Contribution of Health Systems to Disease Control The Swellengrebel Lecture 2007

摘要

There is a longstanding debate about relative benefits of programmes that focus on the control of specific diseases, and approaches that deal with the health system as a whole. Swellengrebel himself was a participant in contemporary debates about the best approach to effective disease control. At a lecture at the London School of Hygiene & Tropical Medicine in 1950 (Swellengrebel 1950), he noted that 'it was not considered consistent with the requirements of a well-organised public health department to have separate services for every preventable disease'. In the lecture he described in some detail the history of the Malaria service in Indonesia between 1898 and 1948, including the difficulties he encountered, and finally overcame, in setting up the service. In current terminology the debate can be framed as one between the proponents of vertical programmes that focus on a single disease e.g. smallpox eradication, and those that encompass a horizontal or integrated approach. Such an approach brings together common functions to address shared goals. However, in practice, there is a spectrum of programmes ranging from single disease vertical programmes, to packages of interventions delivered vertically, through to programmes that are managed vertically but integrated in their delivery (e.g. Integrated Management of Childhood Illness), and finally those that are fully integrated into the health system. Research evidence on the best way forward is disappointingly scanty, for example, a systematic review of strategies for integrating primary health services at the point of delivery in middle and low income countries, detected only five eligible studies from which no consistent pattern emerged (Briggs and Garner 2006).