试点为什么失败:国际组织与中国计划免疫的起步

How experiment fail:INGOs and the launch of EPI in China

全球公共卫生从初级卫生保健到选择性初级卫生保健的转型,通常被解释为战后福利国家的瓦解或是新自由主义的兴起。在批判性地回顾既有政策试点理论的基础上,通过引入了“重组社会”的概念框架,对中国20世纪80年代同世界卫生组织(WHO)和联合国儿童基金会(UNICEF)所合作开展的两组平行试点进行了详细考察。研究发现,影响成败的关键在于能否让参与试点的每一方都“相当有利可图”。比如初级卫生保健合作中心失败的一个重要原因,就在于其“渐进调适”的旨在完成WHO综合评价的努力,反倒被WHO视为理念上的背叛。研究进一步呼吁打开所谓公共卫生全球治理转型的黑箱,关注“重组社会”中力量的倒转。

The collapse of the postwar welfare state or the rise of neoliberalism,are often employed to interpret the transition of global public health,from primary health care(PHC)to selective primary health care(SPHC).This paper,however,rivals this transition by carefully examining two parallel sets of experiments conducted in China in the 1980s in collaboration with INGOs-World Health Organization(WHO)and United Nations International Children's Emergency Fund(UNICEF),with the conceptual framework of“reorder society”.It is found that the key to success is the ability to lead others“believe are their interests”.The failure of the cooperative center,more specifically,lies primarily in its“muddling through”strategy to fulfill the comprehensive evaluation,which was considered a betrayal of WHO’s PHC idea.This study further calls for opening other black boxes of“transition”in global public health governance,where the power ratio is reversed in reordering the society should always be the focus.