Study On The Performance Evaluation Index System Of Public Health In Rural Areas

In the background of building a well-off society in an all-round way ,especially in the process of building a new socialist countryside, the performance of rural public health system has a direct bearing on the utilization of public health services, and influences the health state and safety standards of the majority of rural residents. Long period of time, because the huge gaps between urban and rural areas in economic and social development, the performance of rural public health was restricted. In recent years, accompanied by the establishment of the scientific concept of development, and the start of the new medical reform plan,the basic status of public health in the medical and health system status has been confirmed and the promotion of the equalization of basic public health services has been identified as the key part of the new health reform plan in the near future.How to ensure the new investment of policies and funds to achieve the desired effects, and promote the performance of public health in rural areas,is becoming the urgent and key issues in the construction of enhanced rural public health system.The study of performance evaluation of public health in rural areas,is not only an important basis to understand and master the operation of rural public health system, but also the inevitable choice to promote the performance management of public health and realize the justice and effectiveness of public health expenditure.This paper is divided into six sections.First of all,based on the trend of public health policy research , the theories of public services performance and health systems performance assessment are summarized.And then,through drawing on a wide range of public sector performance evaluation framework and the experiences of the public health performance evaluation at home and abroad, this paper bulid up the evaluation framework of public health performance in rural areas,mainly rely on the"conceptual model of performance about public health in rural areas",which has been established in the preliminary studies of our project team. On the basis of the evaluation framework, the third section carry out the experts survey through Delphi methods,and construct the performance evaluation index system of public health in rural areas. At the same time, the weights and criteria values of each indicator are determined.What's more, the specific methods of compehensive evaluation are exploed. Next, in the fourth section, the datas are collected through the site investigation,and the reliability and validity of the index system are verified, as well as the comprehensive evaluation of the performance in sample countries are calculated. Part V, in accordance with the results of the site application, combined with feedback from public health practitioners, the content and methods of the evaluation system are modified, and the main lessons and deficiencies learned in the study are summarized. Part VI, combined with the evaluation results of the performance in the investigation,the main performance problems are discussed and the strategies of continuous improvement of the performance of public health in rural areas are proposed.This paper's major findings include:1. It is proposed that the evaluation framework of public health system performance in rural areas, including the rural public health inputs, outputs, results in three dimensions. Input refers to the sum of public resources which are required in the the rural public health activities,under a certain institutional environmental and technology conditions. Output is the qualities and quantities of the public health services through the fulfillments of the public health functions.The result refers to the completion of objcets in public health work and also include the impacts on human health and social development.2. It is constructed that the performance evaluation index system of public health in rural areas.The design of index system should insist on the principles as follows: forward-looking, object-oriented, comprehensive, representative and operational. Through two rounds of expert consultation a index system including 3 first-level indicators, 9 second-level indicators, 35 third-level indicators are determined. The weights of indicators are determined through Delphi method.Combined with the development plans of national public health and the results of consulting experts,the evaluation criteria values of the indicators are determined.The relative ratio method for evaluating the results of standardized treatment, and the linear weighted sum method are explored as the evaluation method of comprehensive performance.3. The index system has good content validity, and the internal reliability are considerable.Through the process of expert advisory and review, the content validity ratio (CVR=0.80) of the index system, reflects the content validity is high. Using the Cronbach coefficient method, the overall system reliability(α= 0.6756),means that the internal consistency are acceptable.4.The performance evaluation results of public health in sample sites show conclusions as follows:First,in the rural areas being investigated,the input performance of public health are generally low. There is a tendency that focusing on material input and hardware construction, but neglcting the allocation and treatments of public health human resources .Secondly, performance in terms of output, demonstrate that the output levels of different public health projects are uneven. There are some public health functions,for example,immunization program, maternal and child health, environmental protection,show a better state of performance.But the performance of other public health functions such as health surveillance, health education are very poor. In addition, the results of the performance of rural public health system depends not only on the operation of functions and outputs, but also influenced by other social sectors,producing positive or negative health outcomes. Comprehensive performance evaluation results show that in sample areas, the public health performance can hardly reach the best state in all dimension:inputs, outputs, results at the same time.In this paper, the continuous improvement recommendations of public health performance in rural public health include:1.To improve the public health inputs mechanism in rural areas. In addition to the total resources of rural public health need to continue strengthening,but also a reasonable adjustment in the level and structure of the inputs are needed.Through the adjustment of the funding responsibility and transfer payments,improving the input abilities in grass-roots areas as keypoint,establish a fairly rural public health input mechanism,to achieve the rational allocation of public health resources in different areas and levels.2. To coordinate the provision of basic public health programs. In the process of determination and implementation of basic public health services, we need both concern the direct benefits of public health services and long-term effects.On the basis of maintain the performance of traditional functions such as immune programme, maternal and child health services, we should pay more attention to other functions such as health education, health upervision, and so on.It is important to promote the coordinated development of the basic public health services.3. To strengthen the collaboration both within and outside the public health system. In the process of policy formulation and implementation about public health, the notion "all policies for health "should be put into practice. The coordination and cooperation between departments will lead to realize the full share of social resources, and reduce the potential negative health consequences to maximize which are producing by other departments.So that,the whole society will work together to enhance the health outcomes of public health.4. To improve the performance management. This research find that the differences in efficiency of input-output reflect the state of performance management.It is suggested that according to the reality of rural areas,introduce fairly and scientific instruments for performance evaluation,and focus on the health outcomes of regionwide.What's more,it is necessary to utilize the performance information effectively,and improve the incentive mechanism.Inadequacies of this research:1.In the content of the index system,the mainly problem is that some indicators encountered certain difficulties in data collection.There is a big gap between the actual situation and the expectation.In future research, improvements can be developed in the following ways:to set up the indicators that can be displaced;to modify the connotation of indicators dynamicly;to promote the data collection methods.2. About the research methodology of the index system, there are several points to improve. The weighting coefficient are determined only through subjective expert advice and a simple treatment of mathematical statistics.In the further study,it is necessary to explore an integrated approach of subjective and objective to determine the weights of indicators. The method used for standardization of the evaluation values is linear non-dimensional method.The defects of this method is that the results of processed values show a larger variation.So,it is needed to explore more appropriate methods of the indicator standardization.