村级公共卫生机构与基本健康保障

从农村基本卫生服务供给的角度,讨论重建甘肃省农村村级公共卫生机构的重要性与迫切性,并提出了相关的政策建议。     

The Role of Interorganizational Partnerships in Health Services Provision Among Rural,Suburban, and Urban Local Health Departments

Context: With limited resources and increased public health challenges facing the US, the Centers for Disease Control and Prevention and others have identified partnerships between local health departments (LHDs) and nongovernmental organizations (NGOs) as critical to the public health system. LHDs utilize financial, human, and informational resources and develop partnerships with local NGOs to provide public health services. Purpose: Our study had 2 primary goals: (1) compare resources and partnerships characterizing rural, suburban, and urban LHDs, and (2) determine whether partnerships play a mediating role between LHD resources and the services LHDs provide. Methods: We conducted secondary data analysis using the National Association of County and City Health Officials 2005 Profile Study. We used chi-squared and analysis of variance (ANOVA) to examine differences between rural, suburban, and urban LHDs. We used regression-based mediation methods to test whether partnerships mediated the relationship between resources and service provision. Findings: We found significant differences between LHDs. Urban LHDs serve larger jurisdictions, have larger budgets and more staff, cultivate more partnerships with local NGOs, and provide more health services than suburban or rural LHDs. We found that partnerships were a partial mediator between resources and service provision. In playing a mediating role, partnerships reduce differences in service provision between rural, suburban, and urban LHDs. Conclusions: Partnerships mediate the relationship between resources and service provision in LHDs. LHDs could place more emphasis on cultivating relationships with local NGOs in order to increase service provision. This strategy may be especially useful for rural LHDs facing limited resources and numerous health disparities.     

云南农村生育健康服务资源的现状

通过对云南省4县11个乡(镇)有代表性的个案调查发现:4县社会经济均有明显发展,政府拨出的生育健康服务费用也在逐年增加,但不平衡。调查4县中县、乡、村三级生育健康服务机构健全,县级机构有足够的卫技人员,有为开展生育健康服务所必需的医疗设备、床位及业务用房。乡级生育健康服务资源不如县级,专业人员很少,设备也很简陋。4县按人口平均卫技人员数量不少,然而生育健康专业人员素质偏低,尤其是乡村两级有待培训提高。如何改革云南农村现行生育健康服务体制及经营机制,提高生育健康服务的效率和效益,值得进一步研究。     

Rural Adolescent Health: The Importance of Prevention Services in the Rural Community

Context: Adolescence is a pivotal developmental period for the establishment of positive health and health practices. However, developmentally propelled risk behaviors coinciding with barriers to health services may increase the propensity for untoward health outcomes in adolescence. In addition, the sociocultural context of the rural environment can present challenges to the health of adolescents. Limited data on rural adolescent health, particularly among population subgroups, hinder the ability to adequately advocate for adolescent health prevention services. Methods: A secondary analysis of the 2005 California Health Interview Survey Adolescent questionnaire was conducted. Selected survey items corresponding to the Healthy Youth 2010 objectives were analyzed for 663 adolescents aged 12‐17 residing in rural regions of California. Adolescent subgroup analysis included race/ethnicity, age, and poverty level. Findings: Adolescent health issues of particular concern in this study include sexual health, substance use, mental health, and risk factors for obesity. Predictably, risk behaviors increase with the age of the adolescent. Minority and poor youth demonstrate the greatest vulnerability to untoward health outcomes. Conclusion: Significant risk behaviors and health concerns exist among the rural adolescent population, particularly among poor and minority youth, arguing for the creation and preservation of prevention services for youth in the rural community. Future research using alternative sampling methodologies may be necessary to adequately represent the higher‐risk adolescent in the rural community. More data are needed on vulnerable adolescent populations in the rural community in order to adequately advocate for prevention services.     

参与性农村评估在改善生育卫生服务项目中的应用

在ＲＨＩＰ项目中大量运用了参与性农村评估（ＰＲＡ）方法,简要地回顾了ＰＲＡ的发生和发展,ＰＲＡ的概念和来源,农村快速评估（ＲＲＡ）与ＰＲＡ的区别,ＰＲＡ的应用范围,结合ＰＲＡ在改善生育卫生服务项目中培训和现场应用的实践,阐明了ＰＲＡ在改善生育卫生服务项目中应用的必要性、工作思路和方法及主要工作领域;描述了ＰＲＡ现场应用的工具和方法及ＰＲＡ原则;建议加强高质量ＰＲＡ的培训和实践;在注重行为和态度转变     

Practicing Preventive Health: The Underlying Culture Among Low-Income Rural Populations

Context: Health disparities on the basis of geographic location, social economic factors and education levels are well documented. However, even when health care services are available, there is no guarantee that all persons will take preventive health measures. Understanding the cultural beliefs, practices, and lifestyle choices that determine utilization of health services is an important factor in combating chronic diseases. Purpose: The purpose of this study was to investigate personal, cultural, and external barriers that interfered with participating in a community-based preventive outreach program that included health screening for obesity, diabetes, heart diseases, and hypertension when cost and transportation factors were addressed. Methods: Six focus groups were conducted in a rural community of Louisiana. Focus groups were divided into 2 categories: participants and nonparticipants. Three focus groups were completed with Dubach Health Outreach Project (DUHOP) participants and 3 were completed with nonparticipants. The focus group interviews were moderated by a researcher experienced in focus group interviews; a graduate student assisted with recording and note-taking during the sessions. Findings: Four main themes associated with barriers to participation in preventive services emerged from the discussions: (1) time, (2) low priority, (3) fear of the unknown, and (4) lack of companionship or support. Health concerns, free services, enjoyment, and free food were identified as motivators for participation. Conclusions: The findings of this study indicated that the resulting synergy between low-income status and a lack of motivation regarding health care prevention created a complicated practice of health care procrastination, which resulted in unnecessary emergency care and disease progression. To change this practice to proactive disease prevention and self care, a concerted effort will need to be implemented by policy makers, funding agents, health care providers, and community leaders and members.     

大力实施农民健康工程推动农村卫生事业又好又快发展

1998年我省在全国率先实现以县为单位达到初级卫生保健标准的目标,但农村卫生投入不足、人才短缺、保障能力有限等问题仍然十分突出。2006年,江苏省委、省政府决定在全省组织实施农村新五件实事,将农民健康工程列入其中。经过全省上下努力,2008年新农合参合率达95％,人均最低筹资达到100元,各县最高封顶线提高到6万元以上,在全国率先启动实施农村基本公共卫生服务项目,切实加强农村卫生机构服务能力建设。下一步要切实抓好并不断巩固完善新型农村合作医疗制度、深入推进农村公共卫生建设、进一步健全完善农村卫生服务网络、加大力度培养农村适宜卫生人才四个重点,努力为广大农村居民提供“安全、有效、方便、价廉”的基本医疗卫生服务。     

Client Satisfaction on Maternal and Child Health Services in Rural Bengal

Background:

Services are being provided by health functionaries to the community with the objective of fulfilling their satisfaction but sometimes this is not working for the target population.

Objectives:

The study was conducted to assess the satisfaction of clients′ receiving maternal and child health services and to elicit clients′ suggestion for improving the services.

Materials and Methods:

Anexit interview was employed to collect data using a predesigned and pretested schedule.

Results:

Most of the populations were adult clients. In respect of satisfaction, responses of the clients were either satisfactory (54.31%) or good (23.56%) on maternal and child health services; ‘poor or very poor around 20% and it was significantly worse in respect of satisfaction’. Most of the clients (63.06 to 73.94%) expressed their responses as satisfactory and good regarding the assessment of doctors and it was significant. Most of them (73.31%) expressed satisfactory “response” on the quality of services given by nursing staffs. Suggestions of clients for improving the level of satisfactionwere sought and in this respect, response was little.

Conclusions:

Mostly satisfactory observations on maternal and child health services were found in respect of clients'' satisfaction and there was scope to improve the quality and quantity of services, and accordingly actions may be taken in the working field.     

建设覆盖城乡居民的基本卫生保健制度的内涵和条件

通过对基本卫生保健制度的性质、内涵和条件介绍及对国内、国际有关基本卫生保健制度的定义收集,揭示出每一国民都有权利获得基本的医疗保障和卫生保健的服务,城乡的居民都应该享受到“基本卫生服务包”。然而,我国迄今尚未建立起一个真正的、覆盖城乡居民的、基本的卫生保健制度。通过对未来社会医疗保障、新型农村合作医疗与城市社区卫生服务发展方向的讨论,为增加政府的投资和公共财政支出计划建议如下:到2010年,卫生总费用支出应达到6%GDP,个人支出占卫生总费用的比例应减少至40%以下,政府预算卫生支出应占财政支出的6%～8%,新增比例至少要达到GDP的1%～2%。