| BackgroundAt the end of 2002.the outbreak of Severe Acute Respiratory Syndromes(SARS)has had a serious impact on our national health,economic development,social stability,and national security.This reflects the weakness of China's public health system and service capacity of the Center for Disease Control and Prevention(CDC).In order to change this situation,in 2003,premier Wen Jiabao pointed out in the;"National conference on SARS prevention and treatment"that China would strive to establish and improve the disease prevention and control system in about three years.In response to the call of the state,the CDC at all levels in Shandong province have been established since 2003.After more than a decade of construction.a disease prevention and control system covering both urban and rural areas with constantly improved functions has been basically set up.In this process,the level of service capacity construction of the CDC,the main body of the system,needs to be evaluated scientifically and reasonably to provide a strong reference for the agency itself and relevant departments to make accurate decisions in the next step.ObjectiveThis study comprehensively investigate the CDC service capability of Shandong province through field survey.Meanwhile,a scientific method is used to construct the index system of service capacity evaluation,which is taken as a tool to comprehensively evaluate the sample organization,explore and analyze the reasons and key problems affecting the improvement of service capacity,and put forward corresponding policy suggestions,so as to provide theoretical and evidence-based basis for the further improvement of service capacity of the CDC.MethodsThis study mainly collects data through questionnaire survey and semi-structured interview.Multistage stratified random sampling is adopted in to questionnaire survey,namely select 1-2 municipal CDC for each region according to the geography distribution in eastern,central and western Shandong province,choose 3 county-level CDC for each region according to economic development level of good,medium,and bad,totally 5 municipal and 15 county-level CDC are used as the investigation sites.Information is collected from the human,material and financial resources as well as the services provided by the self-designed questionnaire on the basic situation of the above institutions.At the same time,1 director and 2-3 heads of department are interviewed for each institution,64 people in total.Interview content:discuss the current institutional staffing,financial situation,laboratory construction,function display,path to achieve the integration of medical care and prevention,obstacles to the current development of the institutions and other issues.Descriptive analysis is conducted on the human,material and financial resources of institutions at all levels by using indicators such as relative number,composition ratio and rate,and the chi-square test is applied to the corresponding enumeration data.Delphi method and analytic hierarchy process(AHP)are used to construct the comprehensive evaluation index system of service capacity,determine the corresponding indicators' weight,and calculate the comprehensive score based on the actual indicators completion degree.On this basis,the percentile method was used to classify the service capacity according to the comprehensive score.At the same time,the weighted TOPSIS method,weighted rank sum ratio(WRSR)method and cluster analysis method were used to verify the ranking and grading of service capacity.The service capacity ranking and classification of the institutions calculated by the three methods are compared comprehensively.One-way ANOVA is used to compare whether there are statistically significant differences in scores,performance completion degree and comprehensive scores of each dimension of service ability in agencies which are classified by municipal and county level,by geographical location(east,middle and west)and economic development level(developed,relatively developed and less developed).Results(1)Delphi method and AHP are used to construct the comprehensive evaluation indicator system of the service capability of Shandong province's CDC,including 8first-level indicators,18 second-level indicators and 31 third-level indicators.The positive coefficient of experts participating in the consultation is 95.24%,the authority coefficient is 0.859.and the coordination coefficients of the first,second and third-level indicators were 0.212,0.182 and 0.118,respectively.Cronbach s a coefficient = 0.895.KMO coefficient = 0.883,Bartlett spherical test chi-square value?82.265(P<0.05),indicating that the index system has good reliability and validity,which can be used in the field study.(2)Taking the score of disease prevention and control capability X1,emergency management capability X2,information management capability X3,health hazard factors monitoring and control capability X4,laboratory test analysis and evaluation capability X5,health education and health promotion capability X6,technical guidance and application research capability X7,institution comprehensive guarantee capability Xs of municipal and county-level CDC is used as the independent variable,the comprehensive score of service capability as the dependent variable Y,the comprehensive evaluation model of the service capacity of the CDC is established with the weight of each indicator determined by the AHP:Y=0.2934X1?0.2236X2 +0.1218X3,+0.0587X4 +0.0699X5 +0.1022X6 +0.0472X7+0.0832X8.(3)Among the scores of each dimension of service ability,the scores of disease prevention and control ability and emergency management ability were higher,while the scores of technical guidance and applied research ability,health hazard factor monitoring and control ability were lower.There was a significant positive correlation between comprehensive score,performance completion and economic development level.The correlation coefficients were 0.6641(P=0.0014),0.4627(P=0.0399)and 0.5883(P=0.0064),respectively.The difference of performance completion degree in different division was statistically significant.And.the difference of comprehensive score between different service levels and geographical location distribution had statistical significance.Conclusions and SuggestionsThe comprehensive evaluation index system of the service capability of CDC is well organized,with reasonable weight setting and good reliability and validity.Using this tool to evaluate the service capacity of the sample institutions can truly reflect their service level,and find out the shortcomings that limit the improvement of service capacity,providing reference for the institutions themselves and relevant departments to strengthen the service capacity building of the CDC.At present,there is still a gap between the implementation of human,material and financial resources of Shandong province'sCDC and the national requirements.The level of service capacity is greatly affected by the level of geographical distribution.It is hoped that relevant departments will strengthen support and subsidies for the central and western regions.The comprehensive support capacity of the institution is mainly limited by the level of regional economic development,it is hoped that the financial department can timely and fully implement the allocation in accordance with the budget of the institution,and the government can implement the staffing of the institution as soon as possible according to relevant standards.The institution itself should also strengthen education and training of existing personnel and introduce high-quality talents;strengthen cooperation and exchanges with higher authorities,universities and other scientific research institutions to broaden horizons;strengthen the standardized operation and management according to all kinds of standard,make promotion plan in view of the weakness,promote steadily and scientifically.In a word,the service capacity construction of the CDC is a systematic project,which needs the attention and efforts of all parties,the participation of the whole society,and the most important thing is that the government should pay more attention to it and put it into concrete actions. |
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