山西实施世界银行卫生贷款项目的效果与体会

1990年以来，山西省先后实施了世界银行贷款农村卫生人力开发项目(简称卫生Ⅳ项目)、疾病预防控制项目计划免疫子项目(简称卫生Ⅶ项目)、加强农村贫困地区基本卫生服务项目(简称卫生Ⅷ项目)、性病艾滋病预防控制项目(简称卫生Ⅸ项目)以及传染性非典型肺炎及其它传染病应对项目等5个大型卫生项目。     

实施卫生Ⅷ项目县级卫生资源规划的实践与效果评价

通过介绍加强中国农村贫困地区基本卫生服务项目（简称卫生Ⅷ项目）的实施，分析了项目实施前存在的主要卫生问题，描述了项目实施采取的主要措施，评价了项目实施取得的主要效果，同时也提出了项目实施存在的问题与建议。     

山西省卫生Ⅷ项目存在的问题判断与实施重点思考

山西省卫生Ⅷ项目同兄弟项目实施过程中也出现了一些问题管我省卫生Ⅷ项目的官员．在文中些县对项目的软件与内涵建设重视目配套资金承诺方面做得不够。针关键词基本卫生服务督导检查省市项目一样，实施几年来，取得了显著成效，但由于卫生Ⅷ项目内容的综合性与复杂性．和困难。作者参与了卫生Ⅷ项目的准备，也参与了项目实施的全过程，作为一个连续8年主简要描述了我省项目取得的成效，重点对目前项目运行中存在的问题做了分析判断．认为一不够，项目与日常农村卫生工作结合的不够，对项目的督导和抓落实的力度不够．在兑现项对存在问题作者明确了我省卫生Ⅷ项目下一步实施的总体思路和9个方面的实施重点．     

卫生Ⅷ项目乡镇卫生院卫生服务利用情况评估

[目的]评估卫生Ⅷ项目卫生院卫生服务利用情况，从一个侧面反映卫生院设施建设的效果。[方法]采用分层随机整群抽样方法，抽取了卫生Ⅷ项目、秦巴项目和非项目卫生院共47个，结合定量和定性的方法进行对比研究。[结果]卫生Ⅷ项目建设使卫生院服务利用显著提高，业务收入有较大幅度增加，次均费用增幅缓慢甚至回落。[结论]卫生Ⅷ项目卫生院服务利用情况好。     

以"活动"为载体促进秦巴卫生子项目实施

卫生Ⅷ项目与国家卫生工作方针和日常卫生工作的目标是一致的，其核心是提高医疗单位的服务能力和服务可及性。如何使卫生Ⅷ项目深入持久地开展．并将项目经验推广到非项目乡镇，苍溪县以“活动”为载体，从规范化建设、绿色生命通道建设、创建爱婴医院、开展9亿农民健康教育活动、创建学习型医院、开展新村建设、搭建信息平台、树白衣天使形象等8个角度．全面地覆盖了卫Ⅷ项目的8个领域．实现了项目工作与日常工作的统一。从项目管理的方面进行了总结，以寻求更好的解决方案，     

世界银行贷款卫生Ⅷ项目乡镇卫生院账务处理的实践与探讨

通过对世界银行贷款卫生项目乡镇卫生院账务处理实践的总结，结果显示河南省卫生Ⅷ项目县推广实行的财务处理程序有利于分清乡级项目单位事业账与项目专用账之间的资金关系，正确核算县、乡两级项目投资支出，同时在进行年终财务决算时能够较为简便地进行往来对冲。建议：继续推广使用，并进一步探讨适合乡镇卫生院财务执行活动的改进方案。     

世行贷款卫生项目与中央卫生专项资金项目管理模式比较研究

文章从项目规划立项、项目执行和监测评价等方面对世行贷款卫生项目和中央卫生专项资金项目进行比较研究,旨在总结世行贷款卫生项目与中央卫生专项资金项目基本管理模式的基础上,促进两种资源的统筹利用,优势互补,改进项目管理水平,进一步提高卫生财政资金的使用效率。     

建卫生Ⅳ项目地区卫生人力规划

实现“2000年人人享有卫生保健”的战略目标，必须加强农村卫生工作。目前，最关键的是要解决农村卫生人力开发问题，以逐步建立一支同初级卫生保健任务相适应的农村卫生技术队伍，当务之急是制订出符合项目地区实际情况的农村卫生人力规划。本文根据我省5个项目地区1993年的卫生统计年报资料，结合该地区的卫生人力现状等情况，应用人力／人口比值法从宏观上对卫生人力需求进行规划．制订出2000年项目地区卫生人力的需求和需补量。1规划范围与方法本规划是我省五个项目地区的卫生人力总体规划。目前我国的卫生人力中卫生管理人员和工勤人员…     

督导在卫生Ⅷ项目地区改善卫生服务中的应用探讨

改善卫生服务，督导是监督和指导项目地区卫生服务的重要过程；是发现项目存在的问题并解决问题的活动。阐述了在实施卫生Ⅷ项目过程中，使用的多种督导方法，其中包括现场督导、信息反馈督导、项目工作会督导、专家组督导等督导方式。对不断提高卫生服务水平，发挥了很好的作用，建议进一步增强有效的督导意识，确保项目的顺利实施；科学决策，合理划分各部门的责任；提高督导人员的综合素质，促进卫生服务持续性健康发展。     

卫生许可证许可项目表述探讨

卫生许可证许可项目是卫生行政许可中最重要的部分。如果许可项目表述不准确或含义模糊，就不利于卫生行政部门对食品生产经营者的生产经营活动实施监督，有时可能因许可项目的内涵界定模糊，客观上给少数超越实际卫生条件或许可范围从事生产经营活动者带来可乘之机。一旦出现行政复议或行政诉讼，就会使卫生行政部门处于被动局面。因此，卫生行政许可项目的表述大有学问、至关重要，是每一位从事卫生许可发放工作人员必须牢牢掌握的“必修课程”     

Fare well to Nova Scotia? Public health investments remain chronically underfunded

Inspired by Fiset-Laniel et al.’s (2020) article entitled “Public health investments: neglect or wilful omission? Historical trends in Quebec and implications for Canada”, we assessed public health investments since the establishment of the Nova Scotia provincial health authority in 2015. We analyzed Nova Scotia Department of Health and Wellness budgets from 2015−2016 to 2019–2020 and observed that less than 1% of funding was budgeted for public health annually, an amount well below the recommendation that 5–6% of healthcare funding be spent on public health. Healthcare spending has increased annually since 2015–2016, but proportions of funding to different programs and services have remained static. Specifically, we did not observe a change in investment in public health over time, suggesting that while the government does not necessarily spend too much or too little on healthcare, it spends far too little on public health. This chronic under-funding is problematic given the high rates of non-communicable diseases in Nova Scotia and health inequities experienced within the population. The 2020 COVID-19 pandemic has highlighted the importance of public health work, and the need for a pandemic recovery plan that prioritizes investment in all areas of public health in Nova Scotia.     

Responding to health care reform: preparing tomorrow's practitioners

At a time when all of healthcare is undergoing change and evolution, the healthcare education community has so far escaped intense public scrutiny. To remain valid, we must address the education and the reeducation of healthcare professionals. Baccalaureate health administration programs, in particular, can step in and respond to the changing needs of the industry, the market, and of healthcare professionals by creating articulation formats that provide flexible verti for associate degreed healthcare professionals. Such programs enable a diverse constellation of healthcare professionals to obtain the managerial and organizational skills that are cal and horizontal access key to career mobility in today's turbulent healthcare arena.     

Knowledge,attitudes, beliefs,and behaviors of parents and healthcare providers before and after implementation of a universal rotavirus vaccination program

ObjectiveIn Canada, rotavirus vaccine is recommended for all infants, but not all provinces/territories have publicly funded programs. We compared public and healthcare provider (HCP) knowledge, attitudes, beliefs, and behaviors in a province with a public health nurse-delivered, publicly funded rotavirus vaccination program to a province with a publicly funded, physician-delivered program. A third province with no vaccination program acted as a control.DesignInformation about knowledge, attitudes, beliefs, and behaviors of parents whose children were eligible for the universal program and healthcare providers responsible for administering the vaccine were collected through the use of two validated surveys distributed in public health clinics, physicians’ offices, and via e-mail. Early and postvaccine-program survey results were compared.ResultsA total of 722 early implementation and 709 postimplementation parent surveys and 180 early and 141 postimplementation HCP surveys were analyzed. HCP and public attitudes toward rotavirus vaccination were generally positive and didn’t change over time. More parents postprogram were aware of the NACI recommendation and the vaccination program and reported that their healthcare provider discussed rotavirus infection and vaccine with them. Prior to the program across all sites, more physicians than nurses were aware of the national recommendation regarding rotavirus vaccine. In the postprogram survey, however, more nurses were aware of the national recommendation and their provincial universal rotavirus vaccination program. Nurses had higher knowledge scores than physicians in the postprogram survey (p < 0.001). Parents of young infants were also more knowledgeable about rotavirus and rotavirus vaccine in the two areas where universal programs were in place (p < 0.001).ConclusionsImplementation of a universal rotavirus vaccination program was associated with an increase in knowledge and more positive attitudes toward rotavirus vaccine amongst parents of eligible infants. Nurses involved in a public health-delivered vaccination program were more knowledgeable and had more positive attitudes toward the vaccine than physicians in a jurisdiction where vaccine was physician-delivered.     

Providing long-term care benefits in cash: moving to a disability model

This paper examines the role of a disability approach to the allocation of long-term care benefits. It first highlights the important elements of long-term care that support a disability model. It then reviews the advantages and disadvantages of this approach relative to the traditional indemnity model and summarizes key features of selected domestic and international programs that offer a disability-type benefit. The paper identifies and elaborates on the major implementation challenges and concludes with a recommendation for further examination of the costs and benefits of this approach to the public coffers, the private market, and long-term care consumers.     

Suitable but requiring support: How the midwifery model of care offers opportunities to counsel the vaccine hesitant pregnant population

Uptake of vaccination during pregnancy in Canada is lower than comparator countries. A recommendation from a trusted perinatal healthcare provider is a key opportunity to promote vaccine uptake and improve confidence. This study aims to identify barriers and opportunities to vaccination in midwifery care. Seventeen semi-structured telephone interviews with practicing midwives, educators and public health professionals with immunization training experiences were conducted. Documents pertaining to the midwifery profession (approx. 50) were reviewed. Inductive thematic analysis identified logistical, interprofessional, and information barriers preventing Canadian midwives from administering vaccines and counseling clients about vaccination, as well as opportunities to address each barrier. Key interventions at the level of logistics, training, and client information materials would help address barriers to the integration of midwives into the provision and recommendation of vaccines in perinatal care across Canada.     

Bridging the gap between education and practice in public health, with particular reference to less-developed provinces in China

Ongoing healthcare system reform is one of the most important issues in China. There is an increasing awareness that public health education should be reformed to meet the demands of public health practice. This paper summarizes the current status of increasing public healthcare demand and public health service capacity in China, especially in less-developed provinces, and introduces the current public health educational system and public health administration structure. The paper also provides evidence for a considerable gap between public health education and practice, and suggests possible measures to bridge the gap.     

Changing geographic access to and locational efficiency of health services in two Indian districts between 1981 and 1996

In developing countries, including India, the role of the private sector in the provision of basic healthcare services is gradually expanding, since the public sector provides limited services and covers only limited areas. Using location-allocation models (LAM), this paper (1) examines the changing geographic access to and locational efficiency of basic public healthcare vis-à-vis private healthcare services in two districts located in northwestern part of India, and (2) interrogates the factors that govern their geographic accessibility and locational-efficiency. Although this research confirms regional inequalities in geographic accessibility and locational efficiency of both public and private healthcare services in the selected districts, the locational efficiency of private health services is significantly lower than that of public health services. This paper further demonstrates the use of LAM for new site identification (keeping the existing healthcare sites intact) that will, in the future, improve locational efficiency of these services. This paper not only recommends improved geographic access to both public and private health services and their enhanced complementary role, but also stresses the need to evaluate geographic access from the service-users' perspective and the use of more realistic data on demand and supply in future research. The findings of this paper can be extended to areas with similar geographic settings, and socio-economic and demographic conditions.     

“Chaplains for Wellbeing” in Primary Care: A Qualitative Investigation of Their Perceived Impact for Patients’ Health and Wellbeing

The growing importance of professional chaplains in patient-centered care has raised questions about education for professional chaplaincy. One recommendation is that the curricula of Clinical Pastoral Education (CPE) residency programs make use of the chaplaincy certification competencies. To determine the adoption of this recommendation, we surveyed CPE supervisors from 26 recently re-accredited, stipended CPE residency programs. We found the curricula of 38% of these programs had substantive engagement with the certification competencies, 38% only introduced students to the competences, and 23% of the programs made no mention of them. The majority of the supervisors (59%) felt engagement with the competencies should be required while 15% were opposed to such a requirement. Greater engagement with chaplaincy certification competencies is one of several approaches to improvements in chaplaincy education that should be considered to ensure that chaplains have the training needed to function effectively in a complex and changing healthcare environment.     

Conditional cash transfer programs and food and nutrition security

This paper analyses the relationship between Conditional Cash Transfer (CCT) programs and Food and Nutrition Security (FNS), based on a review of the literature. CCT programs spur outlays on food, particularly in dynamic markets, as well as investments in other goods affecting the nutritional wellbeing of families, including demands for healthcare and education. However, the impact on children's nutritional status and early childhood growth is not clear, as other factors also affect this process, such as: the availability of public services (healthcare; education; sanitation) and the costs of accessing them; duration of the programs; transfer amounts; family sizes and intra-family rules for allocating resources. The program implementation process also warrants analysis, as this may have positive or negative effects on values, social relationships and practices that may deepen poverty and undermine food and nutrition security. As it is vital to integrate CCT programs with other projects in order to ensure their impact on FNS, Brazil's National Food and Nutrition Security Council plays a strategic role through integrated policy planning in this field.     

Emergency management program operational responses to weapons of mass destruction: Veterans Health Administration, 2001-2004

BACKGROUND: Despite the recognition of chemical emergencies, terrorist events, and ongoing threats, little practical guidance exists for healthcare facilities. METHODS: An approach and materials developed by the Veterans Health Administration in a five-element program over the last 2 years to enhance the existing emergency management program is outlined. Nine steps to the development of a comprehensive all-hazards, emergency plan and program, with auditing and improvement tools are offered. RESULTS: Cognitive aids for clinical use are available on-line and in hard copy. A hazard assessment modeled patients as emission sources documenting the operations strategies under which level C personal protective equipment will protect healthcare workers. The development of this response program appears to support a broader, long-standing VHA approach to problem solving. This involves bringing together individual talented field staff, representing specific skills, geographic regions, and work styles; investing in face-to-face consensus development; and developing programs with extensive internal peer-review ("field-based," "bottom-up and top-down," and external reviews). CONCLUSIONS: Comprehensive and effective programs can be constructed at low cost with reasonable speed within large systems with a public mandate, leading to responsible use of public funds internally, and as models for private sector programs. It is the long-term operational cost implications, under budget constraints in health care, which often present the true challenge.