</key></foreign-keys><ref-typename="Report">27</ref-type><contributors><authors><author>WHO</author></authors></contributors><titles><title>DeclarationofAlma-Ata</title></titles><dates><year>1978 </year></dates><pub-location>Geneva</pub-location><publisher>WHO</publisher><urls><related-urls><url>./topics/primary_health_care/Alma_ata_declaration/zh/</url></related-urls></urls></record></Cite></EndNote>[3]：初級(jí)衛(wèi)生保健是一種基本的衛(wèi)生保健。它依靠切實(shí)可行、學(xué)術(shù)上可靠又受社會(huì)歡迎的方式和技術(shù)，是社區(qū)的個(gè)人和家庭通過積極參與普遍能夠享受的，費(fèi)用也是社區(qū)或國(guó)家依靠自力更生精神能夠負(fù)擔(dān)的衛(wèi)生服務(wù)。初級(jí)衛(wèi)生保健主要包括：對(duì)當(dāng)前主要衛(wèi)生問題及其預(yù)防與控制方法的健康教育；改善食品供應(yīng)與合理營(yíng)養(yǎng)；安全飲用水的供應(yīng)及基本環(huán)境衛(wèi)生健康；婦幼衛(wèi)生保??；主要傳染病的免疫接種；地方病的預(yù)防及控制以及基本藥物的提供等內(nèi)容?！缎浴钒l(fā)表后，加拿大ADDINEN.CITEADDINEN.CITE.DATA[4]、澳大利亞ADDINEN.CITE<EndNote><Cite><Author>Smith</Author><Year>2014</Year><RecNum>5</RecNum><DisplayText>[5]</DisplayText><record><rec-number>5</rec-number><foreign-keys><keyapp="EN"db-id="pfpfz5tt4fzp9qedxzk5wz0v2aeav0z025rz"timestamp="1578920004">5</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Smith,J.A.</author></authors></contributors><titles><title>Reflectionsontheframingof'healthequity'intheNationalPrimaryHealthCareStrategicFramework:acauseforcelebrationorconcern?</title><secondary-title>HealthPromotJAustr</secondary-title></titles><periodical><full-title>HealthPromotJAustr</full-title></periodical><pages>42-5</pages><volume>25</volume><number>1</number><edition>2014/04/18</edition><keywords><keyword>Australia</keyword><keyword>*HealthPolicy</keyword><keyword>HealthPromotion/methods/*standards</keyword><keyword>*HealthStatusDisparities</keyword><keyword>Humans</keyword><keyword>PrimaryHealthCare/methods/*standards</keyword><keyword>*SocialDeterminantsofHealth</keyword><keyword>*SocialJustice</keyword></keywords><dates><year>2014</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1036-1073(Print) 1036-1073</isbn><accession-num>24739778</accession-num><urls></urls><electronic-resource-num>10.1071/he13106</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[5]、希臘ADDINEN.CITE<EndNote><Cite><Author>Groenewegen</Author><Year>2013</Year><RecNum>4</RecNum><DisplayText>[6]</DisplayText><record><rec-number>4</rec-number><foreign-keys><keyapp="EN"db-id="pfpfz5tt4fzp9qedxzk5wz0v2aeav0z025rz"timestamp="1578919947">4</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Groenewegen,P.P.</author><author>Jurgutis,A.</author></authors></contributors><auth-address>NIVEL-NetherlandsInstituteforHealthServicesResearch,POBox1568,3500BNUtrecht,TheNetherlands.P.Groenewegen@nivel.nl. DepartmentofPublicHealth,KlaipedaUniversity,Klaipeda,Lithuania.</auth-address><titles><title>AfutureforprimarycarefortheGreekpopulation</title><secondary-title>QualPrimCare</secondary-title></titles><periodical><full-title>QualPrimCare</full-title></periodical><pages>369-78</pages><volume>21</volume><number>6</number><edition>2014/02/12</edition><keywords><keyword>EconomicRecession</keyword><keyword>Forecasting</keyword><keyword>Greece</keyword><keyword>*HealthCareReform</keyword><keyword>Humans</keyword><keyword>PrimaryHealthCare/*trends</keyword><keyword>*QualityAssurance,HealthCare</keyword></keywords><dates><year>2013</year></dates><isbn>1479-1072(Print) 1479-1064</isbn><accession-num>24512835</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[6]等多個(gè)國(guó)家均將初級(jí)衛(wèi)生保健作為衛(wèi)生改革與人群健康水平提高的主要戰(zhàn)略措施。國(guó)際組織也將初級(jí)衛(wèi)生保健作為實(shí)踐衛(wèi)生工作的理論基礎(chǔ)與現(xiàn)實(shí)選擇ADDINEN.CITE<EndNote><Cite><Author>Walley</Author><Year>2008</Year><RecNum>7</RecNum><DisplayText>[7]</DisplayText><record><rec-number>7</rec-number><foreign-keys><keyapp="EN"db-id="pfpfz5tt4fzp9qedxzk5wz0v2aeav0z025rz"timestamp="1578920845">7</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Walley,J.</author><author>Lawn,J.E.</author><author>Tinker,A.</author><author>deFrancisco,A.</author><author>Chopra,M.</author><author>Rudan,I.</author><author>Bhutta,Z.A.</author><author>Black,R.E.</author></authors></contributors><auth-address>NuffieldCentreforHealthandDevelopment,LeedsInstituteofHealthSciences,UniversityofLeeds,Leeds,UK.</auth-address><titles><title>Primaryhealthcare:makingAlma-Ataareality</title><secondary-title>Lancet</secondary-title></titles><periodical><full-title>Lancet</full-title></periodical><pages>1001-7</pages><volume>372</volume><number>9642</number><edition>2008/09/16</edition><keywords><keyword>CommunityHealthServices/organization&administration/*statistics&numerical</keyword><keyword>data/trends</keyword><keyword>*GlobalHealth</keyword><keyword>Goals</keyword><keyword>*HealthPriorities</keyword><keyword>Humans</keyword><keyword>PrimaryHealthCare/organization&administration/*statistics&numerical</keyword><keyword>data/trends</keyword></keywords><dates><year>2008</year><pub-dates><date>Sep13</date></pub-dates></dates><isbn>0140-6736</isbn><accession-num>18790322</accession-num><urls></urls><electronic-resource-num>10.1016/s0140-6736(08)61409-9</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[7]，聯(lián)合國(guó)2000年提出的千年發(fā)展目標(biāo)（MillenniumDevelopmentGoals,MDGs）ADDINEN.CITE<EndNote><Cite><Author>Sachs</Author><Year>2004</Year><RecNum>161</RecNum><DisplayText>[8]</DisplayText><record><rec-number>161</rec-number><foreign-keys><keyapp="EN"db-id="pfpfz5tt4fzp9qedxzk5wz0v2aeav0z025rz"timestamp="1583885777">161</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Sachs,J.D.</author></authors></contributors><auth-address>CommissiononMacroeconomicsandHealth,ColumbiaUniversity,314LowLibraryMC4327,535West116thStreet,NewYork,NY10027,USA.sachs@</auth-address><titles><title>Healthinthedevelopingworld:achievingtheMillenniumDevelopmentGoals</title><secondary-title>BullWorldHealthOrgan</secondary-title></titles><periodical><full-title>BullWorldHealthOrgan</full-title></periodical><pages>947-9;discussion950-2</pages><volume>82</volume><number>12</number><edition>2005/01/18</edition><keywords><keyword>AdvisoryCommittees</keyword><keyword>DevelopingCountries/*economics</keyword><keyword>*Financing,Organized</keyword><keyword>*HealthPriorities</keyword><keyword>*HealthyPeoplePrograms</keyword><keyword>Humans</keyword><keyword>Investments</keyword><keyword>OrganizationalObjectives</keyword><keyword>PublicHealthAdministration/*economics</keyword></keywords><dates><year>2004</year><pub-dates><date>Dec</date></pub-dates></dates><isbn>0042-9686(Print) 0042-9686</isbn><accession-num>15654410</accession-num><urls></urls><custom2>PMC2623094</custom2><electronic-resource-num>/s0042-96862004001200012</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[8]和2015年提出的可持續(xù)發(fā)展目標(biāo)（SustainableDevelopmentGoals,SDGs）ADDINEN.CITE<EndNote><Cite><Author>Morton</Author><Year>2017</Year><RecNum>162</RecNum><DisplayText>[9]</DisplayText><record><rec-number>162</rec-number><foreign-keys><keyapp="EN"db-id="pfpfz5tt4fzp9qedxzk5wz0v2aeav0z025rz"timestamp="1583886207">162</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Morton,S.</author><author>Pencheon,D.</author><author>Squires,N.</author></authors></contributors><auth-address>SustainabilityandPublicHealthBenefits,PublicHealthEngland. SustainableDevelopmentUnitforNHSEnglandandPublicHealthEngland. GlobalPublicHealth,PublicHealthEngland.</auth-address><titles><title>SustainableDevelopmentGoals(SDGs),andtheirimplementation:Anationalglobalframeworkforhealth,developmentandequityneedsasystemsapproachateverylevel</title><secondary-title>BrMedBull</secondary-title></titles><periodical><full-title>BrMedBull</full-title></periodical><pages>81-90</pages><volume>124</volume><number>1</number><edition>2017/10/27</edition><keywords><keyword>*ConservationofNaturalResources</keyword><keyword>*GlobalHealth</keyword><keyword>Goals</keyword><keyword>HealthEquity</keyword><keyword>Humans</keyword><keyword>ProgramDevelopment</keyword><keyword>QualityofLife</keyword><keyword>SocialResponsibility</keyword><keyword>SystemsAnalysis</keyword><keyword>UnitedNations</keyword><keyword>globalgoals</keyword><keyword>globalhealth</keyword><keyword>implementation</keyword><keyword>sustainabledevelopment</keyword></keywords><dates><year>2017</year><pub-dates><date>Dec1</date></pub-dates></dates><isbn>0007-1420</isbn><accession-num>29069332</accession-num><urls></urls><electronic-resource-num>10.1093/bmb/ldx031</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[9]均與初級(jí)衛(wèi)生保健工作有著密切的聯(lián)系。為保障初級(jí)衛(wèi)生保健工作的實(shí)施效果與效率，世界銀行在1993年公布的世界發(fā)展報(bào)告中提出了“基本衛(wèi)生服務(wù)包”（PackageofEssential/BasicHealthService）概念A(yù)DDINEN.CITE<EndNote><Cite><Author>Bank</Author><Year>2003</Year><RecNum>163</RecNum><DisplayText>[10]</DisplayText><record><rec-number>163</rec-number><foreign-keys><keyapp="EN"db-id="pfpfz5tt4fzp9qedxzk5wz0v2aeav0z025rz"timestamp="1583886546">163</key><keyapp="ENWeb"db-id="">0</key></foreign-keys><ref-typename="Report">27</ref-type><contributors><authors><author>WorldBank</author></authors></contributors><titles><title>Investigationinhealth.Worlddevelopmentreport2003</title></titles><pages>51-60</pages><dates><year>2003</year></dates><pub-location>NewYork.OxfordUniversityPress</pub-location><urls></urls></record></Cite></EndNote>[10]，概念指出基本衛(wèi)生服務(wù)包是基本公共衛(wèi)生服務(wù)包和基本醫(yī)療服務(wù)包的衛(wèi)生服務(wù)項(xiàng)目的集合。主要服務(wù)內(nèi)容包括：計(jì)劃免疫、學(xué)校健康服務(wù)、計(jì)劃生育和營(yíng)養(yǎng)服務(wù)的健康教育、結(jié)核病控制、性病艾滋病控制、幼兒常見病護(hù)理等。為進(jìn)一步明確基本公共衛(wèi)生服務(wù)的功能框架，1997年世界衛(wèi)生組織執(zhí)行委員會(huì)通過Delphi法ADDINEN.CITE<EndNote><Cite><Author>Bettcher</Author><Year>1998</Year><RecNum>15</RecNum><DisplayText>[11]</DisplayText><record><rec-number>15</rec-number><foreign-keys><keyapp="EN"db-id="pfpfz5tt4fzp9qedxzk5wz0v2aeav0z025rz"timestamp="1580787272">15</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Bettcher,D.W.</author><author>Sapirie,S.</author><author>Goon,E.H.</author></authors></contributors><auth-address>DivisionofDevelopmentofPolicy,ProgrammeandEvaluation,WorldHealthOrganization,Geneva.</auth-address><titles><title>Essentialpublichealthfunctions:resultsoftheinternationalDelphistudy</title><secondary-title>WorldHealthStatQ</secondary-title></titles><periodical><full-title>WorldHealthStatQ</full-title></periodical><pages>44-54</pages><volume>51</volume><number>1</number><edition>1998/07/24</edition><keywords><keyword>DelphiTechnique</keyword><keyword>Forecasting</keyword><keyword>GlobalHealth</keyword><keyword>HealthKnowledge,Attitudes,Practice</keyword><keyword>HealthPolicy/*trends</keyword><keyword>*HealthPriorities</keyword><keyword>Humans</keyword><keyword>*PublicHealthAdministration</keyword><keyword>WorldHealthOrganization</keyword></keywords><dates><year>1998</year></dates><isbn>0379-8070(Print) 0379-8070</isbn><accession-num>9675808</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[11]確認(rèn)了基本公共衛(wèi)生服務(wù)體系包含的九大基本類別與功能，具體包括：傳染病與非傳染疾病的預(yù)防監(jiān)測(cè)、健康水平監(jiān)測(cè)、健康促進(jìn)、職業(yè)健康、健康環(huán)境保護(hù)、公共衛(wèi)生立法和管理、公共衛(wèi)生管理、特定的公共衛(wèi)生服務(wù)和個(gè)人健康以及高危人群健康。隨著功能框架的確立，各國(guó)政府也明確了公共衛(wèi)生服務(wù)的核心內(nèi)容與核心領(lǐng)域ADDINEN.CITE<EndNote><Cite><Author>Forslin</Author><Year>2013</Year><RecNum>165</RecNum><DisplayText>[12]</DisplayText><record><rec-number>165</rec-number><foreign-keys><keyapp="EN"db-id="pfpfz5tt4fzp9qedxzk5wz0v2aeav0z025rz"timestamp="1583892663">165</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Forslin,B.M.</author><author>Moller,H.E.</author><author>Andersson,R.I.</author><author>Sohlberg,E.M.</author><author>Tillgren,P.E.</author></authors></contributors><auth-address>DepartmentofPublicHealth,CountyCouncilofVasternorrland,Harnosand,Sweden.barbro.forslin@lvn.se</auth-address><titles><title>Thehealth-promotionperspectiveinpublic-healthplansinaSwedishregionoverthreedecades</title><secondary-title>HealthPromotInt</secondary-title></titles><periodical><full-title>HealthPromotInt</full-title></periodical><pages>269-80</pages><volume>28</volume><number>2</number><edition>2012/03/27</edition><keywords><keyword>HealthPolicy/history</keyword><keyword>HealthPromotion/*history/methods/organization&administration</keyword><keyword>History,20thCentury</keyword><keyword>History,21stCentury</keyword><keyword>Humans</keyword><keyword>PolicyMaking</keyword><keyword>Politics</keyword><keyword>PublicHealth/history/methods</keyword><keyword>Sweden</keyword><keyword>healthpolicy</keyword><keyword>healthpolicyprocesses</keyword><keyword>healthpolitics</keyword><keyword>health-promotingpolicies</keyword></keywords><dates><year>2013</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>0957-4824</isbn><accession-num>22447353</accession-num><urls></urls><electronic-resource-num>10.1093/heapro/das009</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[12]，為實(shí)現(xiàn)人們健康效益最大化提供了依據(jù)ADDINEN.CITE<EndNote><Cite><Author>WHO</Author><Year>2003</Year><RecNum>166</RecNum><DisplayText>[13]</DisplayText><record><rec-number>166</rec-number><foreign-keys><keyapp="EN"db-id="pfpfz5tt4fzp9qedxzk5wz0v2aeav0z025rz"timestamp="1583892940">166</key><keyapp="ENWeb"db-id="">0</key></foreign-keys><ref-typename="Report">27</ref-type><contributors><authors><author>WHO</author></authors></contributors><titles><title>Essentialpublichealthfunctions:athree-countrystudyintheWesternPacificRegion</title></titles><dates><year>2003</year></dates><urls></urls></record></Cite></EndNote>[13]。2005年，WHO所有成員國(guó)做出了實(shí)現(xiàn)全民健康覆蓋（UniversalHealthCoverage,UHC）的承諾ADDINEN.CITEADDINEN.CITE.DATA[14]，其內(nèi)涵在于確保所有人都獲得其所需要的衛(wèi)生服務(wù)，而在付費(fèi)時(shí)不必經(jīng)歷經(jīng)濟(jì)困難，使健康促進(jìn)、疾病預(yù)防、疾病治療等主要衛(wèi)生保健措施實(shí)現(xiàn)全民可及。全民健康覆蓋是21世紀(jì)衛(wèi)生系統(tǒng)的核心目標(biāo)?！?013年世界衛(wèi)生報(bào)告：全民健康覆蓋研究》ADDINEN.CITE<EndNote><Cite><Author>Odugleh-Kolev</Author><Year>2018</Year><RecNum>169</RecNum><DisplayText>[15]</DisplayText><record><rec-number>169</rec-number><foreign-keys><keyapp="EN"db-id="pfpfz5tt4fzp9qedxzk5wz0v2aeav0z025rz"timestamp="1583893739">169</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Odugleh-Kolev,A.</author><author>Parrish-Sprowl,J.</author></authors></contributors><auth-address>WorldHealthOrganization,avenueAppia20,1211Geneva27,Switzerland. GlobalHealthCommunicationCenter,IndianaUniversity,Indianapolis,UnitedStatesofAmerica.</auth-address><titles><title>Universalhealthcoverageandcommunityengagement</title><secondary-title>BullWorldHealthOrgan</secondary-title></titles><periodical><full-title>BullWorldHealthOrgan</full-title></periodical><pages>660-661</pages><volume>96</volume><number>9</number><edition>2018/09/29</edition><keywords><keyword>ClinicalCompetence/standards</keyword><keyword>CommunityParticipation/*methods</keyword><keyword>CooperativeBehavior</keyword><keyword>Financing,Organized/organization&administration</keyword><keyword>HealthPersonnel/*organization&administration/standards</keyword><keyword>HealthStatusDisparities</keyword><keyword>Humans</keyword><keyword>Internationality</keyword><keyword>Patient-CenteredCare/economics/*organization&administration/standards</keyword><keyword>SocialDeterminantsofHealth</keyword><keyword>UniversalHealthInsurance/economics/*organization&administration/standards</keyword></keywords><dates><year>2018</year><pub-dates><date>Sep1</date></pub-dates></dates><isbn>0042-9686</isbn><accession-num>30262948</accession-num><urls></urls><custom2>PMC6154062</custom2><electronic-resource-num>10.2471/blt.17.202382</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[15]中指出，以社區(qū)為基礎(chǔ)的干預(yù)是預(yù)防疾病甚至減少死亡的有力措施，因此立足于社區(qū)及基層醫(yī)療衛(wèi)生機(jī)構(gòu)的公共衛(wèi)生服務(wù)是實(shí)現(xiàn)全民健康覆蓋的重要途徑之一。建立可持續(xù)的全民覆蓋的醫(yī)療保健體系離不開初級(jí)衛(wèi)生保健服務(wù)，特別是公共衛(wèi)生服務(wù)的支撐ADDINEN.CITEADDINEN.CITE.DATA[16]。2018年是《阿拉木圖宣言》發(fā)表的40周年，全球目標(biāo)已經(jīng)從“2000年人人享有健康”發(fā)展成為全民健康覆蓋ADDINEN.CITEADDINEN.CITE.DATA[14]。為紀(jì)念《阿拉木圖宣言》的發(fā)表，2018年10月世界衛(wèi)生組織和聯(lián)合國(guó)兒童基金會(huì)在阿斯塔納召開全球初級(jí)衛(wèi)生保健會(huì)議，并發(fā)表《阿斯塔納宣言》ADDINEN.CITE<EndNote><Cite><Author>The</Author><Year>2018</Year><RecNum>12</RecNum><DisplayText>[17]</DisplayText><record><rec-number>12</rec-number><foreign-keys><keyapp="EN"db-id="pfpfz5tt4fzp9qedxzk5wz0v2aeav0z025rz"timestamp="1580784709">12</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>The,Lancet</author></authors></contributors><titles><title>TheAstanaDeclaration:thefutureofprimaryhealthcare?</title><secondary-title>Lancet</secondary-title></titles><periodical><full-title>Lancet</full-title></periodical><pages>1369</pages><volume>392</volume><number>10156</number><edition>2018/10/23</edition><keywords><keyword>*CommunityHealthServices</keyword><keyword>Forecasting</keyword><keyword>GlobalHealth</keyword><keyword>HealthServicesAccessibility</keyword><keyword>Humans</keyword><keyword>PrimaryHealthCare/*standards</keyword><keyword>Workforce</keyword></keywords><dates><year>2018</year><pub-dates><date>Oct20</date></pub-dates></dates><isbn>0140-6736</isbn><accession-num>30343840</accession-num><urls></urls><electronic-resource-num>10.1016/s0140-6736(18)32478-4</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[17]。宣言再次強(qiáng)調(diào)初級(jí)衛(wèi)生保健是實(shí)現(xiàn)人類社會(huì)健康理想的根本途徑ADDINEN.CITE<EndNote><Cite><Author>Walraven</Author><Year>2019</Year><RecNum>168</RecNum><DisplayText>[18]</DisplayText><record><rec-number>168</rec-number><foreign-keys><keyapp="EN"db-id="pfpfz5tt4fzp9qedxzk5wz0v2aeav0z025rz"timestamp="1583893252">168</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Walraven,G.</author></authors></contributors><auth-address>AgaKhanDevelopmentNetwork,Geneva,Switzerland.</auth-address><titles><title>The2018AstanaDeclarationonPrimaryHealthCare,isituseful?</title><secondary-title>JGlobHealth</secondary-title></titles><periodical><full-title>JGlobHealth</full-title></periodical><pages>010313</pages><volume>9</volume><number>1</number><edition>2019/04/18</edition><keywords><keyword>GlobalHealth</keyword><keyword>Humans</keyword><keyword>*PrimaryHealthCare</keyword></keywords><dates><year>2019</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>2047-2978</isbn><accession-num>30992983</accession-num><urls></urls><custom2>PMC6445497at/coi_disclosure.pdf(availableuponrequestfromthecorrespondingauthor),anddeclaresnoconflictsofinterest.</custom2><electronic-resource-num>10.7189/jogh.09.010313</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[18]，并指出經(jīng)過各國(guó)政府及國(guó)際社會(huì)40年的共同努力，全球健康水平得到了明顯的提高，但現(xiàn)階段全球的初級(jí)衛(wèi)生保健水平依然呈現(xiàn)不平衡的趨勢(shì)ADDINEN.CITE<EndNote><Cite><Author>Steinhubl</Author><Year>2018</Year><RecNum>13</RecNum><DisplayText>[19]</DisplayText><record><rec-number>13</rec-number><foreign-keys><keyapp="EN"db-id="pfpfz5tt4fzp9qedxzk5wz0v2aeav0z025rz"timestamp="1580785235">13</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Steinhubl,S.R.</author><author>Kim,K.I.</author><author>Ajayi,T.</author><author>Topol,E.J.</author></authors></contributors><auth-address>ScrippsTranslationalScienceInstitute,LaJolla,California,CA92037,USA;WaveResearchCenter,LaJolla,California,USA.Electronicaddress:steinhub@. ScrippsTranslationalScienceInstitute,LaJolla,California,CA92037,USA;SeoulNationalUniversityBundangHospital,Seongnam,SouthKorea. ScrippsTranslationalScienceInstitute,LaJolla,California,CA92037,USA. ScrippsTranslationalScienceInstitute,LaJolla,California,CA92037,USA;WaveResearchCenter,LaJolla,California,USA.</auth-address><titles><title>Virtualcareforimprovedglobalhealth</title><secondary-title>Lancet</secondary-title></titles><periodical><full-title>Lancet</full-title></periodical><pages>419</pages><volume>391</volume><number>10119</number><edition>2018/02/07</edition><keywords><keyword>*GlobalHealth</keyword><keyword>Humans</keyword><keyword>*User-ComputerInterface</keyword></keywords><dates><year>2018</year><pub-dates><date>Feb3</date></pub-dates></dates><isbn>0140-6736</isbn><accession-num>29407024</accession-num><urls></urls><electronic-resource-num>10.1016/s0140-6736(18)30109-0</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[19]，這種不平衡表現(xiàn)在不同的國(guó)家之間，不同的地域之間甚至國(guó)家的不同地區(qū)之間?，F(xiàn)階段我們依舊不得不面對(duì)全球至少有一半的人口無法獲得基本衛(wèi)生服務(wù)的事實(shí)ADDINEN.CITE<EndNote><Cite><Author>Dressel</Author><Year>2019</Year><RecNum>16</RecNum><DisplayText>[20]</DisplayText><record><rec-number>16</rec-number><foreign-keys><keyapp="EN"db-id="pfpfz5tt4fzp9qedxzk5wz0v2aeav0z025rz"timestamp="1580788351">16</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Dressel,A.</author><author>Mkandawire-Valhmu,L.</author></authors></contributors><titles><title>CelebrateWorldHealthDay:NursingandGlobalHealth</title><secondary-title>JContinEducNurs</secondary-title></titles><periodical><full-title>JContinEducNurs</full-title></periodical><pages>145-147</pages><volume>50</volume><number>4</number><edition>2019/04/04</edition><keywords><keyword>*AnniversariesandSpecialEvents</keyword><keyword>ClimateChange</keyword><keyword>CulturallyCompetentCare</keyword><keyword>*Education,Nursing</keyword><keyword>*Faculty,Nursing</keyword><keyword>GlobalHealth/*education</keyword><keyword>Humans</keyword><keyword>WorldHealthOrganization</keyword></keywords><dates><year>2019</year><pub-dates><date>Apr1</date></pub-dates></dates><isbn>0022-0124</isbn><accession-num>30942887</accession-num><urls></urls><electronic-resource-num>10.3928/00220124-20190319-02</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[20]：10多億人的高血壓未獲得有效控制ADDINEN.CITEADDINEN.CITE.DATA[21]；2億多的婦女無法充分獲得衛(wèi)生保健服務(wù)，還有近2000萬嬰兒未接種所需要的疫苗ADDINEN.CITE<EndNote><Cite><Author>Peck</Author><Year>2019</Year><RecNum>170</RecNum><DisplayText>[22]</DisplayText><record><rec-number>170</rec-number><foreign-keys><keyapp="EN"db-id="pfpfz5tt4fzp9qedxzk5wz0v2aeav0z025rz"timestamp="1583896615">170</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Peck,M.</author><author>Gacic-Dobo,M.</author><author>Diallo,M.S.</author><author>Nedelec,Y.</author><author>Sodha,S.V.</author><author>Wallace,A.S.</author></authors></contributors><titles><title>GlobalRoutineVaccinationCoverage,2018</title><secondary-title>MMWRMorbMortalWklyRep</secondary-title></titles><periodical><full-title>MMWRMorbMortalWklyRep</full-title></periodical><pages>937-942</pages><volume>68</volume><number>42</number><edition>2019/10/28</edition><keyw