| ObjectiveThis research presented the developing status of maternal and child healthcare (MCH) institutions in Gansu province by analyzing the database of resource allocation, service supporting and operation of MCH institutions. In order to provide the information support for the standardization construction of MCH institutions and the scientific strategy of the health administration department at different levels, this paper constructed comprehensive evaluation index system and evaluated the MCH institutions at three levels of Gansu province.Methods1. Based on the data collected from "National Management Information Web-based Reporting System of Women and Children Health Facilities", health resources and performance of MCH institutions in Gansu province from2007to2010were investigated, which included five aspects on the basic status of MCH institutions, resource allocation, service supplying and scientific research and to make comparison for the changing trend of major monitoring index.2. The comprehensive evaluation on the resources and operation of Gansu provincial MCH institutions①To filter evaluation index and set up the comprehensive evaluation index system in seven areas, which included scale of MCH institutions, resource allocation, healthcare qualification, healthcare work efficiency, public hygienic responsibility, economic efficiency and development potential by using Subjective Evaluation Analysis (SEA), Discrete Trend Analysis (DTA), Correlation Coefficient Analysis (CCA), Principal Component Analysis (PCA) and Factor analysis (FA), and Cluster analysis (CA).②To make a comprehensive evaluation for both the municipal level and the county level of MCH institutions with or without bed by the analytic hierarchy process method (AHP), technique for order preference by similarity to ideal solution method (TOPSIS), rank sum ration method (RSR), comprehensive index method.③The combination made for the comprehensive evaluation result of all level MCH institutions with the method of Mean Value method, Borda method and Copeland method and the comprehensive evaluation should be tested beforehand and afterward by adopting KENDALL consistent coefficient test and SPEARMAN rank relation coefficient test.Results1. The circumstances on the resource and operation of MCH institutions in Gansu province.①Basic situation:The study surveyed totally100MCH institutions, among which93%with full funding and75%have provided for hospitalization service.②Resource allocation:There was a shortage of manpower for three level institutions on provincial, municipal and county district, regarding existing employees there were health professionals dominated which was accounted for83.10%, medical practitioner and assistant medical practitioner accounted for79.96%of health professionals, college degree and below accounted for74.98%.The total asset was346.239million and debt was26.277million. The average asset for municipal institution was4.918million, among of which the institution with liabilities was accounted for78.57%. The average asset for the county district was3.269million and the institution with liabilities was accounted for71.76%. The medical devices estimated to be worth more than ten thousand were1142units,25units and9units for the three levels institution of provincial, municipal, county district, the average area of the operating room was13258m2,3352.3m2and1200m2respectively. The number of beds of three levels maternal and healthcare organization on provincial, municipal and county district supporting hospitalization service was300units,37units and20units respectively.③Service support: The annual emergency patient in three levels of provincial, municipal and county maternal and child healthcare was for340.40thousand persons,15.7thousand persons and10.5thousand persons and the average numbers of hospital discharge was19.343persons,322persons and485persons respectively, the rate for caesarean birth was39.23%,25.22%and13.21%, the utilization rate of hospital bed was128.95%,62.27%and51.32%. All levels institutions carried out health care job which included setting up pregnant and prenatal care management regulations, emergency network for pregnancy and prenatal women, birth defects report system establishment, annual work schedule for scattered children and the establishment of life monitoring work regulations for the children under5years old.④Operation circumstance:The average annual turnover for provincial, municipal and county districts was0.2248651billion,4.181million and2.956million. The annual cost was for0.194089billion,4.1805million and2.59million, among of which52%institutions got profit and48%got the balance of payments.⑤Scientific researching:Provincial institution published an average of133papers and12project researches and the cost for annual scientific research was3.9252million. There were4papers and1paper for municipal and county districts.⑥The situations on the resource allocation, service supporting and operation were getting better and getting between2006and2010from the datasheet of Gansu provincial MCH institutions.2. The comprehensive evaluation on the resource and operation of Gansu provincial MCH institutions.①This research had set up the comprehensive evaluation index system for seven size municipal and county level district on a scale, resource allocation, health care qualification, health care work quality, health care work efficiency, public healthcare responsibility and development potential.②The comprehensive evaluation result showed some difference between methods. It was considered the consistency of the integrative evaluation for all level institutions with Spearman rank correlation coefficient.③The consequence of combination evaluation showed Mean Value Method, Borda Method and Copeland Method were closely associated with the original evaluation method.④The comprehensive evaluation result of resource and operational circumstance in Gansu provincial MCH institutions showed leading institutions distributed in the center area of a good economic foundation, in which the resource allocation, service support and operation were in the leading position. The institutions in the eastern area were in the second tier and showed good developing trend, but there were still short in resource and service optimization. The areas of ethnic minorities and periphery area for resource allocation and service support and operation were always at a disadvantage. The evaluation result was more close to the real situation of Gansu provincial MCH institutions. Conclusion1. It was unreasonable to the human resource configuration of MCH institutions at different levels in Gansu province. The infrastructure at grassroots MCH institutions was at a disadvantage position. Although the quality and quantity of service capabilities and public health function was better than before, part of MCH institutions was still in the lower level.2. It was imbalance that the scale and development model in different areas, different levels among MCH institutions. It requires to find the way of reasonable development model for the maternal and child healthcare organization of different areas or under different economic conditions.3. The established indicator system is effective, credible, objective and specific.4. The indicators have strong representative, highly sensitive and independent characteristics.5. In order for the stable and consistent sorted consequence of the comprehensive evaluation and to make an accurate judgment for the precision of combination evaluation, it required to make combination evaluation on the basis of various overall evaluation method and test beforehand and afterward.6. It was consistent between the result of the comprehensive evaluation of resource and operation of MCH institutions and the current situation of maternal and child healthcare in Gansu province.7. The results which were drawn by various assessment models are basically consistent. The general evaluation has achieved the lowest error and the most confident results. The assessment results have strong persuasion and consistent with the social appraisal. |
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