城鄉社區健康營造在社區工作中的理想與困境-以台南市為例

The Purpose and Struggle of a Community Health Promotion Center in Community Work with Particular Reference to Tainan City

楊中和(Chung-Ho Yang)

指導教授 ： 蔡青芬

長榮大學/人文社會學院/社會工作學系(所)/碩士(2016年)

摘要

台南市（含舊台南縣）從1999年開始有16個單位(衛生所、醫療院所、民間團體)承辦社區健康營造計劃工作，從1999年~2014年共有46個單位承辦過計劃工作，到2014年只剩下13個單位、14個區還在運作。台南市共有37個行政區，表示有23個（舊台南縣）行政區的鄉村里民無法享受到，國家推行社區健康營造的政策福利。是什麼困境與問題使健康營造中心無法持續運作？根據以上研究動機，以質性研究方法進行探索，本研究目的是瞭解台南市社區健康營造歷程，在推動上城鄉社區面臨處境的挑戰，運用社區工作因應策略，以協助社區健康營造的永續發展。
根據研究結果，政府推行社區健康營造的目的，就是希望逹到全民預防保健，全民均健目的，減少民眾濫用醫療資源，造成健保財務負擔，拖累國家財政。社區健康營造的永續發展，於本研究發現，醫院型態承辦單位較能永續經營，而社區型態承辦單位永續經營相對辛苦、困難。主因是健康議題完成指標，需要醫療相關的人才及社區民眾參與。台南市區域醫院都集中在台南市區，而（舊台南縣）只有3家區域型醫院，且各區衛生所可能因本身業務繁重都己退出計劃，並可看出城鄉醫療服務分配不均問題。
本研究提出下列建議：由政策面請衛生局與醫療系統承辦計劃或輔助社區民間團體承辦計劃執行。針對社區營造組織配合參與健康促進活動，藉由社區工作方法專業來推行社區健康各項活動方案的進行，社區民眾參與健康促進宣導，學習累積社區健康意識，進而走向全民均健、健康城市的目標。唯有健康政策完善來縮短城鄉醫療服務差距，與社區民眾參與自主及關注社區健康問題，而不是一昧過度仰賴政府的協助，才能逹成全民健康生活的社會。

關鍵字

城鄉 ； 社區工作 ； 社區健康營造

並列摘要

Since 1999， 16 agencies， including government health agencies， clinics， hospitals， and private non-profit organizations， have been involved in planning and delivering community health awareness programs. From 1999 to 2014， a total of 46 agencies have at one time or another planned or delivered a community health awareness program. However， as of 2014， there are only 13 agencies in 14 regions of Greater Tainan City that are still carrying out community health awareness programs.
There are 37 regions in Greater Tainan City. The phenomenon described above means that residents in 23 regions of Greater Tainan do not have access to community health awareness programs that are being promoted and delivered by the government. This thesis’ objective is to uncover the struggles facing these organizations that are preventing them from staying on in the long run. This thesis’ purpose is to provide an overview of Tainan City’s community health awareness programs， understand the history， struggles， and challenges of program delivery， and propose a strategy that would help community health awareness programs to remain viable for the long run.

Research results indicate that the government’s purpose for promoting community health awareness programs is to increase residents’ self-awareness vis-a-vis preventive healthcare and to improve the average health of residents. The government also wants to reduce waste caused by the abuse of medical resources. Abuse of medical resources by the general public has already resulted in a debt-ridden national health insurance system， which has in turn severely affected national financial policies. Research for this thesis has discovered that， compared to community-based volunteer organizations， hospitals are better equipped to carry out community health awareness programs over the long term. Community-based organizations often face more challenges and difficulties when trying to deliver such programs because community health awareness programs and health issues require the involvement of medical professionals and the participation of area residents. However， district hospitals in Greater Tainan City are mostly in the urban districts of Tainan City. In contrast， there are only 3 district hospitals in rural areas of Tainan City (formerly known as Tainan County). Furthermore， district health stations are usually overloaded with work， forcing them to give up community health awareness projects. Hence， another facet of the problem is that the distribution of resources is not equal between rural Tainan and urban Tainan.

This thesis proposes that policies be made so that hospitals and district health stations in Tainan can take the lead in planning and delivering services， or assist private， non-profit community organizations in the delivery of these services. As for community-based organizations’ participation， this thesis proposes that these organizations seek assistance from medical professionals when they plan community health events. These adjustments can help increase participation among residents， increase health awareness in the community， and promote a healthier community. Some solutions include creating holistic healthcare policies， bridging the service quality gap between rural areas and urban areas， and increasing the autonomy and participation of residents in community health issues. These recommendations would wean residents off from overreliance on government aid and they would promote healthier communities and societies.

並列關鍵字

Urban and rural ； Community work ； Community health promotion.

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