搜档网
当前位置:搜档网 › Health and Health Care in South Africa — 20 Years after Mandela(极力推荐一读!)

Health and Health Care in South Africa — 20 Years after Mandela(极力推荐一读!)

Health and Health Care in South Africa — 20 Years after Mandela(极力推荐一读!)
Health and Health Care in South Africa — 20 Years after Mandela(极力推荐一读!)

T h e ne w engl a nd jour na l o f medicine

Health and Health Care in South Africa — 20 Years after Mandela Bongani M. Mayosi, M.B., Ch.B., D.Phil., and Solomon R. Benatar, M.B., Ch.B., D.Sc.(Med.)

In the 20 years since South Africa underwent a peaceful transition from apartheid to a constitu-tional democracy, considerable social progress has been made toward reversing the discrimina-tory practices that pervaded all aspects of life before 1994.1-5 Yet the health and well-being of most South Africans remain plagued by a relent-less burden of infectious and noncommunicable diseases, persisting social disparities, and inad-equate human resources to provide care for a growing population with a rising tide of refugees and economic migrants.4,6 Appropriate respons-es to South African health care challenges would be to address the social determinants of health (which lie outside the health system) as a national priority, strengthen the health care system, and facilitate universal coverage for health care. Reflection on some major health challenges and recent trends in health, wealth, health care, and health care personnel provides glimpses into future prospects. It is acknowledged that al-though there are unique aspects to improving health in South Africa, the local challenges rep-resent a microcosm of impediments to improv-ing population health globally.7 Reversing the adverse health effects of complex, interacting local and global causal factors will be immensely difficult and will take many decades,6,8-10 espe-cially in a world facing profound challenges since the 2008 global economic crisis.11

Major National He alth

Challenges

Health and Poverty

Health should be considered within the broader context of direct and indirect links between wealth and health, although these relationships are complex. When extreme poverty affects a large proportion of the population, as in South Africa, health is predominantly affected by a lack of access to the basic requirements for life — clean water, adequate nutrition, effective san-itation, reasonable housing conditions, access to vaccinations, good schooling, and the childhood and adolescent nurturing that, with the avail-ability of jobs, set the scene for improved health and longevity. At less severe levels of poverty, improved access to basic and then more sophis-ticated health care adds to the prospect of healthier lives.

B oth absolute and relative poverty are rele-vant. In societies with less relative poverty (as indicated by a lower Gini coefficient of income inequality [ranging from 0 to 1, with 0 indicating total equality and 1 indicating maximal inequal-ity]), disparities in health and well-being are less marked.12 Relative and absolute poverty in South Africa share common causes and mani-festations with poverty globally.13,14

B eyond the elimination of legislated racial policies, advances in South Africa during the past 20 years include substantial economic growth, an expansion of the black African middle class, and a greatly increased number of social grants to the very poorest and unemployed.5 (The term “black African” refers to indigenous people who speak an African language.) Social grants have reduced absolute poverty, but 45% of the popu-lation still lives on approximately $2 per day (the upper limit for the definition of poverty). More than 10 million people live on less than $1 per day — the so-called food poverty line below which people are unable to purchase enough food for an adequate diet. Even at an income of $4 per day, the quality of life would not be remotely near the level that the majority of South Africans had hoped for after the end of apartheid. Relative poverty has become worse, with the Gini coefficient increasing from 0.6 in 1995 to almost 0.7 in 2009.15 The top 10% of South Africans earn 58% of the total annual national income, whereas the bottom 70% com-bined earn a mere 17%.16 These disparities, the widest in the world, are associated with diseases of poverty (see below). The persistence of such

T h e ne w engl a nd jour na l o f medicine

disparities is incompatible with improvements in population health.

HIV/AIDS Pandemic and Local Responses South Africa, with 0.7% of the world’s popula-tion, accounts for 17% of the global burden of human immunodeficiency virus (HIV) infection.17 The devastating effects of the pandemic on the lives of individuals, families, whole population groups, and society in general has received spe-cial attention.4,18,19

In 2003, after much government denial and an abysmally slow response with regard to fund-ing for HIV and the acquired immunodeficiency syndrome (AIDS), considerable local and inter-national pressure resulted in the government in-troducing an ambitious program to provide an-tiretroviral therapy (ART) to all patients with HIV infection.20 Spending on HIV increased at an average annual rate of 48.2% between 1999 and 2005. The level of growth was consistently higher than that in other areas of national health expenditure and has continued at an an-nual rate of approximately 25%, with dedicated HIV funding estimated at $400 million (in U.S. dollars) per annum, of which approximately 40% comes from international donors. Of 6 million HIV-positive South Africans, more than 2 million receive ART.6

The U.S. President’s Emergency Plan for AIDS Relief, which has saved the lives of millions of people in South Africa, is now being reconsid-ered and scaled back, with potentially adverse effects on the lives of many who could benefit greatly.21 Prevention is widely accepted as the most cost-effective strategy to curtail the epi-demic, yet a mere 11% ($695 million in U.S. dol-lars) of the planned expenditure on HIV from 2011 to 2016 is allocated to prevention.22 The 2003, 2007, and 2011 national plans for HIV, with funding increasingly skewed toward HIV treatment, have implications for a deteriorating national public health system committed to equi-tably serving all South Africans.17,22

Tuberculosis

South Africa has one of the worst tuberculosis epidemics in the world. Driven in recent decades by the spread of HIV infection, the incidence of tuberculosis increased from 300 per 100,000 people in the early 1990s to more than 600 per 100,000 in the early 2000s and to more than 950 per 100,000 in 2012. Despite notable progress in improving treatment outcomes for new smear-positive tuberculosis cases, the tuberculosis burden remains enormous.23 Multidrug-resistant (MDR) tuberculosis accounts for 1.8% of all new cases of tuberculosis (95% confidence interval [CI], 1.4 to 2.3) and 6.7% of retreatment cases (95% CI, 5.4 to 8.2).24 Since a study involving patients with extensively drug-resistant (XDR) tuberculosis in rural South Africa made interna-tional headlines,25 South Africa reports the most XDR tuberculosis cases in the world. Annual no-tifications increased from 298 in 2005 to 1545 in 2012 (Fig. 1).24 Approximately 10% of MDR tuberculosis cases reported in South Africa are XDR tuberculosis cases.24

Widening Disparities in Health Care

Annual per capita expenditure on health ranges from $1,400 in the private sector to approximate-ly $140 in the public sector, and disparities in the provision of health care continue to widen.3 The national public health sector, staffed by some 30% of the doctors in the country, remains the sole provider of health care for more than 40

special report

million people who are uninsured and who con-stitute approximately 84% of the national popu-

that provides access to health care from the re-the private sector. Up to 25% of uninsured peo-staff in the public sector to spend a limited pro-portion of their time working in the private sec-tor has diluted their public-service activities.crisis,26 with much of the public health care in-Eastern Cape province 27other regions.3,6

He alth Trends

Maternal and Child Mortality and Life Expectancy at Birth

Neonatal mortality, infant mortality, and mor-tality among children younger than 5 years of age have decreased (Table 1),28 despite adverse changes in the pre-2005 period exacerbated by the AIDS denialism of the government led by President Thabo Mbeki. Approximately 330,000 lives or 2.2 million person-years were lost owing to the failure to implement a feasible and timely ART program.29

Reported trends in maternal mortality vary widely. Maternal deaths per 100,000 pregnancies increased from 150 in 1998 to 650 in 2007,30 but other findings suggest that there has also been improvement toward the achievement of Millen-nium Development Goals.6 Many maternal deaths in South Africa are related to HIV infection.31 Although the combination of HIV and tuberculo-sis is the leading cause of death among women of reproductive age in KwaZulu-Natal province, death rates have declined since the launch of the ART program in 2003 (Fig. 2).31

Estimates of life expectancy at birth in the general population increased from 54 years in 2005 to 60 years in 2012 (Table 1).32 This im-provement was due to sustained decreases in mortality among young adults and children, largely because of the rollout of the ART pro-gram and prevention of mother-to-child trans-mission of HIV. HIV-positive adults in South Africa have a near-normal life expectancy, pro-vided that they start ART before their CD4 count drops below 200 cells per cubic millimeter.33

T h e ne w engl a nd jour na l o f medicine

Changing Patterns of Disease

The Global Burden of Disease Study has high-lighted three major aspects of the changing bur-den of disease in South Africa during the past 20 years.34 First, there has been a marked change in causes of premature death, with HIV/AIDS rising to the top coupled with the increasing contribu-tion of violence, injuries, diabetes, and other noncommunicable diseases (Fig. 3). The highest proportion of disability-adjusted life-years lost is attributable to alcohol use, a high body-mass in-dex, and high blood pressure, if unsafe sex is not taken into account as a separate risk factor (Fig. 4). Second, South Africa continues to stack up poorly against other middle-income countries with regard to age-adjusted death rate, years of life lost from premature death, years lived with disability, and life expectancy at birth (Table 2). Finally, noncommunicable diseases are emerging in both rural and urban areas, most prominently among poor people living in urban settings. This rising burden, together with demographic changes leading to an increase in the proportion of people older than 65 years of age, contributes to increasing pressure on short-term and long-term health care services.35,36 The burden of non-communicable diseases will probably increase further as ART further reduces mortality from HIV/AIDS.

Human Resources

and the He alth Sys tem Medical Students and Graduating Doctors The number of new medical students enrolling annually increased by 34% between 2000 and 2012, a period characterized by a major and de-liberate demographic shift toward more black African and female enrollees.37 These patterns have been influenced by controversial affirma-tive-action policies that allow students from previously disadvantaged groups to be admitted with lower entrance scores.38 A new national scheme has been initiated for training physi-cian scientists through an M.B., Ch.B./Ph.D. program in an attempt to sustain academic medicine (located in the public health sector)

special report

in the future.39 Government interest in funding medical research will hopefully support this goal.40-42

The number of graduating doctors increased by 18% between 2000 and 2012, with a shift from gender parity to more women, more black Africans and persons of mixed ancestry, and fewer whites and Indians (Table 3).43 However, the ratio of physicians per 1000 population, which was essentially unchanged between 2004 (0.77) and 2011 (0.76), is failing to keep up with population growth.44 Similar countries such as Brazil (1.76 in 2008), Russia (4.31 in 2006), and China (1.46 in 2010) are doing better than South Africa, whereas India (0.65 in 2009) is not doing as well.44

A program initiated by President Nelson Mandela in the mid-1990s to train medical doc-tors in Cuba was intended to promote a local version of the much-admired Cuban orientation toward primary health care. Participating doc-tors are mainly black Africans from rural areas. The program will expand by a factor of nearly 10 over a 5-year period, with the goal of intro-ducing 1000 graduates annually into the health system from 2018 onward.45 The wisdom of training nearly half of South Africa’s doctors in another country has been questioned, given that the local tradition and capacity for a primary health care approach46 buttressed by well-spent resources could be used to strengthen existing medical schools and establish new training fa-cilities.

Nurses and Community Health Workers Nurses have long been central to health care, especially in rural areas where physicians are re-luctant to practice. Between 2003 and 2012, the total number of nurses in all categories on the Nursing Register increased by more than 40%.47 Although many registered nurses may not be practicing and there may be a shortage of quali-fied nurses, the growth rate has greatly exceed-ed population growth (the population increased 14% from 2003 [46.4 million] to mid-2013 [53.0 million]).48 Community health workers are recog-nized as a means of improving access to health care and encouraging community participation in health care in periurban and rural areas. Most are employed by nonprofit organizations.49

T h e ne w engl a nd jour na l o f medicine

Immigration and Emigration of Health Professionals

South Africa and eight other sub-Saharan African countries have lost more than $2 billion (in U.S. dollars) in investment from the emigration of domestically trained doctors to Australia, Canada, the United Kingdom, and the United States.50 South Africa incurs the highest costs for medical education and the greatest lost returns on in-vestment for all doctors currently working in such destination countries. Previous studies in-dicate that up to 30% of South African doctors have emigrated and that 58% were intending to emigrate to Western countries.51 Immigration of doctors increased from 239 in 2003 to a peak of 427 in 2006, but this was followed by a rapid decline to only 10 registrations in 2013, owing to stringent registration requirements introduced by the Health Professions Council of South Africa.43

Prospects for National Health Insurance

Working toward the goal of national health insur-ance to provide more equitable access to high-quality individual health services has reemerged as a popular notion,6 and a draft plan has been developed.52 Health economists have suggested that it would be feasible to raise the additional required funding.53 However, expectations that equity in health care delivery could be achieved at levels close to current private-sector levels ap-pear to be unrealistic. It is clear from the dis-parities in funding of the private and public sec-tors and the very large number of additional health care professionals required that this is un-likely and, if achievable, would take a very long time.8 Creating a National Health Service would be an even greater challenge.6

improving access to health care

Concerted action will be needed to strengthen the district-based primary health care system, to integrate the care of chronic diseases and man-agement of risk factors and to develop a national surveillance system with the goal of applying well-managed and cost-effective interventions in the primary and secondary prevention of disease within whole populations. South Africa requires at least three times its current health workforce to provide adequate care for patients with HIV/AIDS.54 The recent thrust toward training more community health workers and the successful

development of front-line worker–based programs

* D a t a a r e f r o m t h e I n s t i t u t e o f H e a l t h M e t r i c s a n d E v a l u a t i o n .34

? Y e a r s o f l i f e l o s t i s a n e s t i m a t e o f t h e a v e r a g e n u m b e r o f y e a r s t h a t a p e r s o n w o u l d h a v e l i v e d i f h e o r s h e h a d n o t d i e d p r e m a t u r e l y .

to control tuberculosis and HIV infection offers considerable promise.55

Increasing the number of health care profes-sionals and reshaping health services pose major challenges. The wide gap between planning new training schools and making these functional will not be easily traversed.49 One of the first priorities must be to resuscitate and strengthen existing facilities and to strive for high-quality teaching, conditions of service, and an ethos of care in clinical services (at all levels)2,8 that, in synergy, could foster the dedication of health care professionals to provide services with ex-cellence, rather than merely seek the security of a job and a salary.56,57 Previously expressed con-cern that cutbacks in tertiary medicine in the public sector would hinder postgraduate train-ing remains relevant.2

Given the different strengths and weaknesses of the public and private health care sectors, any strategic alliances forged with the private sector to improve health care services in the public sector will have to be mutually agreeable while biased toward strengthening the public sector in the national interest. The Department of Health of the Western Cape province has set an example.58 Operationalizing such ambitious plans will be extraordinarily challenging and is likely to take many decades.

economic and politic al fac tors

Health Improvement and Poverty Alleviation Although the economic policies of South Africa have not been explicitly articulated, trends in disparities in health and wealth in part reflect the outcome of policies adopted by successive governments in the new South Africa.10 These have shifted from the progressive idea of growth through redistribution, as envisaged in the Recon-

struction and Development Program of the Mandela government in the early 1990s that was intended to narrow the apartheid legacy of eco-nomic disparities, to growth and redistribution within the subsequent conservative Growth, Employment, and Redistribution strategy in line with neoliberal economic policies that were fa-vored by President Mbeki.10 His policies facili-tated economic growth, reduced expenditure on debt servicing and health care,2 and enabled the growth of a black African middle class.10 However, despite a reduction in absolute pov-erty through social grants and a larger middle class that has substantially changed the overall distribution of income, these financial gains came at the expense of increased levels of in-equality.5 The rate of unemployment, defined narrowly by the active seeking of work, has re-mained at 20 to 24% since 1994, with 70% of the unemployed younger than 34 years of age. In the late 2000s, 23% of South Africans lived below the food poverty line, but 54% faced food insecurity.59

special report

* In 2011, there were 162,630 health professionals registered with the Health

Professions Council of South Africa in several professional categories. In ad-

dition, there were 12,813 pharmacists and 9071 pharmacist assistants regis-

tered with the Pharmacy Council in 2010. Of approximately 65,000 commu-

nity health workers in 2011, 47,121 were home-based or community-based

care providers, 9243 were lay counselors, 2040 were directly observed treat-

ment supporters, 2010 were adherence counselors, and 1810 were peer edu-

cators.

? Black African refers to indigenous people who speak an African language.

? Data are from 2003.

T h e ne w engl a nd jour na l o f medicine

The trajectory from the socialistic economic policies of the Mandela government through the neoliberal policies propagated under Mbeki’s much-criticized leadership has been interpreted as a betrayal of the vision of a new, caring, cosmo-politan social democracy. Hence we have wit-nessed a shift toward neo-Keynesian policies as-sociated with support from the Congress of South African Trade Unions and the South African Communist Party for the Jacob Zuma takeover and for the New Growth Path that sets the tar-get of narrowing economic disparities.10

Social and Political Failures Regrettably, many South Africans, including those in leadership positions, have been co-opted into the lavish lifestyles, wasteful consumption pat-terns, and nepotism that frustrate the ethos re-quired to reduce inequities. Many, including long-standing members of the African National Congress (ANC), agree that corruption is at the root of the moral decay in South Africa. Other failings include attacks on liberal aspects of the constitution, interference with the independence of judges, corruption of the criminal justice sys-tem, and infringement of rights to government information.9,60-62 Widespread dissatisfaction with the ANC is reflected in the results of the 2014 elections, in which only 59.3% of eligible voters participated (as compared with 85.5% in 1994) and the ANC garnered 36.4% of eligible votes (as compared with 53.0% in 1994).63

Since the onset of the 2008 global economic crisis, it is becoming more widely acknowledged that efforts to address many critical local and global problems are dominated by a misguided, inadequate development ideology and agenda.11,64 Although global institutional efforts have been stepped up in support of the international devel-opment targets, current economic trends global-ly and in South Africa are preserving privilege for a minority of people (about 20% of the world pop-ulation and 30% of South Africans) while simulta-neously intensifying inequality, poverty, starva-tion, violence, and abuse of our environment.

Conclusions

Much of the hope for narrowing disparities in the new South Africa was embedded in the re-versal of legislated racial discrimination gener-ally and in aspirations for more equitable provi-sion of health care specifically. But this places too much emphasis on legislation and biomedi-cine as the dominant routes to improved health, without consideration of the social determinants of health and the complexity associated with the effective practical application of new laws and health services.

The long-term challenges in South Africa are to narrow disparities in wealth, health, and ed-ucation and to generate opportunities for many more people to survive childhood, reach their full human potential, and lead healthy, produc-tive lives. In the medium term, improving ac-cess to sustainable and effective health care ser-vices is a high priority.6 Short-term measures should include strengthening public health care services, improving resource-allocation policies, and training an appropriate balance of health care professionals. Nurses and community health workers will probably play an increasingly im-portant role in rural areas.

Efforts to achieve sustainable improvements in health with limited resources and much re-duced prospects for economic growth call for improved health care management and gover-nance and widespread shifts in attitude to “do-ing better with less.” Sustaining the ambitious national shift into a new paradigm arguably re-quires that other countries also make major shifts in their policies and expectations to facili-tate survival on a planet with increasing con-straints on natural resources and many threats to a now fragile ecologic environment.7

Such complex (perhaps even intractable) local and global problems require transdisciplinary sociopolitical–economic research projects that could reframe the nature of progress and per-spectives of ourselves as local and global citi-zens.65,66 The magnitude of this task is arguably as daunting as the task of producing an HIV vaccine.

At a time characterized by local and global crises that engender much despondency, and when it seems that we are probably collectively unable to recognize the dire nature of our mu-tual predicament,67 it is appropriate to recollect how President Nelson Mandela’s attitude of mag-nanimity and reconciliation (despite 27 years in prison) spearheaded peaceful progress toward a new South Africa. His example continues to be

an inspiration to many in South Africa and be-yond, as reflected in the affection, admiration, and awe in which he is so widely held.68 Disclosure forms provided by the authors are available with the full text of this article at https://www.sodocs.net/doc/0e9484268.html,.

We thank Dr. Mark Engel, Dr. Brigid Strachan, Dr. Grant Theron, and Miss Sharon Wakefield for technical assistance in the preparation of this article.

From the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.

This article was published on September 29, 2014, at https://www.sodocs.net/doc/0e9484268.html,.

1. Benatar SR. Medicine and health care in South Africa. N Engl J Med 1986;315:527-3

2.

2. Benatar SR. Health care reform and the crisis of HIV and AIDS in South Africa. N Engl J Med 2004;351:81-92.

3. Coovadia H, Jewkes R, Barron P, Sanders D, McIntyre D. The health and health system of South Africa: historical roots of current public health challenges. Lancet 2009;374:817-3

4.

4. Whiteside A. South Africa’s key health challenges. Ann Am Acad Pol Soc Sci 2014;652:166-8

5.

5. Two decades of freedom: a 20-year review of South Africa. Goldman Sachs, 2013 (https://www.sodocs.net/doc/0e9484268.html,/our -thinking/outlook/colin-coleman-south-africa/20-yrs-of-freedom .pdf).

6. Mayosi BM, Lawn JE, van Niekerk A, Bradshaw D, Abdool Karim SS, Coovadia HM. Health in South Africa: changes and challenges since 2009. Lancet 2012;380:2029-43.

7. Benatar SR. South Africa’s transition in a globalizing world: HIV/AIDS as a window and a mirror. Int Aff 2002;77:347-75.

8. B enatar SR. The challenges of health disparities in South Africa. S Afr Med J 2013;103:154-5.

9. Alexander N. Thoughts on the new South Africa. Johannes-burg: Jacana Media, 2013.

10. Habib A. South Africa’s suspended revolution: hopes and prospects. Johannesburg: Wits University Press, 2013.

11. Gill S, Bakker IC. The global crisis and global health. In: Benatar S, Brock G, eds. Global health and global health ethics. Cambridge, United Kingdom: Cambridge University Press, 2011: 221-38.

12. Wilkinson R, Pickett K. The Spirit Level: why equality is bet-ter for everyone. London: Penguin Books, 2009.

13. Benatar SR. Global disparities in health and human rights:

a critical commentary. Am J Public Health 1998;88:295-300.

14. Labonte R, Schreker T. The state of global health in a radi-cally unequal world: patterns and prospects. In: B enatar SR, Brock G, eds. Global health and global health ethics. Cambridge, United Kingdom: Cambridge University Press, 2011:24-36.

15. Poverty trends in South Africa: an examination of absolute poverty between 2006 and 2011. Pretoria: Statistics South Africa, 2014 (https://www.sodocs.net/doc/0e9484268.html,.za/publications/Report-03-10-06/ Report-03-10-06March2014.pdf).

16. Leibbrandt M, Woolard I. Trends in inequality and poverty over the post-apartheid era: what kind of a society is emerging? OECD/NPC/Trends Pharmacol Sci Policy Forum (http://www https://www.sodocs.net/doc/0e9484268.html,/els/soc/48228332.pdf).

17. Abdool Karim SS, Churchyard GJ, Karim QA, Lawn SD. HIV infection and tuberculosis in South Africa: an urgent need to escalate the public health response. Lancet 2009;374:921-33. 18. Cameron E. Witness to AIDS. Cape Town, South Africa: Tafelberg, 2005.

19. Doyal L. Living with HIV and dying with AIDS: diversity, inequality and human rights in the global pandemic. Surrey, United Kingdom: Ashgate, 2013.20. Simelela NP, Venter WDF. A brief history of South Africa’s response to AIDS. S Afr Med J 2014;104:Suppl 1:249-51.

21. Katz IT, Bassett IV, Wright AA. PEPFAR in transition — im-plications for HIV care in South Africa. N Engl J Med 2013;369: 1385-7.

22. Kevany S, Benatar SR, Fleischer T. Improving resource allo-cation decisions for health and HIV programmes in South Africa: bioethical, cost-effectiveness and health diplomacy consider-ations. Glob Public Health 2013;8:570-87.

23. Churchyard GJ, Mametja LD, Mvusi L, et al. Tuberculosis control in South Africa: successes, challenges and recommenda-tions. S Afr Med J 2014;104:Suppl 1:244-8.

24. Global tuberculosis report. Geneva: World Health Organiza-tion, 2013 (http://www.who.int/tb/publications/global_report/en).

25. Gandhi NR, Moll A, Sturm AW, et al. Extensively drug-resis-tant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa. Lancet 2006;368:1575-80.

26. Von Holdt K, Murphy M. Public hospitals in South Africa: stressed institutions, disempowered management. National Planning Commission of South Africa, 2006 (http://www .npconline.co.za/MediaLib/Downloads/Home/Tabs/Diagnostic/ InstitutionandGovernance2/Public%20hospitals%20in%20South %20Africa-Stressed%20institutions,%20disempowered%20 management.pdf).

27. Death and dying in the Eastern Cape: an investigation into the collapse of a health system. Treatment Action Campaign and Section27 Catalysts for Social Justice, 2013 (https://www.sodocs.net/doc/0e9484268.html,.za/ publications/death-and-dying-eastern-cape-investigation-collapse -health-system).

28. Global Health Observatory (GHO): South Africa. Geneva: World Health Organization (http://www.who.int/gho/countries/zaf/en).

29. Chigwedere P, Seage GR III, Gruskin S, Lee TH, Essex M. Estimating the lost benefits of antiretroviral drug use in South Africa. J Acquir Immune Defic Syndr 2008;49:410-5.

30. “Stop making excuses”: accountability for maternal health care in South Africa. New York: Human Rights Watch, 2011 (https://www.sodocs.net/doc/0e9484268.html,/reports/2011/08/08/stop-making-excuses-0).

31. Nabukalu D, Klipstein-Grobusch K, Herbst K, Newell ML. Mortality in women of reproductive age in rural South Africa. Global Health Action. December 19, 2013 (http://www.ncbi.nlm https://www.sodocs.net/doc/0e9484268.html,/pmc/articles/PMC3869952).

32. Dorrington RE, Bradshaw D, Laubscher R. Rapid mortality surveillance report 2012. Cape Town, South Africa: South African Medical Research Council, 2012.

33. Johnson LF, Mossong J, Dorrington RE, et al. Life expectan-cies of South African adults starting antiretroviral treatment: collaborative analysis of cohort studies. PLoS Med 2013;10(4): e1001418.

34. Global Burden of Disease (GBD). GBD data visualizations. Seattle: Institute of Health Metrics and Evaluation, 2014 (https://www.sodocs.net/doc/0e9484268.html,/gbd/visualizations/ regional).

35. Mayosi B M, Flisher AJ, Lalloo UG, Sitas F, Tollman SM,

B radshaw D. The burden of non-communicable diseases in South Africa. Lancet 2009;374:934-47.

36. Tollman SM, Kahn K, Sartorius B, Collinson MA, Clark SJ, Garenne ML. Implications of mortality transition for primary health care in rural South Africa: a population-based surveil-lance study. Lancet 2008;372:893-901.

37. Abdool Karim SS. Medical education after the first decade of democracy in South Africa. Lancet 2004;363:1395.

38. Gauld Z. “The doctor is in”: an exploration of the role of af-firmative action in medical school admissions policies in ad-dressing geographic and demographic maldistribution of physi-cians. Cape Town, South Africa: University of Cape Town, 2012 (http://www.cssr.uct.ac.za/pub/wp/311).

39. Katz AA, Futter M, Mayosi BM. The intercalated BSc (Med)

special report

Honours/MB ChB and integrated MB ChB/PhD tracks at the University of Cape Town: models for a national medical student research training programme. S Afr Med J 2014;104:111-3.

40. Senkubuge F, Mayosi BM. The state of the national health research system in South Africa. In: Padarath A, English R, eds. South African health review 2012/13. Durban, South Africa: Health Systems Trust, 2013:141-50.

41. Mayosi BM, Dhai A, Folb P, et al. Revitalising clinical re-search in South Africa: a study on clinical research and related training. Pretoria: Academy of Science of South Africa, 2009. 42. Mayosi B M, Mekwa JN, B lackburn J, et al. Strengthening research for health, innovation and development in South Africa: proceedings and recommendations of the 2011 National Health Research Summit. Pretoria, South Africa: National Health Research Committee, 2012.

43. Mjamba-Matshoba NB. Numbers of medical students and doctors registering with the Health Professions Council of South Africa. Pretoria: Health Professions Council of South Africa, 2013.

44. Global health workforce statistics: 2013 update. Geneva: World Health Organization (http://www.who.int/hrh/statistics/ hwfstats).

45. Bateman C. Doctor shortages: unpacking the ‘Cuban solu-tion.’ S Afr Med J 2013;103:603-5.

46. Engelbrecht MC, Van Rensburg HCJ. Primary health care: nature and state in South Africa. In: Van Rensburg HCJ, ed. Health and health care in South Africa. 2nd ed. Cape Town, South Africa: Van Schaik, 2012:483-534.

47. South African Nursing Council. Growth in the registers and growth in students/pupils. Pretoria: South African Nursing Coun-cil, 2014 (http://www.sanc.co.za/stats/stat_ts/Growth/Growth% 202004-2013_files/frame.htm).

48. Statistics South Africa home page (http://beta2.statssa .gov.za).

49. Human resources for health South Africa 2030: draft HR strategy for the health sector: 2012/13–2016/17. Consultation document V5. Pretoria: South Africa Department of Health, 2011 (https://https://www.sodocs.net/doc/0e9484268.html,/toolkits/hrh/human-resources -health-south-africa-2030-draft-hr-strategy-health-sector-201213 -201617).

50. Mills EJ, Kanters S, Hagopian A, et al. The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis. BMJ 2011;343:d7031.

51. Awases M, Gbary A, Nyoni J, Chatora R. Migration of health professionals in six countries: a synthesis report. Brazzaville, Republic of Congo: WHO Regional Office for Africa, 2004. 52. Green paper: national health insurance in South Africa. Pretoria: South Africa Department of Health, 2011 (http://www https://www.sodocs.net/doc/0e9484268.html,.za/publications/green-paper-national-health-insurance -south-africa).53. McIntyre D. What healthcare financing changes are needed to reach universal coverage in South Africa? S Afr Med J 2012; 102:489-90.

54. B?rnighausen T, Bloom DE, Humair S. Human resources for treating HIV/AIDS: needs, capacities, and gaps. AIDS Patient Care STDS 2007;21:799-812.

55. Demonstration project — South Africa: PALSA Plus (Practical Approach to Lung Health in high-HIV prevalence countries). Geneva: World Health Organization (http://www.who.int/gard/ countries/demonstration_project_south_africa/en).

56. Erasmus N. Slaves of the state — medical internship and community service in South Africa. S Afr Med J 2012;102:655-8.

57. Phalime M. Postmortem: the doctor who walked away. Cape Town, South Africa: Tafelberg Press, 2014.

58. 2020: The future of healthcare in the Western Cape. Cape Town, South Africa: Western Cape Government Department of Health, 2011 (https://www.sodocs.net/doc/0e9484268.html,.za/other/2011/12/ healthcare_2020_-_9_december_2020.pdf).

59. South African National Health and Nutrition Examination Survey, 2012: SANHANES-I. Cape Town, South Africa: HSRC Press, 2014 (http://www.hsrcpress.ac.za/product.php?productid =2314&cat=0&page=1&featured&freedownload=1).

60. Rotberg RI. Overcoming difficult challenges: bolstering good governance. Ann Am Acad Pol Soc Sci 2014;652:8-19.

61. Feinstein A. After the party. a personal and political journey inside the ANC. Cape Town, South Africa: Jonathan Ball, 2007.

62. Johnson RW. South Africa’s brave new world: the beloved country since the end of apartheid. Johannesburg: Penguin Books, 2010.

63. McKinley DT. The real story of South Africa’s national elec-tions. Johannesburg: South African Civil Society Information Service, 2014 (https://www.sodocs.net/doc/0e9484268.html,.za/site/article/2001).

64. Birn A-E. Addressing the societal determinants of health: the key global health ethics imperative. In: Benatar S, Brock G, eds. Global health and global health ethics. Cambridge, United Kingdom: Cambridge University Press, 2011:37-52.

65. Benatar SR. Global leadership, ethics and global health: the search for new paradigms. In: Gill S, ed. The global crisis and the crisis of global leadership. Cambridge, United Kingdom: Cambridge University Press, 2011:127-43.

66. Health and health care in South Africa. 2nd ed. Cape Town, South Africa: Van Schaik, 2012.

67. Oreskes N, Conway EM. The collapse of western civilization:

a view from the future. Daedalus 2013;142(1):40-58.

68. B arack Obama’s address at Nelson Mandela’s memorial service — in full. Guardian News. December 10, 2013 (http:// https://www.sodocs.net/doc/0e9484268.html,/world/2013/dec/10/barack-obama-nelson -mandela-memorial-service).

DOI: 10.1056/NEJMsr1405012

Copyright ? 2014 Massachusetts Medical Society.

special report

口语测试

八口语测试 1 口语的特点 ●交互性:口语交际是交际双方或多方的活动,通过交际各方相互交流传递信息。 ●即时性: 口语活动一般要求参与者对谈话对方的言语立即作出反应(包括回答问 题、补充、反对、赞成、延续等)。由于这种反应具有即时性,说话者来不及精心 准备话语,因此话语中多有迟疑、停顿、口误、冗余成分等。 ●副语言因素: 口语中说话者往往借助语调、重音、音量等副语言手段来增加表达效 果。 ●非语言因素: 说话者在说话时常借助手势、目光、表情等体势语来表情达意。 ●与听的不可分割性: 除了自言自语、演讲、口授等,一般场合下的口语活动是在“… 听→说→听→说…”的过程中进行的。 2 口语能力的构成 Weir & Bygate (1992) 将口语能力分为微语言技能(micro-linguistic skills)、常规技能(routine skills)和应变技能(improvisation skills)三个层次。 ●微语言技能(micro-linguistic skills) ◆Accuracy in phonology, grammar, lexis, etc. ●常规技能(routine skills) ?Information routines ◆Expository routines: narration, description, instruction, comparison, etc. (expository essay, expository writing:说明文) ◆Evaluative routines: explanations, predictions, justifications, preferences, decisions, etc. ?Interaction routines ◆Sequences of turns: telephone conversations, interviews, conversations at parties, etc. ●应变技能(improvisation skills) ?Negotiation of meaning ◆Level of explicitness: Speakers need to choose an appropriate level of explicitness, taking into account what the listener knows and can accommodate; ◆Procedures of negotiation: speakers need to be concerned about selecting an appropriate level of specificity in the light of listener response, including use of paraphrase, metaphor, choice of general of specific lexical items, conversational adjustments to contact and ensure understanding, and repetition and clarification procedures. ?Management of interaction ◆Agenda management: referring to co ntrol over the content (participants’ right to choose the topic, or introduce topics they want to talk about) and control over the development or duration of a topic; ◆Turn-taking: knowing how to signal that one wants to speak, recognizing the right moment to get a turn, how not to lose one’s turn, recognizing other people’s signals of desire to speak, knowing how to let other persons have a

全国英语等级考试 计算机辅助高考口语考试练习软件文档

模拟试题一 个人信息介绍:(机问人答) 1. A: What’s your name, please? B: My name is ______. 2.A: Where do you study? B. I study at NO.1 senior middle school. 3.A: What subjects do you study? B: I study Chinese, Math, English, Physics, Chemistry, Biology, PE and so on. 4. A.:What subject do you like best? B: As far as i am concerned ,i like English best. 场景1:安排旅行计划(机问人答) 旅行行程单 目的地:西藏 交通工具:飞机 出发日期:5月2日 所需费用:2000元左右 所需行李:衣服、药品、照相机等 1.A: Where do you plan to go? B: I pan to go to Tibet. 2.A: How do you go there ? B: I will go there by plane.

3.A: When do you set off? B: I will set off on May 2nd. 4.A: What luggage do you need to take? B: I need to take some clothes,some medicine as well as a camera. 5.A: How much will the trip cost ? B: The trip will cost about 2000 RMB. 6.A: Which places have you been to already and where do you plan to go next? Why? B: I have been to Shanghai, Nanjing,Suzhou and so on. And i plan to go to Hainan next, for i love the sea so much. 7.A: How do you often go travelling by plane or by train? B: I often go travelling by train, as it is a cheap way to travel. 8.A: Do you think it is a good time to travel during the Spring Festival? B: I don’t think so. After all ,there will be too many people during the Spring Festival. I don’t like the crowds and noises. 场景2:去邮局寄包裹(人问机答) 包裹单 目的地: 包裹重量: 邮寄方式: 包裹内容: 付费方式:

英语 口语考试 机考 指南

口语考试机考指南 机考当天,每场考试监考老师不得少于两人。一人负责计算机操作,其他监考老师负责监控学生是否有夹带或者使用手机进行作弊。一旦发现作弊,口试成绩记为0分。 1.考前准备:考生清单,格式如下表1。U盘或移动硬盘,用于拷贝学生的考试录音。考 试结束后老师们带回录音,交换听评。同时将音频文件夹以“考试时间+考试班级”命名,存在教研室电脑指定位置,之后将统一刻成光盘,作为教学资料存档。提供给学生抽签用的小纸条。建议多做一些。 2.设备检查:机考前,学生全部进入教室,落座,戴好耳机,打开话筒。教师打开语音 授课系统,依次点击学生,请他们说话确认话筒及耳机正常。如有发现有故障的座位,要求学生将耳机摘下,将所在位置的液晶显示器翻转,以表明此位置不可用于考试。(设备检查每次考试只需在考前做一次即可,不需要每考一个班都检查一次) 3.登记座位:设备检查完毕之后,学生按实际可使用的机器数,进入考场落座。教师依次 点击每个落座学生,询问姓名,座位号等信息,并相应登记入表格中。 4.抽取(随机分发)考题,同时登记每个考生所抽取的题目号。考生有1-2分钟的准备时 间。 5.点击考试-点击口语考试-1人考试-点选存储位置,新建文件夹,命名为考试班级名称, 确定,举手,示意考生考试即将开始。按下开始考试,将手放下,示意考生开始答题。 6.考生答题:考试答题时,需要在录音一开始报自己的学号,姓名,班级和抽取的题目。 而后开始正式考试。考生务必将麦打开。考试结束,摘下耳机,坐在位置上。直到老师示意可以离场。考试过程中,监考老师应及时巡视。发现有考生作弊,立即取消考试资格,口试成绩记为0分。 7.考生离场:在最后一名考生放下耳机后。监考老师按下考试结束。系统将在刚才建立的 文件夹中自动生成以座位号命名的wav格式的音频文件。监考老师可以点击阅卷,随机抽取几个考生,确保录音有效。随后示意考生将耳机挂好,离开。 8.下一场考生进场,重复步骤3-7. 9.考试结束后,将本次考试班级的所有录音资料用移动存储工具带走,交换阅卷。 以下为软件操作步骤:

中考英语听力口语自动化考试问答

中考英语听力口语自动化考试问答 一、听力口语自动化考试与以往考试相比有哪些主要变化 1.考试内容实行两考合一。将以往的英语口语等级测试和中考听力测试合并进行,通过计算机一次性完成考试。 2.考试方式实行人机对话。以往的英语口语等级测试方式为“师生对话”,由测试员现场提问,现场测试打分,以往的中考听力考试则在中考笔试时进行,依靠考场内广播或录音机播放听力磁带。实行人机对话后,考生坐在计算机前,戴上考试专用耳麦,由计算机播放听力录音和试题,考生用计算机作答并对着麦克风回答口语题。出题、考试、判卷、结果反馈全部由计算机完成。 3.成绩评定实行电脑评分。考试结束后,由计算机记录下考生的答案,由自动阅卷专用服务器综合各种特征给出评分,经考试组织部门确认后发布。 综上三点,听力口语自动化考试,简化了考试程序,减轻了考生负担,规范了考试要求,避免了人为因素可能造成的不利影响。 二、听力口语自动化考试如何组织 根据省教育厅统一部署,2009年起,全省中考英语听

力口语自动化考试由省教育厅统一组织,统一命制试题、统一考点设置、统一考试时间、统一考试流程、统一评分标准、统一发布成绩。 三、听力口语自动化考试考点和考场如何设置 人机对话考试对考点的要求比较高。省教育厅要求原则上以各初中学校为考点,以各学校的计算机网络机房为考场,考场计算机及相关软硬件配置均须符合考试所要求的基本条件,不符合要求的必须在升级、补充到位的基础上才能申报考点。从目前申报情况看,我市大多数初中学校已符合考场设置条件,全市大多数初中毕业生都可在本校参加听力口语自动化考试。少数不符合考场设置条件学校的学生由各地教育行政部门统一安排到就近的考点参加考试。 四、一个考场内同时有30人进行听力口语考试,会不会互相干扰 按照考场设置要求,一个考场内设置不少于33台考试机和1台监考机,每个考场同时安排30人进行考试。考试所用耳麦和话筒都是特制的,考生只能听到考试机播放的声音,话筒也只对定向的声音录音,完全不影响考试效果。2007年5月开始,省教育厅在苏州、南通、连云港部分学校进行过试点,实践证明效果良好,不会出现考生互相干

中考口语测试样题

襄阳市中考口语测试样题(讨论稿) 说明: 1. 口语测试的时间在15分钟以内; 2. 本谈论稿参考了其它地区以及湖北省英语口语等级考试题型; 3. 增加口语测试是落实英语课程标准以及培养学生学科核心素养要求的需要,有利于引导教师按语言学习规律去教,引导学生按语言学习规律去学,有利于促进学生综合语言运用能力的提高。 样题 第一节:短文朗读(共1小题,5分) (计算机语音和屏幕文字提示)在本节,你将有60 秒钟的时间阅读屏幕上的短文,并作朗读准备。当听到“请开始录音”的提示后,请在90 秒钟内朗读短文一遍。 现在请开始准备。 (屏幕上显示英语短文以及60秒钟准备时间进度条) Dear Liu Ying, I’m glad to get a letter from you. You asked me something about British food. Now, I’m going to tell you what I usually eat every day. I usually have bread and eggs for breakfast. Mom prepares milk for me and tea for Dad. Seventy percent of students have lunch at school. The school dining hall has different kinds of food. My favorite food for lunch is sandwiches. I don’t like hamburgers. Some of students take lunchboxes to school. In the boxes there are usually sandwiches, biscuits and some fruit. Supper is the most important meal in a day from Monday to Friday. Mom cooks very good dishes. We often have meat and vegetables. But at weekends, our biggest meal is in the middle of the day. I also like Chinese food. Please write to tell me something about it! Yours, Tom (计算机语音和屏幕文字提示)现在请开始朗读、录音。 (计算机给出提示后开始朗读,屏幕上显示90秒钟录音时间进度条)(计算机语音提示)朗读、录音到此结束。 第二节:情景提问(共5小题,每小题1分,共5分) (计算机语音和屏幕文字提示)在本节,请你根据屏幕上提供的情景及提问内容要点,提出5个问题。每个问题你有20秒钟的思考和提问时间。 你的同桌刚度完假。于是你向他询问有关情况。请使用屏幕上的信息提出5个问题。 现在请开始提问。

启明英语口语计算机考试系统综述

启明英语听说计算机考试系统 1.1 概述 英语听说计算机考试系统是一套采用现代化计算机技术辅助实现听说考试的系统。与传统的考生直接面对考官的口语考考试方式不同,代之以考生面对计算机,由计算机向考生显示和播放预先录制好的考试题目,考生在计算机面前回答问题,计算机录制并收集考生的答题录音,而后集中由评判教师统一评分。计算机辅助听说考试系统有以下特点: 大规模考生可以同时进行考试; 考试、评卷分离; 考官发音标准,每个考生听到的声音都是一样的; 考试题型丰富多样。 这套考试系统方案,我们根据听说考试的特点,充分融入了启明电子多年在教育行业积累的经验和先进的技术与理念。 1.2 系统业务模型 1.2.1 英语听说计算机考试的概念 考生信息:用于验证和区分每一个参加考试的考生的信息表。一般包括考号、姓名、考点、试室等。 试题信息:由试题制作功能模块生成的试题文件包。这是一套完整试题的文件的集合。 开考指令:在所有的考前准备工作完毕后,监考员就可以启动系统的开始考试指令。随后考试系统将在预先设好的时间间隔内,依次播放考题的内容,考生根据提示录制答案。考生的考试是在统一的指令下完成的。 数据打包:考试完毕后,以考生为单位打包答案,经加密、压缩后的考生答案传输到服务器端;当本场考试结束后,所有考生的答案压缩包又打包成一个以试室为单位的压缩包,以便于传输或刻录,将来评卷也是以试室为单位。 1.2.2 工作流程 听说考试具有时间短、规模大、数据保密性强的特点,必须严格按操作流程来进行。所有监考的教师,考试前一定要进行适当的培训,以掌握听说考试的操作过程。具体工作流程如下:1.2.3 模块结构 模块组成结构如下图所示:

东北大学计算机考研复试英语口语常见问题

随着研究生报名人数的逐年增加,研究生复试一般改为差额复试,考生复试的成绩如何直接影响到其是否被录取。研究生复试一般分为专业课复试与英语复试,而英语复试主要是口语测试。由于从2005年起研究生入学考试英语笔试部分取消了听力,因此,研究生复试中除了传统的口语测试外,很多学校增加了听力部分。这里我们特别邀请了中央财经大学多年的博士生、硕士生与MBA英语复试考官冯玉红和温剑波老师,为大家介绍一下研究生英语复试的备考。 随着研究生报名人数的逐年增加,研究生复试一般改为差额复试,考生复试的成绩如何直接影响到其是否被录取。研究生复试一般分为专业课复试与英语复试,而英语复试主要是口语测试。由于从2005年起研究生入学考试英语笔试部分取消了听力,因此,研究生复试中除了传统的口语测试外,很多学校增加了听力部分。这里我们特别邀请了中央财经大学多年的博士生、硕士生与MBA英语复试考官冯玉红和温剑波老师,为大家介绍一下研究生英语复试的备考。 一般性备考:总结常见热门话题 英语口试备考:考前提前了解考试形式 专业备考:不必担心专业词汇太少 听力备考:不建议听英语考试的听力材料 口试评分标准:分项打分与整体打分 无论参加哪种形式的口语考试,说一口流利、准确的英语都是通过考试的关键所在。因此,语言的基本功与长期的口语素材积累至关重要。一般性备考可以分为下面几个部分: 1..应试材料的准备:为了准备口语考试,可以准备一些材料,如

《英语中级口语教程》、《四、六级英语口语应试》等。当然如果确定参加哪种英语口试,又了解其口语考试的形式与内容,选择针对其考试的口语材料更为有效,如雅思口语、托福口语等。 2. 制定复习计划:根据备考时间与所要参加的口试类型制定复习计划。可以每天准备一个话题,话题的内容最好是热门话题或常考话题。常见口语话题总结如下:Laid-off worker's problem、Reforms of housing policy 、Going abroad 、Globalization 、Information age、Environmental protection and economic development 、Online learning 、2008 Olympic, Beijing、Economic crisis 。热点话题在报纸、杂志上大多可以找到,也是很多考试写作部分常出的题目,因此也可以参照考研或四、六级作文范文。但切忌全篇背诵所找到的材料,最好只借用其中某些素材,然后用自己的语言重新整理。 3. 熟悉考场情况与考试流程 (1)与小组组员的交流(二对二考试模式) 小组成员可先模拟一下考试过程。让自己进入状态,而后可谈一些其他话题,放松一下。 (2)进入考场 入室前要敲门,虽是小节,但关系到你给考官的第一印象。 衣着得体,落落大方。 向考官问候:Good morning/ afternoon. 如果可以,微笑,但绝不可勉强。 (3)自我介绍 要求简洁、有新意,能够让考官记住你。最重要的是,发音要准,不要太快,以别人听懂为目的。但注意一定要听考官的指示语,听到考

计算机英语口语对话实用表达

计算机英语口语对话实用表达 导读:我根据大家的需要整理了一份关于《计算机英语口语对话实用表达》的内容,具体内容:想要学好计算机英语需要大家掌握一些常用的计算英语口语,下面我为你带来计算机英语口语对话表达,供大家备考学习!计算机英语口语对话(一)A:Computers are ... 想要学好计算机英语需要大家掌握一些常用的计算英语口语,下面我为你带来计算机英语口语对话表达,供大家备考学习! 计算机英语口语对话(一) A:Computers are really spreading quickly, I just found the web site of the high school Iattended. 电脑发展得可真快。最近我发现了以前念的那所高中的网站。 、 B:Lots of schools have their own web sites. 很多学校都有自己的网站了。 A:Thats true, but when I was in high school, we just had a few computers, and now it looks likethe whole school is computerized. 是啊,以前念高中时学校只有寥寥几台电脑,现在好象整个学校都电脑化了。 计算机英语口语对话(二) A: So, tell me again what is this new job youre taking? 再告诉我一次,你现在的新工作是什么?

B:Ill be doing web design. · 我在做网页设计。 A:Web design?That sounds like work for a spider? 网页设计?听起来好象在替蜘蛛工作。 B:Im talking about designing pages for the World Wide Web; the Internet.我说的是替国际网络万维网设计网页。 计算机英语口语对话(三) A:Why does a company need a web site? 为何公司需要网站? ~ B:Not all companies need a web site, but it can be very helful in lots of ways. 不是每家公司都需要网站,不过在很多方面倒是很有帮助的。 For instance , many people search the web when they are looking for a place to buy something. 譬如说,有很多人想买东西时就会上网搜索, and if your company has a good web site ,you are much more likely to get that customersbusiness. 如果你的公司有个不错的网站,生意就很可能做起来了。 计算机英语口语对话(四) A:I dont understand why this E-mail keeps getting returned to me. …

计算机辅助大学英语口语测试研究

计算机辅助大学英语口语测试研究 科学技术的发展为测试走向现代化提供了物质基础,尤其是多媒体、计算机和网络技术的迅速发展,使计算机或基于网络的考试进入一个实际应用的阶段。本文详细介绍了牡丹江医学院《大学英语》口语测试改革实践过程,探讨机考对英语教学的正面反拨作用,为其他院校开展大规模英语口语测试,提供了一定的依据。 标签:计算机辅助;口语机考;大学英语 2004年教育部颁布的《课程要求》明确指出:“大学英语的教学目标是培养学生的英语综合应用能力,特别是听说能力,使他们在今后工作和社会交往中能用英语有效地进行口头和书面的信息交流,以适应我国社会发展和国际交流的需要。〔1〕”口语测试是外语语言测试的重要组成部分。科学技术的发展为测试走向现代化提供了物质基础,尤其是多媒体、计算机和网络技术的迅速发展,使计算机或基于网络的考试进入一个实际应用的阶段。如何利用计算机网络技术检测学生的实际口语水平,为高等院校口语教学提供更加科学、有效的测试方法,已成为英语界学者研究和探索的热点问题。所以从不同视角、采用不同方法积极地探索口语测试的有效方法,开辟新的途径是十分必要和紧迫的。 1.我校计算机辅助大学英语口语测试研究 1.1研究背景 2007年8月,教育部出台修订后的《大学英语课程教学要求》,要求“大学英语课程的设计应充分考虑听说能力培养的要求,并给予足够的学时和学分;应大量使用先进的信息技术,开发和建设各种基于计算机和网络的课程,为学生提供良好的语言学习环境与条件。〔2〕” 依据《课程要求》,顺应教学和新时代发展需要,我院从2014年开始对大学英语考试进行了较大规模的改革,取消英语中的听力考试,将其融入计算机辅助英语口语考试,实施机助英语考试方案,来考察和评价学生运用英语进行口语交际的能力。要求全体大一、大二学生参加考试,并且成绩记入期末英语考试总分。 为保证机考口语测试的顺利实施,我校加大教育投入,努力改善硬件设施,扩建了六个语音实验室,建立了共600多台电脑的大学英语自主学习中心;在软件应用方面,购买并安装了“外教社大学英语口语考试系统”。“外教社大学英语口语考试系统”是校园网环境下基于计算机的口语测试系统。 1.2题库建设 题库建设是实现计算机化考试最基础性的工作。题库不是简单地堆积、存放在计算机里的试题集。题库建设是服务于计算机化考试的拼题组卷,所以试题库

2021年电脑程序员职务英语面试口语

电脑程序员职务英语面试口语 关于电脑程序员职务英语面试口语900句 1.What kind of experience have you got for the job? 申请这项工作,你有什么工作经历? 2.I've been a data entry operator for more than two years. 我做数据输入操作员有两年了。 3.Why did you leave your job there? 你为什么要离开呢? 4.Well,I enjoy working in different places and meeting new people.That will widen my experience in the field of puter technology. 噢,我喜欢在不同的环境中与不同的人一起工作,这会在电脑技术领域扩大我的经历。

5.What kind of education have you got? 你受过什么教育? 6.I studied puter science in Havard University,and got a M.S.degree. 我曾在哈佛大学修电脑专业,获得了硕士学位。 7.I majored in puter science. 我主修电脑专业。 8.What specialized courses did you take? 你学过什么专业课程? 9.The specialized courses I pleted include puter science,system design and analysis,operation systems,systems management,PASCAL programming,COBOL programming and D-BASE programming.

全国英语等级考试计算机辅助高考口语考试练习软件文档

全国英语等级考试计算机辅助高考口语考试练习软件文档仅供参考,2014j英语口语考试,by wcl 模拟试题一 个人信息介绍:(机问人答) 1. A: What’s your name, please? B: My name is ______. 2. A: Where do you study? B. I study at NO.1 senior middle school. 3. A: What subjects do you study? B: I study Chinese, Math, English, Physics, Chemistry, Biology, PE and so on. 4. A.:What subject do you like best? B: As far as i am concerned ,i like English best. 场景1:安排旅行计划(机问人答) 旅行行程单 目的地:西藏 交通工具:飞机 出发日期:5月2日 所需费用:2000元左右 所需行李:衣服、药品、照相机等 1. A: Where do you plan to go? B: I pan to go to Tibet. 2. A: How do you go there ? B: I will go there by plane.

1 仅供参考,2014j英语口语考试,by wcl 3. A: When do you set off? nd B: I will set off on May 2. 4. A: What luggage do you need to take? B: I need to take some clothes,some medicine as well as a camera. 5. A: How much will the trip cost ? B: The trip will cost about 2000 RMB. 6. A: Which places have you been to already and where do you plan to go next? Why? B: I have been to Shanghai, Nanjing,Suzhou and so on. And i plan to go to Hainan next, for i love the sea so much. 7. A: How do you often go travelling by plane or by train? B: I often go travelling by train, as it is a cheap way to travel. 8. A: Do you think it is a good time to travel during the Spring Festival? B: I don’t think so. After all ,there will be too many people during the Spring Festival. I don’t like the crowds and noises. 场景2:去邮局寄包裹(人问机答) 包裹单 目的地: 包裹重量:

英语口语大全职场口语篇:计算机水平

英语口语大全职场口语篇:计算机水平 I know how to operate a computer. 我知道如何操作电脑。 I can type 100 words per minute. 我每分钟能打100字。 I'm learned in plane design. 我精通平面设计。 I have an NCRE certificate, Bank 2. 我有全国计算机等级考试二级证书。 I know Page Maker and Mircosoft Word. 我懂Page Maker排版软件和word. I'm experience in IBM, Compact and Great Wall computers.我熟悉IBM,康柏和长城电脑。 I have working knowledge of Windows and Dos. 我有 Windows 和 Dos的工作经验。 I have got MCSE certified. 我已经获得了微软系统工程师认证。 I can deal with the data base system. 我会处理数据库软件。 Actually, I'm quite familiar with Java and C Language.

事实上,我对Java和C 语言相当熟悉。A:Do you have any experiencde working with a computer? B:Yes.I have been a data entry operator for three years. A:What kind of software can you use? B:I have working knowledge of Windows and Dos.Actually, I'm quite familiar with both Java and C++ Programming Languages. A:Do you have any other computer qualifications? B:I have an NCRE certificate, Bank 2. A:Do you know how to use a PC to process the management information? B:I'm sorry to say I'm not familar with processing management information,but I'm sure I could learn quite quickly.It can't be too difficult, and I've got a quick mind. I can handle any problem you give me.

云南省高考英语口语测试介绍

省高考英语口语测试介绍 省高考英语口语测试采用全国英语等级考试(PETS)二级计算机辅助口语考试试题,下面我们介绍一下PETS第二级考试计算机辅助口语考试。 1)概述 PETS第二级考试计算机辅助口语考试时间约为12分钟,满分为5分。口试中计算机播放的指导语为英语。 2)容与结构 口试分为三节,测试考生的英语口语交际能力。考试时间约为12分钟。 口试采取计算机测试的形式。 第一节:考查考生初次见面时向他人提供个人的事实性信息(如、学校、职业、家庭等)的能力。该节约需2分钟。 第二节:考查考生根据动画容,询问具体事情,回答有关具体事情的询问的能力。该节约需6分钟 第三节:就第二节谈论的话题进行继续性问答,考查考察考生回答具体问题;阐述个人观点的能力。该节约需4分钟 口试结构如下表所示:

3)口试步骤 口试考试前,考生输入号,进入测试系统进行试音。

口试考试后,进入第一节,考生回答屏幕上口试教师提出的有关考生个人情况的几个问题。该节时间约为2分钟。 第二节包括两段动画,一段动画考生就动画容提问,明回答;另一段动画明提问,考生回答。该节时间约为6分钟。 第三节和第二节穿插进行,即考生完成第二节第一段动画的话题后,口试教师出现,询问有关这个话题的继续性问题;考生完成第二节第二段动画的话题后,口试教师再询问有关这个话题的继续性问题。该节时间约为4分钟。 4)PETS2级计算机辅助口语过程模拟(见光盘) (1)考试正式开始,计算机播放动画。办公室门打开,镜头推进,口试教师坐在桌子后面,微笑道:Hello. Welcome to PETS-2 speaking test. My name is Wang Jing. Nice to meet you. (2)口试教师向考生提问:“What’s your name, please?”考生听到“嘟”的一声后回答(回答问题时间5秒)。然后口试教师继续提问下列问题(每个问题考生有7秒的回答时间): (for students) l Where do you study? l What subjects do you study? l What subject do you like best? (for those who are not students)

【雅思口语900句】话题14计算机

【雅思口语900句】话题14:计算机 Our life is made more convenient because of the invention of computers. 我们的生活因为电脑的出现而更加方便。 Computer provides people with different sorts of entertainment,such as listening to music and watching films. 电脑给人们提供了不同的娱乐方式,如听音乐和看电影。 It is said that radiation of the computer screen is harmful to our health. 据说电脑屏幕的辐射对我们的健康有害。 Many young people indulge themselves in surfing on the Internet and neglect their studies. 许多年轻人沉迷于上网(网上沖浪)而忽视了他们的学习。 Pregnant women should not sit in front of a computer for too long. 怀孕的妇女不能在电脑前坐过长的时间。 I'm a computer novice. 我是菜鸟(电脑新手)。 For me, computer is a means of study and entertainment. 对我来说. 电脑是学习和娱乐的一种方式。 Computer viruses can cause a lot of damage. 电脑病毒能够带来许多危害。 Many young people are obsessed with playing computer games and neglect their studies. 许多年轻人沉迷于电脑游戏而忽视学习。 Computer can be a two-edged sword. 电脑是一把双刃剑。 Computer is a problem while it brings convenience to people. 电脑给人们带来方便的同时也帶来问题。 Computer has received more and more social attention from all walks of life. 电脑得到了社会各个阶层越来越多的关注。

计算机辅助高考英语口语测试研究

龙源期刊网 https://www.sodocs.net/doc/0e9484268.html, 计算机辅助高考英语口语测试研究 作者:符存 来源:《读与写·中旬刊》2019年第11期 摘要:计算机辅助高考英语口语考试是英语高考口语考试的改革趋势,能较好地体现真实性和交际性,提升口语考试的成效。本文从题型设计原则、考试题型、评分过程和需要注意的问题四个方面论述了计算机辅助高考英语口语考试的实施,为高考英语口语考试改革提供了参考和借鉴。 关键词:计算机;英语口语;测试研究 中图分类号:G648文献标识码:B;;;;文章编号:1672-1578(2019)32-0009-02 目前,高考英语口语考试有直接口试和间接口试两种形式。在直接口试中,考官与考生面对面直接交流,问答交替进行。这种考试形式的优点在于考官和考生之间不仅有话语交流,而且还有表情和肢体交流,真实性较高。缺点在于考官之间的语言表达差异以及对考生的引导方式会直接影响考生口语表达水平,公正性较低,且费时费力,不适合大规模的口语考试。在间接口试中,考生根据计算机屏幕上的文字或语音提示完成交际任务,所有的语言信息将存储在硬盘或光盘上供评分之用。这种考试形式的优点在于可以实现在同一时间对大批量的考生用同一套题进行测试,效率高(高丙梁,2007);这种考试形式还可以避免考官个人差异给考生带来的不同影响,且在考试完成后,组织人员对录音进行交叉评价,避免了考官的个人因素对成绩的干扰,公正性较高。缺点在于间接口试不具备真实的交际特征,一些学者称之为“伪交际”和“伪测试”(金檀、刘力、郭凯,2016)。 虽然对计算机辅助高考口语考试有一些質疑,但是该考试形式的优点毋庸置疑。笔者前期设计了高校学生对高考英语口试看法问卷调查表和高中学生对高考英语口试看法问卷调查表,并对长江师范学院的2014级100名本科生进行了调查。这些本科生中有外国语学院、教育学院、数统学院、物理学院、文学院等不同院系,且来自不同的省市,如重庆、湖北、广西、新疆、江苏、浙江等。经历过计算机辅助高考英语口试的学生普遍认为考试题型合理,能检测到口语能力的高低。而经历过传统直接口试的学生普遍认为口试内容简单,没有体现交际性,检测不出口语能力的高低。 此外,为了解高中生对口语测试的态度,笔者还选取了重庆市铁路中学的一个高三班和新疆克拉玛依十三中学的一个高三班共120名学生进行了调查。在调查两所高中的学生如果要参加高考英语口语测试期待的考试形式时,有30.6%的学生希望是直接与考官对话,60.5%的学生希望是计算机辅助的人机对话,另外有8.9%的学生希望是录音机录音的半直接口试。

相关主题