西部农村村级卫生服务与保健促进措施的评价

目的 对卫生部一联合国儿童基金会在西部5省40个贫困县开展的“综合试点项目”中．所实施村卫生服务和妇幼保健促进短期效果进行综合评价和对比分析，为寻找西部贫困地区农村卫生和妇幼保健促进的措施和有效途径提供依据。方法 选择项目中27个指标，并分为卫生管理、医疗条件、妇女保健、儿童保健4个方面，运用层次分析法、TOPSIS法、线性加权法，综合评价了“综合试点项目”促进措施的作用。结果2000年5省的村级卫生服务与妇幼保健的综合评价值高于1999年，其差异有显著性意义。村级医疗条件、妇女保健和儿童保健的水平有了明显改善。结论 在西部5省开展的“综合试点项目”促进措施有效，促进作用显著。其经验可为我国政府制定促进西部、乃至全国贫困地区农村卫生事业改革的政策提供依据。     

妇幼保健机构专科建设研究

目的 研究并制定妇幼保健专科建设与管理指南,为开展全国妇幼保健机构专科建设提供依据.方法 通过文献研究、现场调查、专家研讨、机构试行等方法,制定妇幼保健专科建设与管理指南.结果 开发27个妇幼保健专科建设与管理指南,包括孕产保健专科5个,儿童保健专科11个,妇女保健专科8个,计划生育技术服务专科、信息专科和健康教育专科各1个.结论 制定妇幼保健专科建设与管理指南,规范妇幼保健服务,为全国开展妇幼保健机构专科建设打下基础.     

贫困农村地区妇幼保健服务利用的公平性研究

妇女儿童是社会脆弱人群的重要组成部分，他们应该公平地获得基本的保健服务。该文采用描述性统计方法以及Slope（斜度）指数法对10个国家级贫困县中2503名15～49岁以婚妇女、1236名0～6岁儿童的保健服务利用的公平性状况进行了分析。结果提示，我国贫困农村地区妇幼保健服务的利用仅达到甚至低于1992年全国农村的平均水平，且贫困地区内不同经济状况的人群，其保健服务的利用也存在不公平性，须引起政府部门的高度重视。     

陕西省三个项目县儿童生长、保健及孕期现状分析

[目的]了解陕西省三个项目县的儿童健康状况、保健水平以及孕期现状,并探索可能的影响因素.[方法]采用三阶段分层整群随机抽样方法,入户面对面调查并测量生长发育相关指标,血红蛋白水平及孕期保健.[结果]调查5岁以下儿童540名,6～35月龄儿童测量血红蛋白305人.5岁以下儿童的生长迟缓率为7.4%;四疫苗全程合格接种率为55.1%;母亲住院分娩率为72.5%.6～35月龄儿童的贫血患病率为30.1%. [结论]陕西省三个项目县妇幼保健的整体水平有待提高.     

农村育龄妇女孕产期保健需求调查

目的 了解安徽省农村地区育龄妇女对孕产期保健的需求状况,为制定有效干预方案提供基础数据.方法 自行设计问卷,对安徽省2县1 836名经产妇进行健康需求调查.结果 大多数农村妇女对孕产期保健知识知之甚少,对孕产期有关保健知识需求占前3位的依次为科学育儿知识与技能(95.8%)、产褥期母婴保健与母乳喂养(91.5%)、孕期营养(90.6%).认为获取保健知识的最佳途径依次为专人进行孕期保健指导(91.2%)、发放宣传小册子(85.6%)、通过电视等媒介(81.3%).22.0%的农村经产妇表示不需要进行产后访视,13.8%的经产妇认为目前产前检查项目已经足够.文化程度高、家庭经济条件较好的经产妇对保健知识、产前检查的需求较高(P均<0.05).结论 文化水平低、经济状况差的经产妇是实施卫生宣传教育的重点,应研究制定合适的健康促进宣传材料和采取灵活的健康促进方式,有的放失地进行健康教育.     

德尔菲法在三级妇幼保健服务项目确定中的应用

根据妇幼保健机构的功能定位确定服务项目是妇幼保健机构建设和管理的重要内容。笔者采用德尔菲专家咨询法,通过两轮专家咨询对妇幼保健服务的重要性打分和一轮集中讨论,围绕着妇幼保健机构的功能定位,在大保健的理念下,梳理了三级妇幼保健服务项目,重新对省、地、县三级妇幼保健机构应该开展的服务项目进行界定。     

妇幼保健机构内部控制建设与实施探索

随着我国市场经济的不断发展,妇幼保健机构的经济体系也在不断地完善,国家每年都要持续投入大量财政资金用于开展妇幼保健领域相关业务.完善的内部控制体系建设可以为妇幼保健机构各项业务和经济活动的开展奠定基础,为单位运行减少风险并保障公益性职能作用的充分发挥.由于妇幼保健机构内部控制起步较晚,其建设工作还有待于探索.采取科学的...     

山东省妇幼保健资源配置现状与公平性分析

[目的]分析2012-2017年山东省妇幼保健资源配置现状及其变化趋势,为进一步优化妇幼保健资源配置提供对策建议。[方法]对2012-2017年山东省妇幼保健资源的相关数据进行描述性统计分析,并采用基尼系数和泰尔指数分析和评价山东省妇幼保健资源配置的公平性。[结果]山东省妇幼保健资源总量呈逐年增长趋势;按人口和按地理配置的基尼系数均在0.3以下;区域内妇幼保健机构、机构床位数、医师数及护士数配置上的差异对总泰尔指数的贡献率远高于区域间差异对总泰尔指数的贡献率。[结论]山东省妇幼保健资源总量稳步增加,按人口和地理配置的公平性较高,区域内差异对妇幼保健资源配置的公平性影响较大。建议卫生行政部门应高度重视,统筹兼顾,进一步优化资源配置,加强人才队伍建设,通过"互联网+医疗健康"信息化平台建设,改善妇幼保健资源配置不公平现状。     

Community-based health insurance in poor rural China: the distribution of net benefits

The collapse of China's Cooperative Medical System (CMS) in 1978 resulted in the lack of an organized financing scheme for health care, adversely affecting rural farmers' access to health care, especially among the poor. The Chinese government recently announced a policy to re-establish some forms of community-based insurance (CBI). Many existing schemes involve low premiums but high co-payments. We hypothesized that such benefit design leads to unequal distribution of the "net benefits" (NB)--benefits net of payment--because even though low premiums are more affordable to poor farmers, high co-payments may have a significant deterrent effect on the poor in the use of services in CBI. To test this hypothesis empirically, we estimated the probability of farmers joining a re-established CBI using logistic regression, and the utilization of health care services for those who joined the scheme using the two-part model. Based on the estimations, we predicted the distribution of NB among those who joined the CBI and for the entire population in the community. Our data came from a household survey of 4160 members of 1173 households conducted in six villages in Fengshan Township, Guizhou Province, China. Three principal findings emerged from this study. First, income is an important factor influencing farmers' decision to join a CBI despite the premium representing a very small fraction of household income. Secondly, both income and health status influence enrollees' utilization of health services: richer/sicker participants obtain greater NB from the CBI than poorer/healthier members, meaning that the poorer/healthier participants subsidize the rich/sick. Thirdly, wealthy farmers benefit the most from the CBI with low premium and high co-payment features at every level of health status. In conclusion, policy recommendations related to the improvement of the benefit distribution of CBI schemes are made based on the results from this study.     

Mothers'' attitudes to and experience of pre-school child health services: a comparative study in two districts in the West Midlands

A postal questionnaire survey was undertaken amongst a ten percent random sample of mothers in Walsall and South Warwickshire in order to determine their views concerning health services available for their three year old children. A response rate of 59% and 75% respectively was obtained. Despite differences in demographic profile between the two districts, the overall views of mothers were remarkably similar. The majority of mothers were happy with services provided but mothers whose first language was other than English were less likely to be satisfied. Criticisms included dissatisfaction with waiting times, inappropriate timing of clinics, insufficient advice given as well as inconsistencies in advice offered. Health visitors in particular were perceived to be helpful and requests for further input from them were made. Specific health needs of children from ethnic minority backgrounds were discovered which should form the basis of further, more detailed local research. The survey also highlighted the high prevalence of accidents and asthma among pre-school children.     

Day care, maternal mental health and child development: evidence from a longitudinal study

Data from a long-term follow-up study of 632 born in Calgary in 1980 are reported, with particular reference to the experience of day care and its association with parental factors and the children's adjustment when they were, on average 6#lb7 years old. The sample was specially selected to include a high proportion of children with serious disabilities, and data for these children have been considered separately. Children with several years of day care behind them did not display attachment problems when they entered elementary schooling. They were however more active and aggressive than children without day care experience. This activity pattern is associated with Type A behaviour, which represents busy, active, competitive children. These traits probably reflect parental ambitions and activity patterns. Mothers who stayed home to look after several children were much more likely to be seriously depressed than mothers who returned to the external labour force in their child's preschool years. Maternal depression was associated with neurosis and depression in the child. This study gives support to the idea that high quality, affordable and universally available day care would be supportive of parental child care roles. Several sub-types of adaptation and day care experience have been identified, and hypotheses for exploration in a longer term study are suggested.     

关于妇幼保健机构实施预约诊疗的思考

目的思考我国妇幼保健机构实施预约诊疗的利与弊。方法文献回顾。结果妇幼保健机构医疗服务特点适合采用预约诊疗服务方式。结论在妇幼保健机构实施预约诊疗一定程度上有利于优化就诊流程,资源合理配置,缓解拥挤及候诊时间长、等待时间长、检验检查等候时间长和医生接诊时间短的＂三长一短＂现象。预约诊疗工作的有效开展需要依托信息技术的运用、妇幼保健机构和就诊人员共同努力。     

城市流动人口妇幼保健服务项目对流动儿童保健状况的改善作用

【目的】 分析城市流动人口妇幼保健服务项目对流动儿童保健状况的改善作用。 【方法】 采取分层整群抽样方法抽取朝阳区和大兴区共11个街乡,实施为期5年的流动人口妇幼保健项目。项目终期,在项目点随机抽取部分流动儿童进行入户问卷调查,与基线调查比较。 【结果】 共调查流动儿童1 005名。结果显示:1)流动儿童看护人对儿童保健服务和知识的知晓率明显提高;2)流动儿童对保健服务的利用明显改善,建册率、儿童保健覆盖率和儿童系统管理率比基线时明显提高,升幅分别为71.7%、76.2%和87.5%;3)流动儿童健康状况明显改善,腹泻、咳嗽2周罹患率比基线明显降低。 【结论】 流动人口妇幼保健服务项目的实施对提高流动儿童看护人保健知识水平、改善流动儿童保健服务和健康状况具有明显的促进作用。     

Determinants of the use of maternal health services in rural Bangladesh

Utilization of health services is a complex behavioral phenomenon. Empirical studies of preventive and curative services have often found that use of health services is related to the availability, quality and cost of services, as well as to social structure, health beliefs and personal characteristics of the users. In this paper an attempt is made to examine the factors associated with the use of maternal health care services in Bangladesh on the basis of data from a survey of maternal morbidity in Bangladesh, conducted by the Bangladesh Institute of Research for Promotion of Essential and Reproductive Health and Technologies (BIRPERHT). The results from both the bivariate and multivariate analyses confirmed the importance of mother's education in explaining the utilization of health care services. Female education retains a net effect on maternal health service use, independent of other women's background characteristics, household's socioeconomic status and access to healthcare services. The strong influence of mother's education on the utilization of health care services is consistent with findings from other studies. Women whose husbands are involved in business/services also positively influenced the utilization of modern health care services. However, the study results are inconclusive with respect to the influence of other predisposing and enabling factors, such as women's age, number of previous pregnancies and access to health facilities. Multivariate logistic regression estimates do not show any significant impact of these factors on the use of maternal health care. The influence of severity of disease condition in explaining the utilization of maternal health care appears to be significant. Multivariate analysis indicate that women having had a life-threatening condition are little over two times more likely to seek care from a doctor or nurse to treat their maternal morbidities.     

Factors affecting delays in tuberculosis diagnosis in rural China: a case study in four counties in Shandong Province

Improving case detection is an urgent and serious challenge for tuberculosis (TB) control in China. We investigated the extent to which TB patients delayed seeking TB care and health services delayed reaching a diagnosis, and socio-economic factors associated with the delays. Standard questionnaires were administered to 190 new smear-positive TB patients who had completed treatment at TB dispensaries in four counties of Shandong Province in 2001. Multivariate analysis using Cox Regression showed that old age, lack of education and distance from home to a township health centre were significantly associated with delay in seeking care from service providers. In examining the delay between first contact with a service provider and diagnosis, we found that women experienced longer delays than men, and that the higher the level of facility patients first visited, the less time was needed to achieve a diagnosis. These two factors were statistically significant in multivariate Cox Regression analysis. We concluded that the elderly, the less educated, women, and those living far from health facilities face the longest delays in reaching TB services and achieving diagnosis.     

妇幼卫生信息系统平台在基层孕产妇保健管理中的应用

目的观察基层妇女保健管理工作中妇幼卫生信息系统平台的应用效果。方法将孕产妇保健纳入妇幼卫生信息系统管理,通过对辖区内妇女保健信息进行采集、处理、共享等,提高孕产妇系统管理的质量。结果基层妇幼保健机构的信息采集后,自动生成有关统计数据和统计报表,完成孕产妇的电子化系统管理,提高妇女保健机构的动态跟踪和监管水平,提升孕产妇系统管理质量。结论基层妇女保健妇幼卫生信息系统平台的应用,拓展了对孕产妇的服务范围,提高了孕产妇系统管理效率,提升了妇女保健的社会价值。     

SWOT analysis of program design and implementation: a case study on the reduction of maternal mortality in Afghanistan

This case study analyzes the design and implementation of the Basic Package of Health Services (BPHS) in Afghanistan by synthesizing the literature with a focus on maternal health services. The authors are a group of graduate students in the Brandeis University International Health Policy and Management Program and Sustainable International Development Program who used the experience in Afghanistan to analyze an example of successfully implementing policy; two of the authors are Afghan physicians with direct experience in implementing the BPHS. Data is drawn from a literature review, and a unique aspect of the case study is the application of the business‐oriented SWOT analysis to the design and implementation of the program that successfully targeted lowering maternal mortality in Afghanistan. It provides a useful example of how SWOT analysis can be used to consider the reasons for, or likelihood of, successful or unsuccessful design and implementation of a policy or program. Copyright © 2015 John Wiley & Sons, Ltd.     

A community survey on maternal and child health services utilization in rural Ethiopia

A household health interview survey on MCH services utilization was carried out in 22 villages of a rural district of Arsi region, Ethiopia, before the launching of an integrated MCH programme. Coverage of antenatal services was 26%, and 61% of the women who received antenatal care reported having had 3 or more visits.Antenatal care was positively associated with living within 10 km of the Health Centre. Twenty-eight percent of the mothers attended the under-5 clinic and most returned for 3 or more visits. In addition, 99% reported having breast-fed their last child but more than 25% started weaning only after the seventh month of age. Differences in practice of treating diarrhoea according to knowledge of ORS were found. Of the 33% of those with knowledge of ORS, almost 90% reported use of ORS for treating child's dirrhoea, showing a positive attitude towards modern health care. The proportion of women using family planning was 5%, with no difference found between Christians and Muslims. Results on EPI coverage validated data from routine reporting. Integration of MCH services including out-reach activities may increase access and coverage of MCH services.