The Appraisal Of Execution Of Basic Public Health Service Projects Of Six Counties In Hunan Province

Objectives:By appraising the execution of the basic public medical service projects of the six counties in Hunan Province, to thoroughly investigate the execution of the basic public medical service projects of the six counties, to analyze the existing problems and their factors of influence, and to propose policy counteractions accordingly.Methods:By means of two-phase random sampling, the research sampled six counties of three prefectures as the research specimens, and by simple random sampling the research took twelve primary-level medical institutes of the six counties at the locus in quo assessment specimens. The specific research methods are as follows:①Through the way of being looked over data means, interviewed and so on, we could get the message of the information about the organization build of the basic Public Health Services item, the way of the provided service of basic medical service items, the human resources conditions of the Public Health and the compensating of the item funds and so on.②We could evaluate the progression of the item and task by checking out the data means and interviewed and listen to relevant people’s views and recommendations.③Site survey and evaluation were carried out by distributing questionnaires. For the site evaluations of health records quality questionnaires, health records of various people from twelve primary-level medical institutes were sampled to evaluate the health records quality; for the basic Public Health Services, we could evaluate the Quality of Service of the items by the questionnaires at the locus in quo.Results:1. All the counties have established leading groups of the basic Public Health Services in which the group leaders were acted by Vice County Mayors; the primary-level medical institutes all have established public health offices to be in charge of Public Health Services; the village clinics also have done something to help in the work organized by the primary-level medical institutes; the six counties have established the structure of three-level service projects in which the county governments were the liability subjects in charge of organizing the execution, the primary-level medical institutes acted as the actual providers of project services, and the village clinics functioned as the basis the project.2. For the primary-level population, of ten thousand people, there are1.8medical staff in10,000service population, among whom the specialty ratio of public health, medical treatment, nursing and others is13:59:17:11, the professional title ratio between intermediate level and primary level is18:82, with none above the intermediate level, and the ratio of graduates with educational background of colleges, junior colleges, technical secondary schools and below is12:47:41. 3. Based on the relationship between the project services by primary-level medical institutes and basic medical services, the service models could be divided into three types:independence, integration, and assistance.4. The six counties have all established leading groups of the basic Public Health Services in which the group leaders were acted by Vice County Mayors the three-level funding system spanning from the province to prefectures then to counties, with a proportion from15%to34%in the level of the prefecture and the county; An initial stage of fund subsidy mechanism has been established while the provincial performance appraisal awaits enhancing; Matching fund not in place and fund precipitation exist in the six counties in2011; The quotient of the project fund subsidy for target population is5RMB per capita, accounting for20%of the project fund.5. In2011, all the six counties have overfulfilled the designated quantitative tasks of the relevant sections of the national medical reform; The average score for the health archives in the primary-level medical institutes is7.50(the full score is10), while differences in scores occur between different regions, projects, types of primary-level medical institutes and service models.6. Questionnaire interviewed120people, of whom73people are aware of public health service projects. The awareness of the residents is 60.83%. The principal access of their awareness is "receiving project services themselves and family members receiving project services". The degree of satisfaction is85.29%.Conclusions:1. The six counties all have established three-level structure of project service spanning from county to town to village, in which the county and city government serves as subject of liability,the primary-level medical institutes mainly provide services and the village clinics play the role of service network.2.There is a shortage of public health human resources teams. There are only1.8medical staff in10,000service population. Among them, only13%people major in basic public health service projects,82%people are elementary academic or have no titles and88%people are college degree and below. Based on the relationship between the project services by primary-level medical institutes and basic medical services, the service models could be divided into three types:independence, integration, and assistance.3. The service models of primary-level medical institutes could be divided into three types:independence, integration, and assistance.4.Preliminarily raising money can be done through provincial and municipal and county level. Project fund managing mechanism urgently awaits further enhancement. 5. There exist a low overall quality level and imbalance in the public health service health projects. Differences exist between different regions, between urban and rural areas, between different projects and service providing models.6. The awareness of the residents is60.83%. The principal access of their awareness is "receiving project services themselves and family members receiving project services". The degree of satisfaction is85.29%.Publicity of basic public health service projects awaits further improving.