Research On The Implementation Process Of National Basic Public Health Services Project

Objective:Basic public health service is one of the important contents and components of the new round of deepening medical and health system reform in China in 2009.Over the past decade and more,the content and quality of the service projects have been gradually enriched,and the health conditions of the residents have been improved.While the basic public health service project has produced a series of results,it has also encountered some problems in the implementation process,such as the imperfect management method of subsidy funds and the unbalanced allocation of health resources and so on.In order to better understand the implementation of basic public health service project,analyze the existing problems,and put forward targeted suggestions for the optimization of service provision.Methods:Based on the Horn-Meter system model,this study analyzes and explores the implementation of service projects from six aspects:policy objectives and standards,policy resource allocation,implementation mode,characteristics of implementation agencies,system environment and value orientation of implementers.The main research methods of this study are:(1)Literature research:Through searching Wanfang,CNKI,VIP,PubMed and other Chinese and English databases as well as China Health Statistics Yearbook,collected relevant research and data on the implementation of service projects,in order to understand the implementation of service projects.(2)Questionnaires and interviews:From November to December 2019,Zhejiang Province,Shanxi Province and Chongqing City were selected by target sampling,in the three provinces and cities,two municipal districts were selected as the survey area,convenient sampling is conducted according to the list of community health service centers/township health centers provided by each urban area,total of 53 primary medical and health institutions were selected.A total of 7,746 questionnaires were collected,including 7,193 for residents and 553 for basic public health service practitioners.At the same time,semi-structured interviews were conducted with managers of 53 institutions according to the interview outline.The quantitative data were analyzed by spss25.0,and the descriptive analysis mainly used constituent ratio,awareness rate and satisfaction rate,The qualitative interview materials are sorted and refined by using nvivo11.0 as the analysis tool,and the original words of the interview information are used as the reference description.(3)Case study method:describe the practice of service projects in Shanghai and Xiamen,and analyze the practical experience of the region.Results:According to the theoretical model,the service project implementation and the existing problems are analyzed and found:First,policy objectives and standards:the service aims at improving the health level of residents and promoting the equalization of projects,in order to achieve the goal,the specific standards are formulated,including:service provision standard,assessment standard and health management service rate of each sub project.Second,policy resources:resource allocation to guarantee the implementation of the project has been strengthened,grassroots health technicians have been increasing,the government’s financial subsidy input to the project has been increasing year by year,supporting policies and regulations have been gradually implemented,and the ability to apply information technology has also been continuously improved.Third,the implementation mode:the organization and management mode of service items is generally the three-level mode of the state,province,city,district and county;The appraisal method is three-level performance appraisal;The service provision mode is mainly for residents to establish health files and other sub projects;The residents’ feedback on services showed that the respondents’ awareness and satisfaction with the project were 85.90%and 93.94%.The general population and the elderly were slightly less satisfied with the project than other groups.Fourth,the characteristics of implementing agencies:The implementing agencies of service projects mainly include professional guidance from professional public health institutions to provide service technology and direct service from grassroots medical and health institutions.The number of these two types of institutions keeps increasing,but the educational background and professional technical titles of grassroots health technicians are generally low.Fifth,system environment:good political,economic and social environment promotes the effective implementation of the project.Sixth,the value orientation of practitioners:on the whole,the staff of primary medical and health institutions have a positive attitude towards basic public health service projects.Through the analysis of the implementation of the project,it is concluded that there are mainly the following problems in the provision of service projects:there is deviation between the project content and the objective setting and the actual situation;Supporting resources need to be further improved,and the growth of service projects cannot meet the increase of costs;The service delivery mode is relatively simple,and the residents do not have a deep understanding of the service items.The service capacity of primary medical and health institutions is relatively weak and the informatization level is insufficient.Grassroots health workers have low educational background and low professional title,and their service ability needs to be improved.Through the analysis of the practice of basic public health services in Shanghai and Xiamen,the main signing by using the family doctor service system to promote the basic public health services to provide,at the same time,relying on the information construction to promote the integration of medical and public health,the future optimization services provided by promoting medical proof fusion quality will become the focus.Conclusion:In the past decade,the level of basic public health service has been improving continuously.The quantity and content of services,the number of institutions and personnel of services have been steadily improving.However,there are still some problems in the implementation of service projects,such as deviation between the project setting and the actual situation,the inability of subsidy funds to cover the cost,the fixed service supply mode,the insufficient capacity of institutions and personnel.In this regard,targeted suggestions are put forward:first,improve the top-level design of the project,and clarify the access mechanism of service projects;The second is to increase financial investment and implement supporting policies,such as fund management and performance appraisal;Explore innovative service mode to promote the integration of medicine and prevention;Finally,on the basis of strengthening information construction,efforts should be made to improve the service ability of primary medical and health institutions and primary health personnel.