妇幼保健与计划生育技术服务合作的探索

为探索促进妇幼保健和计划生育技术服务工作共同发展的新途径，扬州市妇幼保健院在2001年12月进行了与市计划生育指导所合作的新尝试。     

市县级妇幼保健与计划生育服务机构资源整合研究

为推动妇幼保健机构和计划生育服务机构的资源整合,采用现场问卷调查、专题小组访谈、个人深入访谈等方法调查了7个省的5个地市级和9个区县级14所完成了妇幼保健和计划生育整合的实施机构。了解其资源整合模式、资产归属、人员安置和人员薪酬分配等内容,梳理归纳了整合中存在的技术人员未得到有效补充、人员培养和配备不能满足新形势需求、免费计划生育技术服务政策落实受到影响、妇幼保健与计划生育信息整合有待加强、科室设置还需规范等问题,提出建立健全补偿与激励机制、加强人才队伍建设、加强绩效考核和薪酬管理、加强医疗服务机构价格管理和信息化建设、做好生育全程优质服务等建议,为我国妇幼保健和计划生育服务的资源整合提供借鉴。     

宁阳县妇幼卫生管理模式的探索

宁阳县重点加强了“两点”（高危妊娠管理，产科建设），“两线”（孕产妇系统化管理，儿童系统化管理），“两证”（婚前医学检查证明，出生医学证明）．“两册”（孕产妇保健手册、儿童保健手册）的规范化管理；不断加强对全县妇幼保健队伍的配备和培训工作力度，健全和完善了以村妇幼卫生人员为基础．乡镇防保站为枢纽．以县妇幼保健院为龙头的三级妇幼保健工作方针和工作发展方向，有效的降低了孕产妇和5岁以下儿童死亡率，较大幅度的提高了人民群众的健康文明素质。     

妇幼保健机构与计划生育机构优化整合:进展、问题与对策

目的探讨妇幼保健与计划生育机构优化整合的进展与问题,为全面推进整合提供借鉴参考。方法采用问卷调查和专家座谈讨论等方式收集相关数据资料,进行统计分析。结果市、县和乡三级已完成妇幼保健计划生育服务机构数分别占原有妇幼保健机构数量的29.41%、61.31%和19.45%;妇幼保健机构在占地面积、建筑面积、职工总人数、卫生技术人员数、固定资产总值和业务收入等方面资源均优于计划生育机构;整合过程中存在机构设置、人员编制、财政支持等政策不足以及部分人员相对消极、认知不足等问题。结论样本省域妇幼保健与计划生育机构资源优化整合起步较早、进展较快,但优化整合政策有待进一步调整完善,整合后须加强标准化建设和规范化管理,以促进两大资源有机融合。     

我国县区级妇幼保健机构儿童保健学科建设策略的探索

目的寻找县区级妇幼保健机构儿童保健学科建设的制约因素,探索应对的策略。方法从人才、科研、服务等方面在万方数据库、中国知网空间检索儿童保健或妇幼保健学科建设的文献,建立文献纳入和排除标准,对检索到的文献按标准筛选、系统评估,寻找制约学科建设与发展的因素。根据部门规章及国家儿童保健技术规范构建县区级儿童保健学科建设基本框架。结果人员配备不足（2010年全国县区级妇幼机构平均保健人员数为14人）、高层次人才匮乏（2010年全国县区级妇幼机构高级职称比例为5．7％）、常用设备配置不到位（2010年全国县区级妇幼机构智力测查工具拥有比例44．4％,耳声发射仪拥有比例36．8％）、科研实力薄弱（2008年全国县区级妇幼机构平均科研经费1．2万元,平均省级以上期刊发表论文数2．6篇）、保健服务低层次等是县区级妇幼保健机构儿童保健学科建设的制约因素,学科建设基本框架包括二级专业组设置、服务项目、人才队伍、硬件配备、科研课题、综合管理等六个方面内容。结论县区级妇幼保健机构要明确儿童保健学科的功能定位、发展方向,围绕学科建设基本框架,形成学科带头人为主导、课题项目为突破口、培育优势亚专业的运行模式。     

Cost-effectiveness of family planning and maternal health service delivery strategies in rural Bangladesh

Two alternative service delivery strategies to improve the effectiveness and efficiency of the Bangladesh national Family Planning and Maternal and Child Health programme have been tested: (1) service delivery at cluster spots, a centrally located neighbourhood spot, rather than at the client's home, and (2) increased frequency of outreach clinics merged with immunization spots. The cost-effectiveness of these strategies was compared with baseline estimates of the cost of providing services. The data were collected in two rural sites of Bangladesh, Mirsarai Thana of Chittagong and Abhoynagar Thana of Jessore, in August 1996. The results of this analysis indicate that cluster service delivery of contraceptive services in their present form are not more cost-effective than home delivery services. The cost per birth averted was lower in only one out of three services in each of the field sites. When the cost-effectiveness of increasing the frequency of SCs combined with EPI services was examined, the service delivery was found to be more cost-effective for all services in one thana and for two out of three services in the higher performing thana, Abhoynagar. This implies that the provision of a wider range of services is improving overall cost-effectiveness.     

农村地区县妇幼保健院助产服务现状及优势分析

目的:调查农村地区不同类别助产机构产科服务提供情况及服务能力,对县妇幼保健院助产服务现状和优势进行分析。方法:在全国随机抽取44个地市全部助产服务机构2010年产科服务情况进行问卷调查,重点对农村地区(县和县级市)中不同类型助产机构进行分析。结果:农村助产服务机构中县妇幼保健院占6.5%,县妇幼保健院产科床位数占辖区产科总床位数的18.1%,分娩数量占辖区分娩量的42.9%,平均每个县妇幼保健院年分娩为1 259人,高于县级综合性医院和其他医疗机构。县妇幼保健院中能提供综合产科和综合新生儿科服务的比例最高分别为85.3%、61.9%,高于县级综合性医院83.1%、59.4%,并明显高于其他医疗机构32.4%、19.3%。结论:县妇幼保健院是农村地区助产服务的主要力量之一,与其他助产机构相比,县妇幼保健院在助产服务提供数量和能力方面都具有一定优势。应进一步加强对妇幼保健机构的规范化建设,以保证其职能的履行。     

Management information systems in maternal and child health/family planning programs: a multi-country analysis

A diagnosis was conducted of management information systems (MIS) for maternal and child health and family planning programs in 27 African, 5 Asian, and 8 Latin American and Caribbean countries. The diagnosis covered the collection and use of information on physical infrastructure, human resources, equipment/supplies, services provided, coverage attained, and program quality and impact. It was found that many programs do not produce certain basic input and output indicators and that even among those that do, information is too infrequently brought to bear on management decision-making. Constraints under which the MIS operate in these countries are identified, and some rudimentary calculations of what would be required to improve MIS functioning are made.     

成都市区、县妇幼保健院运行状况分析

目的:通过分析成都市区县妇幼保健院运行数据,评价区县妇幼保健院的运营绩效和发展能力,为妇幼保健院发展决策提供参考。方法:数据收集利用妇幼卫生机构管理信息网络报告系统进行网络直报,选择2008、2009两年运行数据进行对比分析。结果:区县妇幼保健院从资产、运营绩效都保持了良好增长状态,但科研工作开展不理想。结论:县区妇幼保健院虽然运营绩效、发展能力总体较好,但规模、发展能力存在不平衡,科研能力与投入不足,需要管理者们大力关注。     

Women at risk: Gender inequality and maternal health

Gender inequality has been documented as a key driver of negative health outcomes, especially among women. However, studies have not clearly examined the role of gender inequality in maternal health in an African setting. Therefore, the authors of this study examined the role of gender inequality, indicated by lack of female autonomy, in exposing women to maternal health risk. Data were obtained from the 2007 Zambia Demographic and Health Survey on a weighted sample of 3,906 married or partnered women aged 15–49 years. Multivariable analyses revealed that low autonomy in household decision power was associated with maternal health risk (Odds Ratio (OR) = 1.52, p < .001). Autonomy interacted with household wealth showed that respondents who were in the wealthier households and had low autonomy in household decision power (OR = 2.03, p < .05) were more likely to be exposed to maternal health risk than their counterparts who had more autonomy. Efforts to lower women’s exposure to maternal mortality and morbidity in Zambia should involve interventions to alter prevailing gender norms that limit women’s active participation in decisions about their own health during pregnancy and delivery.     

新疆莎车县基层妇幼保健人力资源现状分析

目的分析新疆喀什地区莎车县乡级妇幼保健人员资源现状和存在问题。方法由乡级医疗保健机构填写"妇幼卫生基本情况调查表",结合莎车县2014年妇幼保健年报数据,及对该县妇幼保健管理人员、服务提供者和服务对象开展定性调查,综合分析该县妇幼人力资源配置和分布。结果 2014年莎车县乡级妇幼保健人员208人,其中120人(57.69%)从事助产接生,平均每5 000人口配备1.25名妇幼保健人员。12.50%的妇幼保健人员具有大专以上学历,3.37%具有中级及以上技术职称。妇幼保健人员分布按照常住人口数量计算得到的基尼系数为0.21,按照地理面积计算得到的基尼系数为0.62。结论莎车县乡级妇幼保健人员数量不足,学历和职称结构偏低,专业能力有待提高;乡级妇幼保健人员按照常住人口配置的均衡性优于地理配置。     

县、乡两级妇幼卫生与计划生育服务体系整合研究——以湖北省崇阳县为例

目的:以湖北省崇阳县为例,描述妇幼卫生与计划生育服务体系整合的方式,分析关键要素,为推进整合提供借鉴和参考.方法:运用定性访谈、问卷调查等方法收集资料;采用QSR Nvivo 8.0软件及SPSS 17.0软件进行定性和定量资料的分析.结果:崇阳县充分认识到整合的重要性,积极落实配套政策,保持原有补偿方式不变、不减编不减员,迅速推进了机构合并,合理调整服务内容和方式,并整合了妇幼与计生信息平台.结论:对整合的正确认识、稳妥的人事制度及稳定的经费支持有力地推动了整合工作的落实,但未来在人员编制管理、激励机制、服务内容及形式等方面仍需进一步的探索和创新.     

Health and family planning services in Bangladesh: a study in inequality

The development of health and family planning services in Bangladesh is examined in the context of the country's political economy. Inequities of power, influence, opportunity, and the ownership and distribution of assets and income are seen to lie at the root of the "Bangladesh crisis." In this, the country is not unlike many others in the Third World, only more so. The internal and external pressures which have contributed to a coercive attitude toward the problem of too rapid population growth are discussed. The allocation of Bangladeshi health service resources is examined in terms of expenditure, manpower, and facilities; they are found to be both inequitably distributed and inefficiently applied. Some alternatives to present patterns of development are touched upon. It is concluded that despite the country's poverty, most people do not have to go without basic primary health care (including family planning), which can be afforded even by countries as economically impoverished as Bangladesh.     

Measurement and analysis of inequality of opportunity in access of maternal and child health care in Togo

Background

Access to maternal and child health care in low- and middle-income countries such as Togo is characterized by significant inequalities. Most studies in the Togolese context have examined the total inequality of health and the determinants of individuals’ health. Few empirical studies in Togo have focused on inequalities of opportunity in maternal and child health. To fill this gap, we estimated changes in inequality of opportunity in access to maternal and child health services between 1998 and 2013 using data from Togo Demographic and Health Surveys (DHS).

Method

We computed the Human Opportunity Index (HOI)—a measure of how individual, household, and geographic characteristics like sex and place of residence can affect individuals’ access to services or goods that should be universal—using five indicators of access to healthcare and one composite indicator of access to adequate care for children. The five indicators of access were: birth in a public or private health facility; whether the child had received any vaccinations; access to prenatal care; prenatal care given by qualified staff; and having at least four antenatal visits. We then examined differences across the two years.

Results

Between 1998 and 2013, inequality of opportunities decreased for four out of six indicators. However, inequalities increased in access to antenatal care provided by qualified staff (5.9% to 12.5%) and access to adequate care (27.7% to 28.6%).

Conclusions

Although inequality of opportunities reduced between 1998 and 2013 for some of the key maternal and child health indicators, the average coverage and access rates underscore the need for sustained efforts to ensure equitable access to primary health care for mothers and children.

     

实行防保互助金制度 加强农村妇幼保健工作

本文论述了河北省邢台地区实行防保互助金制度的具体做法以及如何进行资金筹集、管理使用和成效.