Study On The Status Of Rural Basic Public Health Service In The County Of Hunan Province

Objective To investigate and analyze the status of rural basic public health service in the county of Hunan province, and to explore the difficulties and the insufficiency of rural basic public health services, and puts forward to the corresponding countermeasures, so as to provide policy advice and reference for the government to further promoting the basic public health services. This study has a dramatically practical significance to promoting equalization of basic public health services projects and improving the population health level.Methods We get the data about rural basic public health services project implementation from the county health bureau, which contains relevant policy documents, funds collection and distribution, organizational management program, service organizations and personnel, Chinese rose annual report, annual appraisal, annual summary report, etc. We also interviews key characters at the in-situ panel, to access basic public health services implementation(difficulties and problems, suggestions for further advance), at the same time we use sampling survey, randomly sample five towns from 23 towns of the county, and then we randomly selected 30 incumbency people in each category from the health record of a certain township health center, and check the documents, interview service object by telephone, evaluate the quality and authenticity of basic public health services implementation according to the request of the national basic public health service specification.Results 1. The rural basic public health services project implementation organization network and institutional framework has been basically formed in the county, however, the project funds do not meet the national requirements, and do not have enough understanding of the importance of basic public health services, attache great importance to the treatment, with contempt for the prevention, grassroots health service staff team construction is lag, the personnel quality is poor, the business level is not high; It is short for professional and full-time personnel quantity, workload is heavy, salary is low, responsibility is not strong, the funds needed in some place cannot reach in time, all kinds of levels of subsidy funds cannot meet the needs of existing services, basic public health service information system cannot communicate with other health information systems. 2. The project is advancing at a quick speed, among the 11 basic public health service projects, the implementation of the residents’ health records management, immunization service, and the elderly health management is better. The rates of health management of 0 to 6 years old children, maternal, hypertension and diabetes and patients with severe mental illness are high. However, the proportion meets the specification requirements is low, services become a mere formality, and the quality is not high. By 2014, the residents by inputting rate was 79.6%, the key crowd by inputting rate was 84.7%, archives update rate was 68.8%; Immunization rate was 98.4%; The elderly physical examination rate was 98.9% in 2013, the physical examination rate was 35.3% in 2014,the examination table records are complete, and received at least one health management service. The rates of health management of 0 to 6 years old children and maternal are higher, while the service times is far from the specification requirements, and the proportion meets the specification requirements is low. In 2014 newborns supervision rate was 93.2%, the management rate of 0 to 6 years children was 90.1%, pregnancy building volume rate was 92.5%, prenatal service rate was 93.3%, postpartum visit rate was 75.3%, during the pregnancy the maternal who received above 5 times follow-up service rate is 0.0%; Both the health management rate of Hypertension and diabetes in 2013 are around 77.5%, but in 2014, the rates became down to the level of 2012(45.0%), and more follow-up of patients was lost, in 2014 the control rates of blood pressure of patients with high blood pressure and blood sugar of diabetes are about 50%;The specification management of patients with severe mental illness was 64.7%, the illness stability rate was 73.3%.The characteristic Chinese medicine service is good, by 2014,the traditional Chinese medicine maintenance rate of 0 to 3 years old children was 74.2%, and the total physical identification of traditional Chinese medicine treatment was 92.4%. Health education is develop better in the county and township, while the form is single, which lack of personalized health education, village clinics is unconditional to carry out health education. The sampling survey results of five villages showed that the management rates of 11 projects was about the same with its report data, while the service times did not reach the requirements of the specification, the health consciousness of rural residents was poor. The related information report rate of infectious diseases, public health emergencies and health supervision and assist were 100%, while lack of public health emergencies contingency plans, major infectious diseases of emergency disposal plan and training and drills. 3. The county has a relatively perfect performance appraisal system for basic public health service project to implement, every half year for an assessment, 20% of the funds will be allocated for the balance payment according to the two assessment results, rural doctors’ subsidies is distributed by township health center for their performance appraisal after completing the task proportion labor remuneration, while there are still some problems in the specific implementation process, mainly reflected in the appraisal formalization, reward and punishment of performance appraisal is not appropriate, giving and gain of primary health services staff are not proportional, and so on.Conclusion 1. The organization network about rural basic public health services project implementation in the county has formed, safeguard mechanism and management measures of funds are increasingly perfect, the project has been fully advanced,while still present some problems, such as the funds of service project is inadequacy, the service project expenses is lag, uneven distribution, project service funds were bundled to the related county level administrative work expenses. 2. The county’s information system construction of the basic public health service is lagged, can not be docking with other health information systems, information resources can’t be shared, the utilization rate of electronic health records is low, grassroots health service personnel cannot effectively use the residents’ health records information system to carry out the basic public health services. 3. Basic public health services project has been rolled out. However, the basic health services personnel own poor quality, lack service ability and service level, and their service quality need to improve. 4. This county has reasonable performance appraisal mechanism, while there are some imperfect situations, such as the appraisal formalization, reward and punishment of performance appraisal is not appropriate. 5. Suggestions: ①Strengthen coordination and cooperation across organization, and play a role of the various departments adequately. ② Broaden the financing channels, and carry out the service funds. ③ Complete the basic public health services information system gradually, exchange health information with other systems. ④ Improve the health education and publicity to increase residents’ health awareness; ⑤ Strengthen the construction of grassroots health service ability. ⑥ Perfect performance appraisal and strengthen the application of performance appraisal results.