| ObjectiveThrough comparison of MCH training between prefectures with program and those without programs, to evaluate the effectiveness of nine health programs, knowing about status of mastering key knowledge in terms of obstetrics/maternal health care, pediatrics/children health care as well as the status of conducting MCH service using knowledge and techniques acquired from training.MethodsUsing questionnaire, qualitative interview, on-the-spot archive checking, on-the-spot examination, thoroughly evaluated the training effect from four levels: response, study, behavior and result. Compared the evaluation of trainees from regions with program and without program towards examination of MCH service key knowledge, overall improvement of MCH service ability as well as the training itself. Meanwhile, knew the feedback of the service objects regarding MCH service.ResultsFrom 1999 to 2006, in the program-conducting regions, the programs bore all training related expenses including transportation, board and lodging, etc. The payment and usage of the training funding were conducted stringently according to requirements of the World Bank. In line with the requirements of the central government, respective provinces conducted short-term trainings, long-term trainings, overseas trainings and technical aids, etc. The above activities already completed accounted for 172.7%, 121.1%, 99.2%, and 97.4% of the planned respectively.Among various training courses in program-conducting counties, MCH management, information statistics, health education, comprehensive women & children health care knowledge made up 6.00%,13.00%,12.00% and 69.00% respectively. While in control counties, the corresponding percentages are 0.00%,21.05%,5.26% and 73.68% respectively ((P=0.532) . In program-conducting counties (cities) the distribution proportions of various inputs are 36.95% for city level and 63.04% for county level, in control counties, the corresponding proportions are 5.26% and 94.75%(P=0.000). In program-conducting counties, the trainees included administrators, financial staff and MCH staff, while in non-program-conducting regions, MCH staff made up the majority of trainees.The result of the MCH service core knowledge examination for the trainees showed: in the examination of obstetrics/maternal health care comprehensive knowledge, core knowledge and technique during delivery, the score of county-level trainees from program-conducting regions was higher than non -program- conducting regions(P=0.036,P=0.003). While in the examination of obstetrics/maternal health care comprehensive knowledge(P=0.000,P=0.002,P=0.004), core knowledge and technique during delivery, pregnancy, infant health care, at the country level, the same thing occurred(P=0.063).As for health care service for women and children with knowledge and technique learnt from training, the program-conducting countries had higher ratio in making kidney function checkups and correctly using delivery flow chart than control countries(P=0.037,P=0.037). In terms of escorting pregnant and lying-in women for diagnostics shift, identification of critical children diseases and conveyance, children nutrition monitoring, children inchoate development propaganda, the program-conducting village performed better than the control villages(P=0.031,P=0.031,P=0.013, P=0.000). In program-conducting counties, the total number of critical pregnant and lying-in women treated in 2006 increased 2.8 folds in comparison with 1999, while during the same period, there was only a 0.83 times increase in control counties.As regards the evaluation from trainees and those units where they were from towards the training, in program-conducting counties, among county-level ,country-level, village-level trainees, 70.21% of them thought the training effect was very good with appreciable improved knowledge and technique; 25.53% felt it was comparatively good with moderate improvement of knowledge and technique: 4.24% of them believed it was mediocre without any improvement of knowledge and technique. In the control counties, the percentages were 20.00%, 73.33%, 6.67% respectively(P=0.001).Evaluation from service objects about the improvement of women&children health care service after training: in program-conducting counties, 90% interviewees thought the medical treatment condition of country-level hospitals and village-level infirmaries were much better than before, and the other 10% thought there had some improvement, and no one believes that there was no change (P =0.000) . Otherwise, control counties fell into the scale of 50%, 40% and 10%. As regards the attitude of medical staff towards patient, 80%, 10%, 10% fell into the scale of good, common, bad respectively in program-conducting counties. And to control counties the data about attitude of medical staff towards patient are 75%, 15% and 10%(P=0.829). With regard to the medical technology level of country-level hospitals and village-level infirmaries, in program-conducting counties, 80% thought there was a manifest improvement, 20% held these was a relatively improvement, and 0.00% had no definite idea. And to control counties the data about medical technology level are 30%, 50% and 20% (P =0.000) .Improvement in health of target group: in program-conducting regions, the mortality rate of pregnant and lying-in women decreased from 103.2/100,000 in 1999 to 56.7/100,000 in 2006, witnessing a 45.1% decline. The mortality rates of children under 5, infants, new-borns decreased from 34.8‰, 27.4‰, and 17.6‰in 1999 to 18.5‰, 14.7‰, 10.4‰in 2006, dropping 46.8%, 46.3% and 40.9% respectively. The above values declined with a higher extent compared with rural areas in China. The delivery rate in hospital of pregnant and lying-in women increased more than rural areas of China, rising from 48.5% in 1999 to 81.0% in 2006, a 67.0% increase.. Conclusion and SuggestionProgram-conducting counties achieved better training effect in terms of response, study, behavior, result than control counties. The program-conducting regions held short-term training, long-term training, overseas training, technical aid according to the requirement of the document and reached the training target completely. At the response level, the program-conducting counties had a better overall assessment of the trainee toward training in comparison with control counties. At the study level, the trainees achieved better scores in examination of core knowledge, mastery of comprehensive knowledge about obstetrics/maternal health care. At the level of behavior, the overall MCH service level increased. At the result level, the department in charge and the service objects gave a positive evaluation regarding the after-training change of service technique. The mortality rate of pregnant and lying-in women as well as children under 5 decreased in target groups. It is suggested that we should pay more attention to and strengthen the evaluation of training, establish a set of scientific evaluation system, attach importance to the change from training intensity to training practical technique and conduct phasic and long-term evaluations timely in accordance with plan.
|
PDF Full Text Request