From Big Medical Encyclopedia


TREATMENT AND PREVENTION FACILITIES in the USSR — see articles devoted to separate institutions: Out-patient clinic , Hospital , Clinic , Policlinic etc.


Types to lay down. - professional, institutions in foreign countries are very diverse. They developed under the influence of a number of factors of social and economic character, historical traditions, administrative division of the countries and territorial accommodation of the population, and also features of local pathology and security with shots of health care. With change of these factors the nature of activity and structure changed to lay down. - professional, institutions.

In the terminology used for names to lay down. - professional, institutions, there is no uniformity. Often institutions appear in the different countries under the same name, to-rye significantly differ from each other on functions, organizational and regular structure and volume of work or, on the contrary, different names are used for institutions identical or close in character. The international classification to lay down. - professional, institutions are not available, and almost completely there are no comparative researches in this area. For collecting and distribution of information on security of various countries with medical institutions of WHO applies the following most general gradation to lay down. - professional, institutions.

Stationary treatment and prevention facilities are presented to hl. obr. with hospitals — institutions, in the state to-rykh at least 1 doctor constantly works and to-rye provide hospitalization of the patient, and also medical service and sisterly leaving. The institutions which are engaged in generally tutorial help do not belong to this category of institutions.

General hospitals provide (main) medical and nursing according to the main sections of medicine (e.g., on therapy, surgery, obstetrics), specialized medical aid on surgical and therapeutic specialties etc.

Level of specialization of bed fund of such BCs is various, highest it in the developed capitalist states. In large the nek-ry countries along with a complex of other departments departments for recovering would be created to unload specialized bed fund and to increase its turnover.

In developing countries-tsy of the general type, especially if they are not in the large cities, have beds of three profiles — therapeutic, surgical and obstetric and gynecologic. These often would lack for personnel of the corresponding qualification and the necessary equipment. At the same time central-tsy the general type in developing countries, concentrated generally in the capitals and the largest cities, can have up to 10 and more departments; on the functions and structure they are quite often similar with large-tsami the general type of the developed capitalist states.

Specialized hospitals provide medical and nursing on one of medical specialties. Their profiling is quite wide, and the average bed fund fluctuates in considerable sizes. Narrow-purpose specialization to lay down. - professional, institutions it is characteristic of the developed capitalist states. The number of specialized BCs also grows in developing countries (e.g., in Afghanistan, Bangladesh, Liberia, Mali, the People's Democratic Republic Yemen, Nigeria, etc.); these are infectious, tubercular, gastroenterological, ophthalmologic, psychiatric-tsy, leper colonies. In a number of the countries there are centers of rehabilitation, and also to lay down. - professional, institutions a dignity. - hens. type for persons with a certain profile of pathology.

Local or rural hospitals are placed usually in rural areas, in their state constantly works 1 or several doctors. On the functions they would be the general type, but in comparison with the last provide medical and nursing in limited scales.

Rural-tsy developing countries in the majority are staffed only by paramedical staff, lack for the equipment and pharmaceuticals; their power fluctuates from 10 — 15 to 150 — 200 beds. Usually at out-patient and polyclinic departments would function.

The medical centers and maternity homes usually have insignificant bed fund (e.g., in Upper Volta on average of 60 beds, in the Central African Republic, Senegal — 50 beds, Congo — 30 beds, Niger — 15 beds, Burundi — 10 beds, on Madagascar — 7 beds, Nigeria — 3 — 4 beds etc.). The medical centers — the small medical institutions known also as the rural centers of health care, clinics with bed fund, rural maternity homes etc. The medical assistant (there is no constantly working doctor), the nurse, the midwife and others is on their staff, to-rye provide hospitalization, the limited medical, and also sisterly help. In the certain developed countries where population density is rather high and there would be a possibility of service of the population city the general type, is tended to decrease in bed fund in rural and local-tsakh and the medical centers. The average value of employment of beds in them, as a rule, is lower than 50%, and sometimes decreases to 20%. In the USA, e.g., among residents of rural districts the tendency to avoid treatment in small local-tsakh and to ask for the help in large city-tsy is observed. In France in rural-tsakh only obstetric departments and departments for recovering are kept, surgical treatment is not carried out to them since 1958. However for developing countries where 70 — 80% of the population live in rural areas and transport relations are poorly established, preservation of rural BCs and medical centers admits necessary so far.

In developing countries a problem of development of network to lay down. - professional, institutions — one of the most difficult. Level of security with bed fund in the majority of these countries is extremely low, influence of long years of colonial oppression affected here. Number of medical institutions and security of the population of nek-ry developing countries with hospital beds for 1972 — 1975, on ofitsa. to the data provided in prod. In‘ 03, similar data on the developed capitalist countries — in table 2 are presented in table 1.

In statistical materials also division stationary is used to lay down. - professional, institutions according to in what maintaining they are: 1) the public medical institutions which are under authority of the central, regional or local authorities; 2) the private noncommercial medical institutions subsidized or not subsidized by the government and managed on a nonprofit basis by non-governmental organizations, such, e.g., as the religious missions, the industrial enterprises, managements of large-scale land enterprises or various philanthropic organizations; 3) the private commercial medical institutions managed on a commercial basis.

The gradation used by WHO to lay down. - the prof. of institutions it is very conditional and does not reflect variety of forms to lay down. - the prof. of institutions of foreign countries. She has a little abstract character and ignores the fact what to lay down. - professional, institutions are an integral part of system of rendering the medical aid existing in this or that country. At the same time the health system caused by a socio-political system defines extent of participation of the state in the solution of questions of health protection of the people and, therefore, the state or private character to lay down. - professional, institutions, the principles of functioning and creation of health services, sources of their financing and degree of availability to the population depend on it. In developing countries the tendency to the choice of a noncapitalistic way of development spreads, it affects also health care. Not accidentally in many of them (Angola, Afghanistan, Burma, Guyana, Iraq, Congo, Mali, Mozambique, Panama, Peru) all are under authority of the state or the majority to lay down. - professional, institutions (tab. 1). In the developed capitalist countries to lay down. - professional, institutions are or under authority of public institutions — the central government or local authorities (it is characteristic of most medical institutions of such countries as Great Britain, Italy, France, Sweden, etc.; generally institutions of the extra hospital help belong to individuals), or belong to individuals or the organizations — religious and philanthropic about - to you, the industrial enterprises, corporations etc. (tab. 2).

For to lay down. - professional, institutions of the capitalist countries the high level of specialization is characteristic, on the one hand, with another — quite wide range of functions including not only providing the population to lay down. and prof. help, but also training of workers of health care and carrying out medico-biol. researches. The increasing recognition is gained by the system of step-by-step patient care demanding group of patients and creation of special departments to respectively six phases of the step-by-step help: intensive, intermediate, self-service, long, at home and in out-patient clinic.

In the developed capitalist states not only the available quantity of beds, but also technical equipment of BC becomes important criterion of security with the hospital help already. In the central stationary medical institutions of the capitalist countries automated control systems are quite widely used, and also the electronic computer facilities in diagnostic and other purposes are applied. The ground mass of stationary institutions in these countries would be made by with power up to 500 beds. See also Hospital, hospitals abroad ; Hospital construction, design and construction of hospitals abroad ; the characteristic of medical institutions abroad in articles devoted to the certain countries [e.g., Austria (see), Great Britain (see), etc.].

Extra medical institutions

the Medical centers (without hospital) and the medical and sanitary centers (the centers of health care, the centers of health) — the main type to lay down. - professional, institutions on rendering the extra hospital help abroad. These institutions provide preventive maintenance and carry out actions for strengthening of health of hl. obr. country people. Their main functions usually consist in rendering primary medical aid and treatment before hospitalization therefore quite often they are called also the centers of primary medical aid, however quite often they have also opportunities for hospitalization, the truth limited. In industrially developed capitalist countries the medical centers are usually completed with medical shots (sometimes on a number of specialties) and paramedical staff. In the majority of developing countries management of the medical centers is performed by medical assistants.

The main objectives of the rural medical centers are: 1) early diagnosis and treatment of patients; 2) medical and preventive maintenance of children; 3) organization of fight against certain diseases (leprosy, tuberculosis, venereal diseases); 4) fight with inf. diseases; 5) obstetric aid; 6) organization of medical statistics; 7) dignity. - a gleam, work among the population; 8) implementation of actions for environmental control.

Clinics — one of kinds of the medical centers. It is the specialized out-patient institutions rendering to lay down. - professional, the help to patients of veins. diseases, mental diseases, tuberculosis etc., or the servicing certain age or social groups of the population. Clinics are designed to pay the main attention to prevention of spread of diseases and their early identification.

In a number of the developed capitalist countries clinics perform the functions inherent to a clinic (see) in the USSR. E.g., antitubercular clinics in Belgium (see) give help to patients with an active form of tuberculosis and contacting to them and incorporate mobile antitubercular crews for production of a X-ray analysis and tuberkulinovy tests to the population.

Rural clinics in developing countries are usually staffed by one medic (more often it is the nurse) or the persons who had short-term medical training and service the population of one or several nearby villages. Qualification of personnel and very small opportunities force to limit functions of rural clinics in developing countries to rendering primary medical aid. In the nek-ry countries in the most remote areas in clinics there are 5 — 7 beds for hospitalization of the emergency and nontransportable patients and obstetric aid.

The centers of protection of motherhood and childhood, the centers of health protection of children, the centers for health protection of school students are among the medical centers servicing certain age or social groups of the population. The similar centers quite often carry the name of consultations (children's consultations, clinics for women, etc.).

Out-patient departments at hospitals, offices of general practitioners and specialists are widely used for the extra hospital help in the capitalist countries. Development of the group practice which is carried out in technically more equipped centers with laboratories, rooms for medical procedures, etc. is characteristic. Similar practice is widespread in Great Britain (see), United States of America (see), France (see) and some other countries.

Mobile (mobile) crews of health care are created for implementation of actions for fight with inf. incidence. They function in a number of developing countries (The Central African Republic, Guinea-Bissau, Congo, Liberia, etc.) and actions are responsible for identification of cases of diseases, vaccination and for protivoepid. 1 doctor, 1 medical assistant, 2 — 3 technical workers and to 10 assistants to medical brothers are their part, as a rule. In the nek-ry countries (Upper Volta, Cameroon, etc.) their task comes down to detection of diseases and vaccination. Sometimes mobile crews carry out purposeful protivoepid, actions against a trypanosomiasis, a frambeziya and other diseases.

Laboratories of public health care function in the majority of developing countries and in a number of the capitalist states. They make different researches and analyses.

According to a joint WHO research and the United Nations Children's Fund, published in 1975, in many developing countries more than 85% of villagers and poor segments of the population have no access to health services. Therefore development of network to lay down. - professional, institutions and ensuring availability of medical aid to the population remains to one of the most important problems of health care of developing countries.

The organization of work to lay down. - professional, institutions in the socialist countries in detail is considered in articles about health care of the certain countries (see. Bulgaria , Hungary , German Democratic Republic etc.)



Bibliography: The organization of hospital service, the Report of Committee of WHO experts, it is gray. tekhn. dokl. No. 395, Geneva, 1971; Bridgman R. F. The rural hospital, its structure and organization, Wld Hlth Org. Monogr. Ser. No. 21, Geneva, 1955; Modern management methods and the organization of health services, Publ. Hlth Pap. No. 55, Geneva, WHO, 1974; Roemer M. I. Evaluation of community health centers, Publ. Hlth Pap. No. 48, Geneva, WHO, 19 72; World Health Statistics Annual, 1973 — 1976, v. 3, p. 236, 1976; World Health Statistics Report, v. 28, No. 9, p. 353, 1975, V. 30, No. 3, p. 372». 1977,

O. P. Shchepin, E. V. Galakhov.