妇幼卫生项目评价的设计

为提高我国的人口素质和人群的健康水平,我国政府对公共卫生事业的投入增加,干预性卫生项目在各个层面相继开展,同时也有一些国际组织与我国政府合作开展了一系列的卫生项目活动,因此,如何设计出一个好的评价方案对项目的执行的效果进行正确的评价就显得尤为重要.本文将介绍在项目评价中常用的几种设计方法.     

关于卫生项目评价应用思考

围绕项目绩效开展项目监管工作,是实现项目目标以及卫生计生项目科学管理的重要举措。目前国际上使用较为广泛的诸多模型在国内使用时仍存在一定的局限性,本文基于国内开展卫生项目评价过程中存在的三个基本问题,结合国家卫计委项目监管中心工作实践,阐述了对卫生项目评价的理解,并根据卫生项目评价理论假设,提出了卫生项目复合评价模型逻辑框架的思考。同时强调卫生项目复合评价应正确理解使用评价要素基本概念,关注项目的效果,对项目实施影响因素进行客观和深入的分析。     

开展血防群众监理工作的调查评价

目的:评价群众监理在血防重点村综合治理卫生项目工作中的作用.方法:通过工作前后对比,评价其作用.结果:灭螺操作情况、灭螺前后控制人畜上滩情况、个人防护情况、"急感"防治等工作均有显著性差异,效果明显.结论:在血防重点村综合治理卫生项目工作中应大力推广血防群众监理制度.     

某燃气公司新建项目卫生学评价

为了解燃气行业存在的职业病危害因素和职业卫生现状,确定是否达到卫生学要求,按规范测定生产性有害因素浓度(强度).结果总体工程噪声单项指数Pi=0.52,综合卫生评价基本合格.应加强新建、改建、扩建项目预评价工作.     

定性研究及其在卫生项目评价中的应用

从定性研究的特点和方法入手,并结合具体的卫生项目评价实践,提出定性研究在卫生项目需求评价、过程评价、效果评价及实施效果影响因素分析方面具有很大的应用价值,是定量研究不能替代的。在卫生项目评价中应更加重视定性研究的应用,并将定性和定量两种方法结合使用。     

建设项目职业卫生预评价工作初探

<北京市职业病防治卫生监督条例>第13条第二款提出:"卫生行政部门必须参加建设项目的设计审查和工程验收,并根据国家<工业企业设计卫生标准>对建设项目进行项目卫生学预评价".也就是说,卫生行政部门在参加建设项目的设计审查和工程验收时,其审批的主要依据是建设项目的卫生学预评价报告.我们所开展的建设项目职业卫生预评价包括可行性研究阶段(或设计审查阶段)预评价(下简称预评价)和竣工验收阶段评价两部分.竣工验收阶段评价工作已开展多年,预评价工作刚刚起步.经过1998年的试运行阶段,1999年起北京市开展的预评价工作基本步入正轨.现就开展建设项目职业卫生预评价工作谈几点体会.     

大连市某废物处理厂扩建项目职业病危害预评价

目的 识别、评价扩建项目可能产生的职业病危害因素,为卫生行政部门审批该项目提供技术依据.方法 采用类比法、检查表法及经验法,对类比项目的职业病危害作业现场进行调查、采样和检测,并对该项目进行综合分析评价.结果 该建设项目的选址、总体布局、生产设备布局、厂房设计、职业病防护设计、卫生辅助用室设施等基本符合国家有关规定;该类比现场的24种毒物、2种粉尘、噪声和高温检测结果均符合国家标准.该扩建项目属职业病危害严重的建设项目.结论 该项目按类比项目采取的防护措施落实到位,并采纳了所提出的建议,生产过程中可能产生的职业病危害是可以预防的,综合分析评价该项目是可行的.     

某社区地震灾区过渡安置房建设项目卫生学预评价

目的 对某社区地震灾区过渡安置房建设项目规划、设计等进行卫生学预评价,使过渡性安置房的建设符合卫生相关的要求.方法 依照卫生学评价通则对建设项目进行卫生学调查,使用本抗震救灾卫生防疫工作队自制现场调查表通过现场调查、查看规划设计图纸,运用检查表法进行卫生学评价.结果 该安置区存在日后投入使用危害健康的因素包括两条明沟排污沟、朝向不合理可能导致特定气象条件下室内小气候恶化、公共卫生服务设施的细节规划尚不到位等问题.该项目在选址、总体平面布局、卫生设施、建筑卫生学等方面基本符合相关技术要求.结论 本项目在施工设计过程中,需进一步细化和优化方案,严格落实报告书中提出的各项卫生要求,同时在安置区投入使用后应加强卫生管理,将有关危害因素控制在国家卫生标准范围内,以保障地震灾区人民群众的健康.     

某公司40 MW发电机组建设项目职业病危害预评价

目的 识别、评价建设项目可能产生的职业病危害因素,为卫生行政部门审批该项目提供技术依据.方法 采用类比法和检查表法对项目中可能存在的职业病危害因素进行识别分析、定性和定量评价.结果 该项目<可行性研究报告>的选址、总体布局、生产工艺和设备布局、建筑物卫生学、职业病危害防护措施基本符合<工业企业设计卫生标准>等国家有关职业卫生标准的要求.个人使用的职业病防护用品、职业卫生管理、应急救援措施等方面需要进一步补充和完善.结论 经综合分析,该项目生产过程中产生的职业病危害是可以预防和控制的,从职业卫生角度分析该项目是可行的.     

大型辐照装置职业病危害放射防护预评价重点环节分析

目的 针对大型辐照装置职业病危害放射防护预评价重点环节进行分析,为以后做同类预评价工作提供借鉴。方法 以某大型辐照装置预评价为例,分别探讨安全装置设计评价、屏蔽设计验证计算、放射卫生管理评价三个方面内容。结果 该项目拟设置的安全装置全面,屏蔽设计合理,放射卫生管理措施符合相关标准要求。结论 大型辐照装置放射源活度大,在预评价中应尽量依照偏保守的原则进行评价,确保辐照装置安全运行。     

卫生项目评估的有关问题研究

本文介绍了卫生项目评估起源及发展情况,阐述了卫生项目评估的有关概念,包括卫生项目,卫生干预,项目费用支付分析,卫生项目评估,过程评估,产出评估等.这些卫生项目评估概念的讨论和明确对于卫生项目评估活动的进一步开展将是有益的.     

Evaluating community-based health professions education programs

This paper assumes the reader (1) has little knowledge about program evaluation, and (2) is interested in evaluation to improve a community-based health professions education program. There are other important and useful approaches that can be used to address an evaluation of a community-based health professions education program, and readers are encouraged to explore them--they appear in health education, public health education, in evaluation, and in program theory literature. The paper is organized around a group of questions as a reference or organizer for the reader. These include topics like why evaluation is wanted, what kinds of questions can be addressed through evaluation, who stakeholders are, who should conduct the evaluation, what methods can be used, and how to analyze data and report results from the evaluation. In the paper, I have attempted to include examples that are related to community-based health professions programs. Finally, the paper ends with the recognition that there is much more to learn in the field of evaluation and suggestions for ways to continue pursuit of knowledge in this topical area.     

卫生项目评价面临的机遇与挑战

卫生项目评价的核心功能就是为卫生资源配置提供信息与决策建议,以提高卫生资源的利用效率。近年来,我国卫生领域的新形势和新动向为卫生项目评价带来了重大的发展机遇,与此同时,卫生项目评价的理论与实践也有其需要克服的瓶颈。所以,有必要对我国卫生项目评价理论、方法与实践面临的机遇与挑战进行较深入的探讨。     

Performance Evaluation of Community Health Workers: Case Study in the Amazon of Peru

A shortage in human resources for health is a growing crisis that has led to an inability to provide adequate health services to impoverished populations. By “task-shifting”, health systems can delegate certain activities, such as health promotion and referral, to trained community members to help fill the human resource gap. An effective community health agent program can improve maternal and child health and overall effectiveness of rural health systems. Such a program is most effective when the community health agents receive supervision and evaluation of their performance. There is a shortage of literature that provides instruction and example on how to conduct a performance evaluation in the developing world to improve maternal and child health outcomes. The current study provides a case study of a performance evaluation in the Amazon region of Peru and how the findings can be used to make program adjustments. A set of instruments to measure the performance of CHWs was adapted from the literature and then implemented in the field. The instruments were used to measure the quality of home visits by the CHWs, their knowledge of the health topics, and structural activities. Three communities with an active CHW program in Loreto, Peru were chosen to receive the evaluation. All CHWs in the communities were evaluated. The scores from the evaluation were compared internally to identify strengths and weaknesses of the program and within the population of CHWs. The evaluation was completed on 52 home visits and 27 CHWs in three communities. The CHWs were found to be most effective at creating good relationships with caregivers and delivering health messages, and least effective at interacting with the child during the home visit and using material to deliver health messages. The evaluation instruments were well suited for the CHW program that utilizes home visits to teach about child health and development.     

New approach in the evaluation of a fitness program at a worksite

The most common methods for the economic evaluation of a fitness program at a worksite are cost-effectiveness, cost-benefit, and cost-utility analyses. In this study, we applied a basic microeconomic theory, "neoclassical firm's problems," as the new approach for it. The optimal number of physical-exercise classes that constitute the core of the fitness program are determined using the cubic health production function. The optimal number is defined as the number that maximizes the profit of the program. The optimal number corresponding to any willingness-to-pay amount of the participants for the effectiveness of the program is presented using a graph. For example, if the willingness-to-pay is $800, the optimal number of classes is 23. Our method can be applied to the evaluation of any health care program if the health production function can be estimated.     

Using Evaluation Techniques To Select Health Education Programs

Health educators often are faced with the job of selecting a new program to meet particular objectives. When one or more options is available, the selection process may involve the application of rather sophisticated evaluation skills whether or not the health educator is aware of the fact. By consciously applying evaluation techniques, health educators can increase the likelihood that a new program will meet their needs. The article provides guidelines for choosing an effective program by posing questions that normally are raised at the end of a program during the summative evaluation but are equally relevant at its beginning during the program selection stage. Seeking the answers to these questions before a program is implemented can contribute much toward ensuring the desired outcomes will be achieved.     

Local public health performance measurement: implementation strategies and lessons learned from aligning program evaluation indicators with the 10 essential public health services.

This case study summarizes the development and implementation of the evaluation framework, preliminary data results, and lessons learned for overcoming barriers and challenges. The framework development was based on best practices in evaluation and the Public Health Essential Services. Results were as follows: (1) implemented a department-wide framework for program evaluation; (2) developed and implemented 34 program evaluation plans; (3) collected data on 52 indicators across 492 measurable objectives; and (4) identified challenges and recommendations to improve evaluation processes. Although the importance of program evaluation is recognized in public health, program evaluation models do not take into account the variety of goals inherent in the diversity of public health programming. The case study presented provides guidance and lessons learned for the evaluation of public health practice in local governments.     

Objective evaluation and prediction of client improvement in mental health aftercare.

External funding sources and review boards appropriately are mandating more objective, clear-cut demonstrations of mental health program effectiveness. Mental health adult aftercare programs, traditionally characterized by globally-defined, imprecise goal and outcome measurement, can be objectively, empirically evaluated. The current paper illustrates how structured ratings and observations can be used feasibly to yield quantified "hard data" on client improvement and program effectiveness. The paper also presents the results of a program evaluation research study which indicate that while psychosocial history variables predict initial client appearance in aftercare, program participation-involvement behavior (and not psychosocial history) predict client improvement. Implications of these finds and the need for objective approaches to aftercare program evaluation are discussed.     

Ethical review of health promotion program evaluation proposals

Some policies state that program evaluation falls within the domain of administrative research that does not require review by an ethics review board. We propose that some health promotion program evaluations include at least one element of research and can be distinguished from quality assurance. Although American and Canadian evaluation societies provide important guidelines and standards for evaluation practitioners, processes for accountability to the public are provided by research ethics boards. The field of health promotion is, by its nature, replete with challenges to existing research ethics boards. Given the dearth of published literature on the ethics of health promotion evaluation or practice, the field could benefit from the open debate that reviews of proposals would encourage.