Study On The Status Of Basic Public Health Service Project In Three Counties Of Gansu Province

Public health is science and art, which prevents diseases, prolongs human lives and promotes population health through organized community efforts, including improving environmental sanitation, control of communicable diseases, education of attention to personal hygiene, providing services for the early diagnosis and preventive treatment of disease by health care organizations, as well as the establishment of social institutions to ensure that every resident in the community can reach to healthy standard of living. In2009, the CPC Central Committee and the State Council issued "views on deepening medical and health system reforms" and clearly proposed that promoting equal access to basic public health services through the implementation of the national basic public health services and major public health service projects across the country.The national basic public health services is important content of implementing medical and health system reforms and promoting equal access to basic public health services, in addition to a significant part of public health system construction. This study analyzes the basic public health services projects status and performance assessment in the three counties of Gansu, and discovers difficulties and shortcomings, which has a dramatically practical significance to promoting equalization of basic public health services projects in Gansu Province for sustainable development, improving sanitary condition and the health of population, so as to provide policy advice and reference for the government to further promoting the basic public health services.According to an embodiment of basic public health services project, the level of economic development and cultural differences among cities and counties in Gansu Province, this study selects County Kangle, County Huining and the region Liangzhou as samples, and surveys34institutions including the county Health Department, disease prevention and control agencies, MCH, township health centers (community health centers), village health stations(community health service stations). Data analysis methods in this study:(1)Mean, ratio and proportions are used for descriptive analysis of quantitative data (2) Nvivo8.0is utilized to qualitative data analysis:code, organization, summarizing and analysis on interviews of different levels and staffs, and analysis of basic public health services organization and implementation, financial management, the status of implementation and performance evaluation, etc.(3) Analysis equity in health service staff of different types utilizing the Lorenz curves and Gini coefficient, with the survey of serving population of primary health service agencies in2012as the base.The main results of this study:(1)The basic public health services project implementation network and institutional framework has been formed in each sample counties (districts), nevertheless, as the project boosted too fast and the workload, there are some false reports of implementation of the project.Within12basic public health services projects, vaccination services and prevention and treatment of infectious diseases, as traditional project of basic public health services, in which implementation is better, while the emergent public health event reporting and handling, supervision and co-management of health conditions are relatively weak. Through qualitative data analysis, basic health services staff suggest that workload, short of staff, lack of service ability are main factors to impact the basic public health services implementation. In addition, rural residents’poorer health consciousness restricts project implementation.(2) The configuration of doctors and nurses in11primary health service agencies investigated is fair, while the special public health workers and medical technicians are extremely unfair. With the population of the agencies In2012as a base, calculate the Gini coefficient of various health service population and the result is 0.26,0.22,0.47,0.59respectively. Gini coefficients of doctors and nurses are less than0.3, the configuration is more fair, But Gini coefficients of the special public health population and medical technicians are more than0.4, which have exceeded the warning line, professional titles of Workers in primary health care agencies are mainly primary, accounting for53.4%, only0.7%is senior title, and intermediate titles account for14.0%,28.3%is non-professional title. Educations of health service workers are mainly tertiary education, accounting for58.4%, bachelor degree or above account for16.2%,22.9%is secondary school. Ages of workers are mainly25to34years old, which is accounting for43.4%, followed by35to44yearsold and accounte for28.0%.(3) Each sample counties has established a comprehensive performance appraisal system, which promotes the basic public health services projects smoothly. However, there are still some problems in the specific process, mainly in the appraisal formalization, reward and punishment of performance appraisal is not appropriate, giving and gain of primary health services staff are not proportional. This is contrary to the original intention of basic public health services performance appraisal to a certain extent, and restricting the successful development and implementation of the project.Suggestions:(1) strengthen coordination and cooperation across organization, and play a role of the various departments adequately;(2) explore the novel financing mechanism to implement the county-district level funding;(3) complete the basic public health services information system gradually;(4) improve the health education and publicity to increase residents’ health awareness;(5)strengthen primary health service staff ability building with a number of measures simultaneously;(6) establish a sound performance appraisal mechanism to promote projects efficiently and sustainably.