Research On Evaluating Performance Of Township Health Center

ObjectivesThe objectives of this thesis lie in finding the differences among 7case TH-Cs which are comparable in external environment and health resource and the trend of some THCs between 2000 and 2004 in some special dimension through comparing the key , representative, attainable indicators, combined with the information from field survey and interview with stakeholders, and giving advice to improve the performance of THC so as to promote the utilization of rural residence in THC service.MethodsField survey: the basic data mainly comes from field surveys including surveys on economic, society, population of the counties , towns and the staff, infrastructure, finance, workload, capacity and quality information of the sample THCs, and also the questionnaire on the satisfaction degree of staff with the director of the THC and the patients with the THC.Deep interview: the points of view about the differences among THC mainly come from the deep interview with different stakeholders including officials from Health Department of Guangxi, vice county director in charge of health cause, director and financial staff of sample health bureau, vice township director in charge of health cause, director and financial staff of sample THCs and other relevant stakeholders.Sample survey: the data about evaluating the quality of THC comes from the sample survey from THCs on the 200 copies of outpatient prescriptions andinpatient medical records in 2004.Literature review: it adopts literature review when setting dimensions and choosing indicators.ResultsAccording to the World Bank routine, The thesis sets four dimensions for the performance of THC which are technical efficiency I x allocative efficiency x quality and equity. Technical efficiency mainly measures the economic benefit of THCs, allocative efficiency mainly measures social benefit, quality measures the capacity of service delivery and equity measures whether the service is accessible to rural residents. Meanwhile according the WHO, satisfaction degree/responsiveness is a new tendency to evaluate the performance of health section, so we add satisfaction degree/responsiveness as another dimension. This dimension measures the degree of satisfaction about staff to leaders and patients to the THCs.Based on the requirement and 39 indicators in the < management criteria for comprehensive hospitals at levels > issued by Ministry of Health, combined with the trend of evaluating performance and the points of different stakeholders, according to the principles of specific N measurable N attainable xrealistic and time-bound, we choose the follow key performance indicators.In the dimension of technical efficiency, there are sickbed occupancy N number of outpatient per day per health technicians and number of inpatient per year per health technicians;in the dimension of allocative efficiency, there are two indicators which are number of staff for preventive health care per 10 thousand rural residents and the proportion of health technician;in the dimension of quality , there are using rate of antibiotics ? using rate of hormone and positive proportion of ultro - B test;in the dimension of'responsiveness/satisfaction degree, there are satisfaction degree of medical staff to the leaders and the satisfaction degree of patients to THC.Using the data from survey we make statistical analysis for 7 case THC of each indicator and find the main difference. According to the deep interview andfield survey we analyze the main reasons for the difference.ConclusionsAccording to the performance and difference of indicators among THCs, we find there is a trend that the THCs attach much importance to medical service but less importance to preventive health care and also much importance to economic profit while less importance to social profit. This phenomenon is closely related to the reduction of government subsidy. THC is now mainly depending on the market to support the development and cant afford the public health function with little subsidy. At the same time, the THCs which are running well are heading for building themselves into hospitals in stead of THCs, that is also an inevitable trade off for THC with an principle of " the survival of the fittest" .Nevertheless, with similar government subsidy, different THCs also have different performances. We find the government regulation also plays an important role. With less force of government in terms of finance, it can manage the THC by controlling the appointing and removing the director of THC.Furthermore, the ability of the director of THC also plays important role in improving the performance of THC.Therefore increase the input from government especially on the preventive health care, strengthen the professional management and appointing capable director are key methods to improve the performance of THC.