通过改进挽留政策提高农村和边远地区卫生人力的可及性：WHO2010全球政策建议解读_《中国循证医学杂志》

作者：

兰州大学循证医学中心，GRADE中国中心（兰州 730000）;

关键词：

卫生人力农村和边远地区 GRADE系统政策指南循证决策

DOI：

10.7507/1672-2531.20130179

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

农村和边远地区卫生人力资源不足是世界各国普遍关注的卫生问题之一，严重影响卫生公平的实现。对此，WHO提出全球政策建议——通过改进挽留政策提高农村和边远地区卫生人力的可及性。本文重点从循证医学方法学和指南制定角度，对该政策指南制定的关键步骤进行解读，主要包括背景及问题的提出、证据的检索与遴选、证据质量分级与推荐方案形成，从而进一步探讨卫生决策过程中如何正确认识、获得、评价与应用当前可得的研究证据，以及如何基于证据，利用GRADE系统做出科学可行的推荐，强调证据及GRADE系统在循证卫生决策中的重要作用。

引用本文： 李秀霞,陈耀龙,王小琴,吴琼芳,王琪,韦当,姚亮,张宗久,杨克虎. 通过改进挽留政策提高农村和边远地区卫生人力的可及性：WHO2010全球政策建议解读. 中国循证医学杂志, 2013, 13(9): 1037-1042. doi: 10.7507/1672-2531.20130179 复制

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1. WHO. Increasing access to health workers in remote and rural areas through improved retention: Global policy recommendations. 2010. WHO Press, World Health Organization. 20 Avenue Appia, 1211 Geneva 27, Switzerland.
2. http://www.who.int/rpc/guidelines/en/ [2013-01-07].
3. 刘晓云. 吸引和留住农村卫生人力的国际经验及启示. 中国卫生政策研究, 2012, 5(10): 33-8.
4. WHO handbook for guideline development. World Health Organization. 2010. Available at: http://www.who.int/hiv/topics/mtct/grc_handbook_mar2010_1.pdf.
5. The world health report 2006 – Working together for health. Geneva, World Health Organization. 2006.
6. World Urbanization Prospects: The 2007 Revision Population Database. New York. NY, United Nations Department of Economic and Social Affairs. 2008.
7. Grobler L, Marais BJ, Mabunda SA, et al. Interventions for increasing the proportion of health professionals practising in rural and other underserved areas. Cochrane Database Syst Rev, 2009, (1): CD005314.
8. Wilson NW, Couper ID, De Vries E, et al. A critical review of interventions to redress the inequitable distribution of healthcare professionals to rural and remote areas. Rural Remote Health, 2009, 9(2): 1060.
9. Gruen RL, Weeramanthri TS, Knight SE, et al. Specialist outreach clinics in primary care and rural hospital settings. Cochrane Database Syst Rev, 2004, (1): CD003798.
10. Bärnighausen T, Bloom DE. Financial incentives for return of service in underserved areas: a systematic review. BMC Health Serv Res, 2009, 9: 86.
11. Frehywot S, et al. Compulsory service programme as a means of deploying and retaining health workers in rural, remote and underserved areas – a global analysis. World Health Organization. 2010.
12. Dieleman M, et al. Realist review and synthesis on retention studies for health workers in rural and remote areas. Geneva, World Health Organization. 2010.
13. De Roodenbeke E, et al. Outreach services as a strategy to increase access to health workers in remote and rural areas. Geneva, World Health Organization. 2010.
14. http://www.gradeworkinggroup.org. [2013-01-14].
15. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336(7650): 924-926.
16. 李幼平, 王莉, 文进, 等. 注重证据，循证决策. 中国循证医学杂志, 2008, 8(1): 1-3.
17. Moat KA, Lavis JN, Wilson MG, et al. Twelve myths about systematic reviews for health system policymaking rebutted. J Health Serv Res Policy, 2013, 18(1): 44-50.
18. 陈耀龙, 杨克虎, 姚亮, 等. GRADE系统方法学进展. 中国循证儿科杂志, 2013, 8(1): 1-2.
19. Bosch-Capblanch X. Handbook for Supporting the Development of Health System Guidance. Basel: Swiss Centre for International Health. 2011.

《中国循证医学杂志》

通过改进挽留政策提高农村和边远地区卫生人力的可及性：WHO2010全球政策建议解读

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《中国循证医学杂志》

通过改进挽留政策提高农村和边远地区卫生人力的可及性：WHO2010全球政策建议解读

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