四川省部分贫困地区乡(镇)卫生院基本卫生服务能力现况调查

[目的]了解四川省部分贫困地区在接受卫生项目资助之后乡(镇)卫生院基本卫生服务开展情况,总结经验与不足,为改善贫困地区乡(镇)卫生院提供基本卫生服务的能力,提高居民健康水平提供科学参考.[方法]在某贫困县分层随机抽取3个乡(镇),利用自行设计的问卷对其乡(镇)卫生院进行机构调查;并分层随机抽取87名普通村民进行问卷调查.[结果]各乡镇卫生院的基本设施齐全,开展的基本卫生服务基本能满足居民的需要,但还存在一定的问题.[结论]为改善贫困地区居民健康水平,建议增加对乡镇卫生院的投入,保障基本设施的建设;加强乡镇卫生院卫生技术队伍的建设,保证卫生服务的质量;加强对卫生服务各领域的重视,提高卫生服务能力.     

贵州省三穗县乡、村卫生队伍现状调查

目的了解贵州省三穗县乡、村卫生队伍现状。方法 2010年8月对贵州省黔东南苗族侗族自治州三穗县10个乡镇卫生院和123个村卫生室卫生人员共213人进行问卷调查。结果平均每乡镇卫生院人员8.4人,每千农业人口乡镇卫生院人员0.43人,每村乡村医生和卫生员0.74人,每千农业人口乡村医生和卫生员0.66人,明显低于贵州省平均水平;乡镇卫生院人员执业助理医师占58.9%,执业医师占20.2%,注册护士占16.7%,药剂人员占2.4%,检验人员占0.9%,无专业技术人员占0.9%;医(药、护、技)士占82.1%,医(药、护、技)师占28.6%,无职称者占1.2%;大专占52.4%,中专占34.5%,本科占11.9%,无医学学历者占1.2%。村卫生人员乡村医生占91.5%,执业(助理)医师占8.5%;中专占75.2%,大专9.3%,无医学学历者占15.5%;平均月均收入740元。结论三穗县乡村卫生人员短缺;专业素质偏低,结构不合理;村卫生人员基本待遇有待提高。     

广东省梅县乡(镇)卫生院卫生人力资源的现状调查分析

乡(镇)卫生院是农村三级医疗预防保健网的中心环节,是我国农村实现“2000年人人享有卫生保健”的关键。本文通过对广东省梅县乡(镇)一级卫生院卫生人力状况的调查分析,结果表明,目前该县乡镇卫生院的机构稳定,卫技人员占编比例合理,年龄较轻,成为今后农村卫生院发展的优势。但存在着卫生技术人员的总体数量不足,素质较差,各类专业技术人员的构成比例失调和层次分布不合理等问题,同时提出了如何加以改善的对策措施。     

郑州市乡镇卫生院卫生资源调查分析

[目的]分析郑州市乡镇卫生院卫生资源问题,提出解决的建议.[方法]采用描述性统计分析方法.[结果]卫技人员总体素质偏低,卫生设施配置不均衡,筹资渠道单一,卫生资源利用率较低.[结论]构建合理的专业与职称结构,改善各地乡镇卫生院的基础设施,调整乡镇卫生院卫生资源的配置比例,利用现代营销管理手段,提高卫生资源的利用率.     

以基本卫生需求为导向优化配置农村卫生资源构想

贫困地区的卫生资源有限,制约着卫生事业的发展。现行的卫生资源配置过分强调了行政区划设置原则,严格按县、区、乡、村四级序列比照配置,县级卫生机构配置还较合理,而农村社区的区、镇设中心卫生院(全民所有制),乡设乡卫生院(集体所有制),村设卫生室(个体与集体所有制并存),没有从医疗和卫生     

绥宁县乡（镇）防疫人员现状调查分析

绥宁县乡（镇）防疫人员现状调查分析杨盛成（绥宁县卫生防疫站４２２６００）乡（镇）防疫人员是基层防保队伍的重要组成部分，为了解基层防保工作现状，我们于１９９４年８月对全县３１所中心乡（镇）卫生院防疫人员现状进行了调查分析，结果如下。１内容和方法由县卫生...     

江西省卫生资源利用现状及发展趋势

为了实现全省卫生资源优化配置 ,使资源配置标准的测算符合省情、市情 ,提高卫生资源的利用率和资源配置的综合效益 ,1999年 10月在全省开展卫生资源利用现状调查。调查内容与方法调查工作按市区、县 (市 )城区、乡 (镇 )三个卫生医疗服务圈进行。调查卫生部门的医院 (卫生院 )、妇幼保健院 (所 )〔下称妇保院 (所 )〕、中医医院、工业及其他部门的医院 (卫生所 )(下称其他部门 )、防疫机构、妇幼保健机构以及乡 (镇 )卫生院从事卫生防疫或妇幼保健的人员。调查 1994～ 1998年卫生资源利用状况。用计算机软件ＥＸＣＥＬ汇总及分析。以 1998…     

2014年贵州省黎平县乡村卫生服务能力状况调查

目的了解2014年黎平县乡村卫生服务状况,为改善其服务能力提供依据。方法采用课题调查表,召开乡(镇)卫生院长和防保组长培训会议,统一方法、标准和内容,然后由乡(镇)卫生院防保人员下到各村进行现场询问、调查、收集相关资料。结果黎平县2014年乡、村卫生业务用房平均为1 371.44和65 m2,乡、村卫技人员每千农业人口分别为0.91和0.82人。乡级卫生人员中,大专以上学历的占85.30%,村级中专以上学历占95.27%,乡(镇)执业医师、执业助理医师、注册护士分别占总人数的16.93%、21.60%和27.62%,村级执业助理医师以上资格占3.24%。乡(镇)卫技人员20~39岁占69.27%,工龄1~19 a的占73.09%;90%的乡(镇)卫技人员愿意从事基层卫生工作,村卫技人员全部交纳了新型农村社会养老保险。结论黎平县2014年乡村卫生设施、设备得到改善,但存在人员短缺、专业结构不合理、职称和执业资格低等情况,今后需要采取切实有效的措施加以解决。     

构建农村新型区域卫生服务体系

一、总体构想以６６个中心卫生院 (原区卫生院 )为龙头 ,中心卫生院与原辖区内的乡镇卫生院实行合作经营 ,乡镇卫生院与村卫生站实行一体化管理 ,形成在县 (市 )卫生局直接领导下的区域性农村卫生服务体系。区域性卫生服务体系有三大优势 :(一)管理优势。在撤乡建镇之后 ,区委区公所等组织机构消亡 ,原区卫生院更名为中心卫生院 ,直属县 (市 )卫生局领导 ,由于有组织能力、技术权威等历史经验 ,对辖区内卫生事业的管理 ,应该是顺理成章的。(二)运行优势。松散的区、乡、村卫生网络将变成立体的、紧密的区域性卫生服务体系 ,达到资源共享、效…     

中国西部部分地区乡村两级基本医疗设备及卫生人员配置现况研究

利用2000年卫生部-联合国儿童基金会在中国西部新疆、甘肃、青海、宁夏、贵州等5省40个卫生综合试点项目县终期评估的调查资料，分析西部农村基本卫生资源的配置现况。结果表明：调查地区乡村两级医疗卫生人员缺乏，现有人员整体素质偏低，而且乡卫生院和村卫生室最基本的医疗器件严重不足，特别是在距离乡较远的村，有相当比例的村卫生室既没有一次性注射器，又没有高压消毒锅，医疗器件的消毒没有保障。本次调查地区住院分娩率较低，但村卫生室的产包配置率也十分低下。建议加强人员培训和基本医疗器件的配备，确保人民群众的医疗卫生需求和安全。     

What a few illiterate women committed to their cause can do

A doctor, affiliated with a health center in Tamil Nadu, reports her experiences in changing the quality of poor people's lives through empowerment, knowledge, and sensitivity to real issues. Success was achieved in 40 villages by empowering health workers to educate the illiterate and poor about sanitation, hygiene, nutrition, clean water, and how to bring government medical services to their villages or clean water within easy access to villagers. Health workers mobilized the community through group meetings, women's groups, cultural programs, and street theater. Poor women organized their own and neighboring villages in a labor protest at harvest season against low wages. Villagers demanded government services be implemented in their villages. Government health workers had been assigned to their villages; however these workers visited only the wealthy areas. These workers were contacted and urged to bring the immunization and other government services to other villages. Efforts were successful in bringing safe water, higher wages, and health services within reach of the poor in these 40 villages. The question was raised about the role of the health worker. A doctor is equipped to prescribe expensive drugs, high protein diets, vitamins, and rehydration fluids, while real issues such as access to clean, safe water, which cause disease in rural villages, are ignored, and the poor are blamed for their laziness and filth. The role of health worker involves organized effort to make basic changes in people's lives, regardless of poverty and illiteracy.     

提高与孕产妇及围产儿死亡有关的卫生服务效果研究

本文对１９９０年至１９９２年阆中、仪陇孕产妇、围产儿死亡及乡、村卫生机构资源和妇幼人员的知识技能进行调查，并对孕产妇死亡原因进行病例－对照分析，发现产后出血是孕产妇死亡的主要危险因素。此外乡级医务人员知识技能，住院分娩率以及孕产妇和家属保健知识对减少孕产妇死亡，提高卫生服务效果也有重要的作用。     

中国结核病控制项目社会评价试点研究

目的明确社区居民以及医疗服务提供者掌握的肺结核相关知识；了解肺结核病患者和可疑症状者的就诊途径；了解肺结陔归口管理存在的问题。方法采用个人访谈、观察、专题小组访谈、问卷凋查等定性研究和定量研究相结合的方法，抽取结核病患病率高、病人发现率低的3个贫困县，每个县选择2个乡镇，每个乡镇选择2个村进行调查。结果在贫困、边远和不发达地区，经济困难、文化落后给贫困群体带来的对疾病整体认知低下；女性、老年人是就诊的弱势群体；社区居民因症就诊的经济负担很高；结核病防治人力明显不足；预防和治疗机构之间缺乏协调。结论要提高结核病人的发现率及结核病患者治疗管理质量，需要开展适用于不同人群，多种形式相结合的结核病知识健康促进活动．提高医疗服务接受者对结核病的认知；开展不同形式的结核病防治知识培训，提高医疗服务提供者的结核病防治水平。     

The Effects of Chronic Disease Management in Primary Health Care: Evidence from Rural China

Health systems globally face increasing morbidity and mortality from chronic diseases, yet many - especially in low- and middle-income countries - lack strong chronic disease management in primary health care (PHC). We provide evidence on China’s efforts to promote PHC management using unique five-year panel data in a rural county, including health care utilization from medical claims and health outcomes from biomarkers. Utilizing plausibly exogenous variation in management intensity generated by administrative and geographic boundaries, we compare hypertension/diabetes patients in villages within two kilometers distance but managed by different townships. Results show that, compared to patients in townships with median management intensity, patients in high-intensity townships have 4.8% more PHC visits, 5.2% fewer specialist visits, 11.7% lower likelihood of having an inpatient admission, and 3.6% lower medical spending. They also tend to have better medication adherence and better control of blood pressure. The resource savings from avoided inpatient admissions substantially outweigh the costs of the program.     

北京市乡村两级基本医疗卫生服务包设计研究

阐述了北京市乡村两级基本医疗卫生服务项目的 筛选原则与依据,提出了北京市农村基本卫生服务包的筛选标准,获得了北京市乡村两级基本医疗卫生服务包的筛选结果,分析了基本医疗卫生服务包的合理性、适应性及可操作性,并探讨了开展基本医疗卫生服务的保障条件,以供其他地区借鉴.     

P.C. Sen Best Paper Award (2002). Profile of care providers in five blocks of Nasik Maharashtra. A window on rural health services in Maharashtra

Five blocks of Nasik district in Maharashtra were surveyed in 1999-2000 for distribution and academic degrees of doctors of all kinds. The five blocks have 84 % villages without any health care provider (read doctor) no matter qualified or quack. All the 555 doctors including Govt. doctors are concentrated in 16 % of villages, mainly in small townships and market centers. Physical access to any doctor is thus tedious. Often it requires travelling and hidden costs like loss of wages for the accompanying person. It also involves a hidden cost of deferred treatment. To ensure access to rational medical care at affordable cost a major overhaul of the existing health services is necessary.     

新农合对卫生服务提供公平性影响的4年连续追踪调查

目的通过基线与3次追踪调查的比较,研究新农合对卫生服务提供公平性影响的动态变化,为完善合作医疗实施方案提供科学依据。方法采用多阶段分层随机抽样抽取3个县9个乡27个行政村约1 890户农民作为研究对象,连续4年入户调查,将4次调查结果进行纵向对比研究,运用集中指数(CI)、不平等斜率指数(SII)进行公平性评价。结果4次调查均有超过半数的农户的就医距离<1 km;各层农户对新农合定点医疗机构服务态度评价很好及较好的比例均在半数以上。3指标的CI均接近于0,但CI及SII绝对值均呈逐年上升趋势。结论新农合实施以来,农民就医较方便,对定点医疗机构的卫生服务满意程度较高,卫生服务提供公平性较好,但应注意防止不公平现象的上升。     

郊区居委会和行政村居民健康素养现状比较

目的对比2017年上海市某郊区居委会和行政村常住居民健康素养水平差异,分析其影响因素,为相关部门制定及实施健康素养干预措施提供依据。方法采用多阶段随机抽样的方法于2017-06/08在全区11个街镇内进行问卷调查,调查内容包括居民的基本情况以及健康素养水平,采用卡方检验比较健康素养水平差异,采用分层卡方检验及Logistic回归分析方法进行影响因素分析,检验水准α=0.05(双侧)。结果共调查监测居委会居民825人、行政村居民990人,健康素养水平分别为23.27%(192/825)、16.36%(162/990);除慢性病防治素养和基本医疗素养外,居委会居民其余各维度素养水平、总体健康素养水平均高于行政村居民(P<0.05);根据文化程度、家庭人均年收入因素分层后,居委会和行政村居民总体健康素养水平差异无统计学意义(χCMH12=1.309,P=0.253;χCMH22=1.672,P=0.210);回归分析提示文化程度(OR=1.553,95%CI:1.389~1.736)、家庭人均年收入(OR=1.195,95%CI:1.067~1.339)是郊区居民健康素养水平的影响因素,村居委分类不是直接影响因素。结论居委会和行政村居民健康素养水平不同可能是由于两地居民文化程度、家庭人均年收入等方面的差异导致的。提升郊区居民健康素养水平,应关注居委会和行政村居民文化程度、家庭收入等方面差距,重视健康素养水平差异,强化行政村低收入、低文化程度居民的健康教育工作。     

Immunization: full coverage the aim.

In November 1988, nursing students at Khon Kaen University in northeast Thailand conducted a baseline survey in 16 villages before a retraining program for village health workers began. It consisted of a 1-week intensive training program and meetings between officers and village health workers. The goal was to achieve full immunization coverage for children under 5. After retraining, the workers implemented their health education and immunization recruitment programs with a refresher course 4 months later. The nursing students conducted a follow-up survey in June 1989 so researchers could compare the effects of the 8 intervention villages with data collected in the 8 control villages. The intervention indeed brought about improvement in immunization coverage, mother's and health worker's knowledge, and health worker participation in program planning and coordination in the case villages. For example, full immunization coverage among children under 1 increased from 65% to 89% while in the control villages it remained at 56%. It also increased among children over 5 (30-81%) but in the control villages it only rose slightly (23-31%). The percentage of mothers who were very knowledgeable about infectious diseases increased from 1% to 8% yet in the control villages it decreased from 2% to 0. Mothers with high level of knowledge about immunization was higher in the 2nd survey in both groups, but the increase was greater in the intervention villages (12-33% vs. 14-21%). High level of knowledge about infectious diseases among health workers grew considerably (3-72%) in the case villages but in the control villages it decreased from 10% to 2%. In addition, health workers in the case villages improved their contact with health officers but not those in the control villages (47-64% vs. 70-36%). Program participation increased in the intervention villages (11-36%) but fell in the control villages (22-13%).     

云南省贫困农村妇女对基本生育健康服务的利用

本文对云南省2个县3个乡的1766名已婚育龄妇女的基本生育健康服务利用状况进行了调查分析。结果表明,农村妇女对基本生育健康服务的利用普遍不足,贫困妇女对服务的利用更低。妇女对各项基本生育健康服务的利用也不平衡,表现为对孕产期保健服务、妇科病防治服务和计划生育术后追踪服务的利用不足,对计划生育手术服务的利用相对较多。