| I Background"The CPE Central Committees and State Councils Suggestion on Deepen Medical Health System Reform" was issued in 2009. It explicitly declared to develop the basic public health service project. Since 2009, our country has put forward unified basic public health services for urban and rural residents step by step, such as disease control and prevention, maternal and child healthcare, health education and so on, and worked hard to intervene on health problems of urban and rural residents to reduce major health risks and to improve the accessibility of public health service for all residents, for narrowing the gap between urban and rural, different regional, and different population, to ensure the equity. Also the council issued many other relevant supporting policies, including guidance on performance appraisal, subsidy funds managing measures and formulated the basic public health service norm. Shanghai established relevant policies according with the actual situation of Shanghai on the basis of the documents of the country.The current researches about basic public health service project were mainly focused on:the background and connotation of basic public health service project, the current situation, the existing problems, and financial transfer payment of capital, compensation and performance appraisal measures, there were few integrated study about the implementation process and the effect of the project.In 2011, the migrant population accounted for 44.3% of the total population of Shanghai, and the proportion of migrant pregnant women was even higher, but the healthcare management situation of the migrant maternal and children is worrisome. According to research review, the rate of establishing child healthcare card of migrant children was between 60%～80%, and it’s about 15% lower than that of local children.The implementation of the national basic public health services plays a major role in improving maternal and child health and equity. Most of the current studies focused on the current situation of maternal and child health care utilization, the problems, cost estimates, and few comprehensive studies concerned about the specific implementation process and the effect of basic maternal and child health service. From September 1th,2012, Xuhui district of Shanghai began to implement the Free Basic Child Healthcare Service Policy, so we try to understanding implementation process and the existing problems of the basic maternal and child health services project, to analysis and explore the effect of the Free Basic Child Healthcare Service Policy, and provide some suggestions for strengthening the policy implementation and improving the policy effect.Ⅱ ObjectivesThis research aims to understand the implementation process of the basic maternal and child healthcare service policy of Xuhui district, and to evaluate the effect of the the Basic Maternal and Child Healthcare Service Policy in improving services utilization, and to make suggestions for further improving the related policies.Ⅲ MethodsQualitative and quantitative research methods were used in this study.For qualitative study, we used policy review, document analysis combined with qualitative interviews, according to the principle of information saturation. We conducted individual in-depth interviews respectively with policy makers, project managers, service providers and the clients. The content mainly involved the relevant supporting policies for basic maternal and child health service in district-level, including the policy formation process, the specific content and expected effect, policy management situation (policy propaganda, regulatory supervision, funds management and performance appraisal), and the existing problems.For quantitative research, we used twice cross-sectional retrospective survey among clients. The questionnaire included basic demographic characteristics, awareness about the basic public health services and the free basic child healthcare policy, the basic maternal and child health services utilization situation of infants and their mother, and their satisfaction for service, etc.Ⅳ Results1. The Free Basic Maternal Healthcare Service had not been introduced in Xuhui Distrct. Because it was hard to identify the maternal birth insurance information; The basic child healthcare free policy was implemented from September 1th,2012. The lack of the major stakeholders (doctors at the community level and clients) in the policy making process induced the inconsistency of implementation among different community health service centers in the early stage, such as who would recive the free survice and how many times could they recive service for free. The basic public healthcare service policy and the free child healthcare policy were not fully propagandized. There was no enthusiasm to dissaminant the free policy for community health service providers.55.9% of clients known the free basic child healthcare policy, mainly from their doctors and cashers of the community health service center, and only 6.6% were from the propaganda of community. At the same time, the weak maternal health service consciousness, the incomplete information system, and the lack of health promotion can affect the use of basic maternal and child healthcare services.2. Before the implementation of the basic maternal and child healthcare service policy, all basic service utilization indexes of local objects were higher than that of migrant objects. For example, the systematic maternal healthcare rate of local objects was 68.2%, higher than 35.2% of migrant objects; more than four times physical examination rate within one year-old was 95.7% for local children, and only 72.8% for migrant objects.3. After the implementation of the basic maternal and child healthcare service policy, all basic service utilization indexes of local objects were still much higher than that of migrant objects. For example, the systematic maternal healthcare rate of local objects was 64.5%, higher than 39.5% of migrant objects; more than four times physical examination rate within one year-old was 97.0% for local children, and only 84.0% for migrant objects.4. For the maternal healthcare utilization indicators, only the more than nine times of prenatal care rate has statistically significant difference between two surveies before and after the implementation of the basic maternal and child healthcare service policy, and it was higher after the policy implementation. For the child healthcare utilization indicators, most of indicators had significantly risen up after the policy implementation, such as examination rate in 4-6 month-old rose from 93.0% to 96.2%, examination rate in 7-9 month-old rose from 83.6% to 93.3%, examination rate in 10-12 month-old rose from 92.6% to 97.7%; systematic examination rate within 9 month-old rose from 75.9% to 84.3%, systematic examination rate within 12 month-old rose from 72.7% to 82.5%. The examination rates among migrant child rose much higher than lacol child. After balancing other possible confundings by logistic regression analysis, the Free Basic Child Healthcare Service Policy had significant effect in improving the systematic examination rate within 6,9 and 12 month-old, and the OR value was 2.753 for the systematic examination rate within 12 month-old.5. Compared with the satisfaction of prenatal care, postnatal visit postnatal examination and child immunization before the implementation of the Free Basic Child Healthcare Service Policy, the satisfaction level after policy implementation didn’t obviously change. But for that of child health examination, it rose from 45.5% to 54.0%, increased by 18.7%, and the satisfaction score increased from 26.61 to 27.33 with a full-mark of 30, and the difference was statistically significant between the two surveies.V Conclusion and RecommendationThe Free Basic Child Healthcare Service Policy is effective in improving child healthcare service utilization and the satisfaction during the examination of mothers. In order to further improve the policy effect of basic public health services, we need to intensify policy propaganda, and improve residents’ healthcare consciousness. At the same time, the improvement of the performance salary system and labor remuneration of health workers at community level is necessary. |
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