Study On The Development Status And Countermeasures Of County-level Maternal And Child Health Institutions In Zhejiang Province Under The Background Of County Medical Alliance

Objective:The study was aimed to investigate the development status of county-level maternal and child health(MCH)institutions before and after county medical alliance in typical regions of Zhejiang Province.We also analyzed the impacts of county-level medical alliance construction on MCH through the theoretical and empirical research.The experience and problems of different development models integrating to the medical alliance were summarized.We put forward some policy and strategic suggestions for promoting the development of county-level MCH institutions under the county medical alliance.Contents:The development status of county-level MCH institutions which participating in the county medical alliance by different ways were researched.The impacts of the county medical alliance construction on the resource dependence and the current situation of the county-level MCH institutions were analyzed.Policy and strategic suggestions to promote the development of county-level MCH institutions were proposed.Methods:The relevant theories and methods that can be applied to the analysis of the development status of county-level MCH institutions and the impacts of the county medical alliance construction were sorted out and summarized through literature research.The research was based on the site survey in Dongyang City,Tongxiang City,Yuyao City and Deqing County of Zhejiang Province.Qualitative and quantitative data were collected for the construction of county-level medical community,the development status of county-level MCH institutions and interaction relationship between them.The comparative analysis method was used to conduct descriptive statistics on the data of the development status.Combined with the subject framework method and resource dependence theory,the specific impacts of the county medical alliance on MCH were analyzed.Results:1.The four county-level MCH institutions were differed in their own development and approaches of integrating into the medical community.In terms of development characteristics,Maternal and Child Health Hospitals of Dongyang City and Tongxiang City had both clinical and health care services.The MCH hospital of Dongyang City was featured by Chinese medicine service for many years.While the Tongxiang City’s concentrated regional MCH service resources from 2018.Deqing County Maternal and Child Health Center was engaged in public health services;Yuyao City Maternal and Child Health Center was merged with the general hospital in 2019 and transformed into the MCH hospital.In terms of integration into the medical alliance,Dongyang,Yuyao and Tongxiang MCH institutions were members of the medical alliance in the role of a head unit or one member.In addition,four MCH institutions joined MCH health or public health guidance teams of the medical alliance.But the Maternal and Child Health Hospital of Deqing County had not been included in the county medical community so far.The power of the MCH Hospital of Tongxiang City in the guidance team was weak.2.The resource dependence relationship was reflected in the competition of customer resources between the county-level MCH institutions and the medical alliance.There was a symbiotic dependence relationship between the medical alliance and MCH institutions in the MCH management resources.On the customer resources,there was mainly highly competitive dependence relationship between Dongyang City MCH Hospital and other head units of the medical community.Tongxiang City and Deqing County Maternal and Child Health Hospital mainly built up a low competitive dependence relationship with medical alliance.Yuyao City MCH institution transformed from a low competition to a high competition.In terms of MCH management resources,the symbiotic dependency relationship between the Dongyang Maternal and Child Health Hospital and the units of the medical community showed more obvious consistency.But the consistency of that in the remaining three institutions was weak.3.There were obvious differences in the development status and key influencing factors of the service and management levels of MCH institutions.Based on the development trend of resource elements analysis,Tongxiang Maternal and Child Health Hospital had better resource conditions,Deqing County Maternal and Child Health Hospital had the weakest health resources;Tongxiang Maternal and Child Health Hospital had the best medical resource outcome at the service level;Dongyang City Maternal and Child Health centers had the strongest competitive advantage in management.Based on analysis of relationship among resource elements,the policies in the maternal and child health resources integration and county medical alliance played an important role in the development of service class resources of county-level MCH institutions.Moreover,the functions of policies in special integration were stronger than that of medical community.Technical resources and its derived relationship resources were more helpful for the organization to achieve management functions.The policies for MCH guidance teams also had some auxiliary effects to implement the management functions.Conclusion:The prerequisites such as the social-economic conditions,the MCH level,the policies and its directions of the county medical alliance were similar in the four regions.But their MCH institutions were different in competitive environment,development process and integration into the medical alliance.There existed some development problems under the background of medical community,such as weakened service base and limited guidance as well as management functions.At the same time,there were golden opportunities for the participation in the medical community or integration of measures to consolidate the foundation of some service groups and improve talent and technical competitiveness.Under the background of the county medical alliance,local governments were insufficient in improving the regional MCH service capabilities,valuing MCH institutions and clearly positioning the role of their work.County-level MCH institutions need strengthen or optimize service and management functions,and enhancing core competitiveness.Suggestions:On the one hand,the government should ensure the coordinated development between county-level MCH institutions and medical alliance according to the former’s actual situation.Secondly,appropriate resources and policy preferences should be given to the MCH to promote sustainable development of the MCH institution.Thirdly,the mechanism of unified guidance and management should be established for MCH to maintain long-term and stable development of primary maternal and child health care network.On the other hand,county-level MCH institutions should be clear about the function orientation and promote health care closely combined with clinical practice.In the meanwhile,actively cross-regional collaboration with foreign countries should be on the agenda to enhance the institutions’core competitiveness in talents and technologies.