我国农村卫生队伍建设存在的问题及对策

<正>卫生人力资源是卫生资源中最基本、最活跃的要素,是发展卫生事业的决定性资源[1]。农村卫生人力资源是有中国特色的提供农村初级卫生保健服务的主导力量,其直接影响着农村卫生服务的可及性和公平性,关系我国农村卫生事业的可持续发展。目前,我国进行的新型农村合作医疗制度建设需要强大的卫生人才队伍,以保障广大农民的健康。因此,建立具有较高专业素质的农村卫生队伍具有重要的现实意义,加强农村卫生队伍建设已刻不容缓。     

信息化对农村卫生人力资源开发的影响

信息技术的飞速发展为农村卫生人力资源开发提供了新的机遇,也带来一定程度的挑战.主要表现是:信息化可以加速优质卫生教育资源的传播,加快卫生人力资源的培养;可以加速卫生人力资源的合理流动,为农村吸引卫生人才创造了良好的基础;有利于农村与城市地区共享人力资源;推动农村卫生人力资源管理的变革,降低了管理成本,提高管理效益;信息化也可能加速农村卫生人才的流失,加大了留人难度;信息化给农村卫生人力资源管理带来巨大挑战.     

山西省农村卫生资源配置及其公平性分析

卫生资源的合理配置将使其取得尽可能大的社会和经济效益。本研究通过统计描述和Gini系数分析说明山西省卫生资源的配置状况：政府农村卫生投入不足；农村卫生人力资源的素质较差、结构不合理；卫生资源按人口和地理配置，仅基本处于相对公平的状态。据此得出，调整和完善农村卫生经济政策，进一步改善农村卫生投资状况，实施卫生资源规划，合理配置农村卫生资源，提高卫生人员素质，调整人力资源结构是农村卫生工作应当考虑的重要内容。     

北京市农村卫生人力资源现状分析

提升卫生人力素质,建立具有一定专业水平的农村卫生服务队伍,是农村卫生服务体系建设与发展规划的目标之一[1].经过多年的建设,北京市农村三级服务体系已初步建立.     

运城市农村卫生资源配置现状及对策研究

目的: 了解运城市农村卫生资源配置现状,为合理规划和配置农村卫生资源提供参考依据.方法: 用普查和抽样调查的方法对县、乡、村各级医疗机构基本情况进行调查,并对部分医务人员、卫生行政人员和村民进行深入访谈.结果: 各级卫生机构功能定位不清,卫生资源配置结构不合理,卫生人力资源素质低,床位资源利用率低,卫生经费投入不足.结论: 健全农村社区卫生服务网络,大力发展适合农村卫生服务的全科医生培养,强化农村卫生服务保障制度.     

医学教育和农村卫生人力资源

进一步提高全民族的健康水平,拥有9亿农民的广大农村,无疑是我国卫生工作的重点.搞好农村的卫生服务,人才是关键.近两年来,我国政府制定了一系列的政策,以规范和加速发展农村卫生人力队伍.特别是2002年,国务院颁发了<中共中央国务院关于进一步加强农村卫生工作的决定>,同年,由卫生部、教育部等5个部委联合下发了<关于加强农村卫生人才培养和队伍建设的意见>,对加强农村卫生人才培养和队伍建设,不断提高农村卫生队伍整体素质和服务水平,提出了具体的要求和实施意见.在所有的措施和办法当中,医学教育占据着非常重要的位置.我国农村卫生人力资源状况如何?医学教育现状如何?怎样有针对性地发展医学教育?本文将就这些问题进行探讨.     

湖州市农村社区全科医学人才培养的实践与探索

农村卫生工作是我国卫生工作的重点,但目前农村社区卫生人才数量短缺、总体素质不高,特别是全科医学人才严重匮乏已成为制约我国农村卫生事业发展的瓶颈.根据农村社区卫生人力资源现状及社区服务功能的要求,本项日通过构建融理论教学、实践教学、素质教学为一体的"实用型"全科医学人才培养方案,采用定向招生、定向培养、定向就业的"订单式...     

中国农村卫生人力资源存在的问题及对策

农村卫生人力资源是整个农村医疗卫生事业中的“第一资源”，由于我国农村卫生人力资源存在数量不足、素质低下、结构不合理和分布不均等问题，要实现《2001—2010年全国乡村医生教育规划》目标，必须采取各项措施，加强农村卫生人力资源的开发与建设，提高农村卫生人员整体素质和使用效率。     

浅谈农村乡镇卫生院的管理与改革

在“中共中央国务院关于进一步加强农村卫生工作的决定”中明确指出：农村卫生工作是我国卫生工作的重点，关系到保护农村生产力，振兴农村经济，维护农村社会发展和稳定的大局，对提高全民族素质具有特别重要的意义。农村乡镇卫生院是农村卫生工作的前沿阵地，是国家对广大农民群众实施基本医疗、预防保健、健康教育的重要基地。但目前农村乡镇卫生院的卫生现状不容乐观，体制改革滞后，资金投入不足，卫生技术人才匮乏，基础设施落后。因此需大力加强农村乡镇卫生院的管理与改革，使其展现蓬勃发展的生机和旺盛的生命力，很好地配合农村新型合作医疗工作的开展，认真贯彻落实“三个代表”的重要思想，切实解决广大农民群众就医问题，促进社会事业的全面发展。     

襄阳县乡(镇)卫生院编外卫生人力资源现状调查

在诸多的卫生资源中,卫生人力资源是最宝贵的资源。卫生技术人员的构成和素质是决定一个地区卫生事业发展的关键。人们往往注意了在编的卫生人力资源,而忽视了编外的卫生人力资源。在编外卫生人力调查方面还未见报道。为了加强对编外卫生技术人员的.管理,为今后制订农村卫生人力规划提供科学依据,本文就襄阳县乡(镇)卫生院的编外卫生人力资源现状作调查分析。     

广州市白云区实施农村初级卫生保健现况调查

目的了解当地农村初级卫生保健的实施现状,分析其存在的问题,探讨提升农村初级卫生保健服务质量和水平的路径。方法通过实地考察、与农民访谈和问卷调查,利用Excel和SPSS13.0对数据进行统计分析。结果农村居民卫生保健知识薄弱,了解健康知识途径单一;农村基本卫生服务还未能覆盖所有人群,服务质量有待进一步提高。结论要大力加强农村初级卫生保健教育宣传,增强农村居民的卫生保健意识;要争取财政投入,努力提升基本医疗卫生服务质量和水平。     

加强农村卫生服务体系建设 促进人人享有基本卫生保健

建立国家基本卫生制度、实现人人享有基本卫生保健是国际社会＂全民健康覆盖＂目标的具体体现。过去几十年,江苏省农村卫生服务体系得到了较好发展,基本建立具有较高可及性的农村服务组织网络,为实现农村居民人人享有基本卫生保健打下了良好的基础,同时还存在诸多亟待解决的问题。为此提出建议：明确政府健康责任,改革卫生投入机制;优化卫生服务体系布局,提高高质量卫生服务的可及性;加强基层卫生人才队伍建设,提高基本卫生服务质量;完善薪酬分配制度,调动卫生人员积极性。     

Rural Health Care in Bolivia*

ABSTRACT: Eighty percent of Bolivians live in rural areas. However, because of a lack of resources and an urban / curative health sector orientation, rural primary health care services are woefully inadequate. Consequently, Bolivia has the worst health conditions of any of the Latin American countries. The broader factors which underlie Bolivia's poor health conditions, such as the low standard of living and impediments to socioeconomic development, are reviewed. Rural primary health programs are hampered by a lack of local support, overdependence on central and distant Ministry of Health supervisory staff, a lack of strong national political support for rural primary health care programs, the absence of public sector support for social programs, and a lack of appropriately trained health providers who are comfortable in the rural sociocultural mileu of community-oriented primary health care. The experience of Andean Rural Health Care is briefly described, and the potential contribution of private organizations working with local communities and with the Ministry of Health is addressed. The most viable option for improving rural primary health care in Bolivia is the census-based community-oriented approach.     

海南省乡镇卫生院卫生人力资源现状调查

目的了解海南省乡镇卫生院卫生人力资源现状,发现其存在的问题,并提出相应的建议和对策,为卫生行政部门制定卫生人力资源发展规划提供参考依据。方法采用分层整群抽样的方法收集到176所乡镇卫生院的4 262名卫生人员信息,对海南省乡镇卫生院卫生人力资源的性别、年龄、学历和职称构成进行描述。结果海南省176所乡镇卫生院卫生人员配置和专业结构较为合理,院均24.2人,医护比为1:0.87,医防比为1:0.292;年龄构成不合理,35~44岁年龄组仅占31.1%;学历水平较低,中专学历占64.3%;高级人才短缺,高级职称人员仅占2.3%。结论卫生主管部门应该重视农村卫生人力资源的重要性,科学合理地对卫生人力资源进行配置,重点应放在提高农村卫生人员整体素质,加强卫生人才队伍的建设上。     

我国农村卫生服务存在的质量问题分析及解决对策

随着我国卫生服务水平的发展，农村卫生状况已经有了极大的改善，然而农村卫生服务质量还是存在相当多的问题。本文针对农村卫生的特点，指出农村卫生服务机构中存在的质量问题，并分析其原因，提出解决问题的对策。     

Perceptions of Local Health Care Quality in 7 Rural Communities with Telemedicine

CONTEXT: Rural health services are difficult to maintain because of low patient volumes, limited numbers of providers, and unfavorable economies of scale. Rural patients may perceive poor quality in local health care, directly impacting the sustainability of local health care services. PURPOSE: This study examines perceptions of local health care quality in 7 rural, underserved communities where telemedicine was implemented. This study also assesses factors associated with travel outside of local communities for health care services. METHODS: Community-based pretelemedicine and posttelemedicine random telephone surveys were conducted in 7 northern California rural communities assessing local residents' perceptions of health care quality and the frequency of travel outside their community for health care services. Five-hundred rural residents were interviewed in each of the pretelemedicine and posttelemedicine surveys. Between surveys, telemedicine services were made available in each of the communities. FINDINGS: Residents aware of telemedicine services in their community had a significantly higher opinion of local health care quality (P =.002). Satisfaction with telemedicine was rated high by both rural providers and patients. Residents with lower opinions of local health care quality were more likely to have traveled out of their community for medical care services (P =.014). CONCLUSIONS: The introduction of telemedicine into rural communities is associated with increases in the local communities' perception of local health care quality. Therefore, is it possible that telemedicine may result in a decrease in the desire and need for local patients to travel outside of their community for health care services.     

Provision of health care in rural Afghanistan: needs and challenges

Afghanistan's health system is severely limited in terms of preventive and curative services, referral systems, and human resources. Most of the country's citizens reside in rural areas, a majority of which are served by "basic health units" (small and simple facilities that provide primary care), and these rural residents face additional challenges regarding timely access to quality health care. The analysis described in this article, which focuses on data derived from 2 rural health units during a 1-year period, revealed that infectious diseases, mainly acute respiratory infections, were a primary concern and that there is a clear need for increasing access to health services. In addition, our results showed that women are underrepresented as patients and appear to be at higher risk than men of tuberculosis.     

Service Use of Rural and Urban Medicaid Beneficiaries Suffering From Depression: The Role of Supply

Despite the prevalence and consequence of depression in rural areas, the literature on treating depression in rural areas is relatively scarce and inconclusive. The use of mental health services by rural people suffering from depression and the role that supply may play in explaining these differences are not well understood. Understanding these issues for rural Medicaid beneficiaries is important as Medicaid managed carefor physical and behavioral health care is expanded to rural areas. This study compares the mental health service use of rural and urban Medicaid beneficiaries, ages 18 to 64, in Maine suffering from depression and examines what influence mental health and primary care supply have in explaining observed differences. Two models are used to estimate the use of ambulatory mental health services: (1) a logit likelihood estimate of whether a beneficiary uses any outpatient mental health services for depression; (2) an ordinary least squares regression estimating the number of annualized ambulatory mental health care visits among users. Rural beneficiaries suffering from depression have lower utilization than urban beneficiaries. Rural and urban Aid for Families with Dependent Children (AFDC)--and Supplemental Security Income (SSI)--beneficiaries suffering from depression rely more on mental health than on general health care providers to receive ambulatory mental health care. Rural beneficiaries (AFDC and SSI) rely relatively more on general health care providers than urban beneficiaries. Multivariate analysis suggests that mental health supply and patient-level factors, but not primary care supply, account for utilization differences. This article describes the need to better understand factors limiting participation of primary care providers and to study the role of supply across multiple states.     

Family Medicine Physicians’ Perspectives Regarding Rural Behavioral Health Care: Informing Ideas for Increasing Access to High-Quality Services

Primary care settings often function as the front lines for behavioral health services in rural areas. The lack of formal behavioral health care in rural areas is also well documented. Rural family practice physicians were interviewed regarding the state of behavioral health care in their communities and their ideas for increasing access to quality care. Thirteen family practice physicians in rural locations participated in in-depth semi-structured interviews. Interviews were transcribed, coded, and analyzed following a phenomenological design. Physicians described a lack of quality behavioral health services and challenges for integrating and collaborating with those that do exist. Participants also described the changing role of stigma, service delivery strategies that are currently working, and the unique role primary care plays in rural behavioral health care. Several ideas for increasing access to and efficacy of services are discussed; these ideas are informative for future research and interventions.

     

Rural pharmacy not delivering on its health promotion potential

OBJECTIVE: To investigate the level and perceived quality of health promotion advice received from rural pharmacists. DESIGN: Self-administered written survey on access to and quality of pharmacy services in rural Western Australia completed by rural residents. SETTING: Rural pharmacy. PARTICIPANTS: Four hundred and eighty-three respondents who regularly used a pharmacy. OUTCOME MEASURES: Items in the survey included frequency of receiving prevention advice and satisfaction ratings on health and pharmacy services. RESULTS: Eighty-eight per cent of respondents had never discussed exercise or diet with their pharmacist and 65% had never discussed preventing health problems. Receiving good prevention advice predicted satisfaction with health services in general but not satisfaction with pharmacy services. CONCLUSION: Pharmacies are being underutilised with respect to their capacity to deliver heath prevention advice and ways to capitalise on this potential need to be investigated.