摘要：Health service reform is on the policy agenda throughout the world.Since the Declaration of Alma-Ata in 1978, much of the discussionabout the role of primary healthcare (PHC) in health service reformhas centred on the political attraction to decentralised health systems[1,2]. The primary goals of PHC are to make health services effectiveand efficient in the improvement of people’s health by focusing on:enhancing health status; reforming health service delivery, healthcareprovisions and financial sustainability; and strengthening the localand national health services [3]. The philosophical commitment of theAlma-Ata declaration was that people or service users have the right toaccess essential and universal healthcare services without any personaland institutional constraints. They should, indeed, be involved inshaping and delivering their own health plans and policies at national,regional and local levels [4]: nothing about us without us [5]. Thereform, however, is not one concept in itself and it is highly contestedbecause in many cases it is unlikely that a causal relationship betweenthe aspects of reform and changes in the performance of health systemscould be established [6,7]. It has been decades since a commitmentwas made to improve people’s health by spending billions in clinicaladvancement and infrastructure development globally, but the outcomeis rather disappointing because healthcare is still beyond the reach ofmany poor people. Women and children are suffering, children frompoor households are malnourished and at risk of dying and death tollshave increased at an exponential rate like the speed of the ‘Bloodhound’car [3,8]! Penchon et al. [9] argue that ‘continued investmentin clinicalcare brings diminishing returns’ (p. xxxi). In a similar vein, severalauthors argue that ill-distribution of resources between central andlocal government and the limited space provided to the local peopleto exercise their power in making healthcare decisions, are some of theattributes in the context of the developing world [10,11].
