Primary Health Care in the United Arab Emirates

The aim of this paper was to assess some of the important variablefactors concerning health care in United Arab Emirates (UAE),with special emphasis on primary health care (PHC). Other aspectsconsidered are the population per bed, population per physician,population per dentist, population per pharmacist and populationper nurse, all of which influence health care delivery in theUAE. There is a gradual improvement in health status, whichcan be seen by the increase of life expectancy in both malesand females, and decrease in leading cause of death from infectiousdiseases. The health strategy of 1986–1991 has achievedits goals and has been reviewed and the new 5 year strategyhas been formalized to adopt some major aspects in the developmentof health care delivery. Overall results showed that every 1235people will be served by one physician and other health serviceindicators are bed/doctor 3.9; bed/nurse 1.3; population/dentist15 763; population/pharmacist 13 174; and population/nurse 438.Also, a very good coverage of PHC has been achieved throughoutthe country so that no more than 200 people live in an area>30 km away from health service or without a PHC clinic.All PHC clinics provide curative, preventive and promotive serviceswith a small percentage of rehabilitation services. The governmenthas adopted the PHC approach as the long-term strategy for achievingthe goal of health for all by the year 2000. This was supportedby the ministerial decree no. 139/86 in 1986. Recommendationsare also made for improving health services and performanceas well as better meeting the specific medical care needs ofthe people through expansion of PHC services.     

2008年全国妇幼保健机构职能履行现状分析

目的:通过对2008年全国2 767所妇幼保健机构的群体保健工作以及医疗保健技术服务的调查,掌握全国妇幼保健机构职能履行情况。方法:基于现代化的网络传输系统开发《全国妇幼卫生机构管理信息网络报告系统》,实现信息网络实时直报。结果:大部分妇幼保健机构开展了多项群体保健服务管理工作,医疗保健技术服务工作开展较顺利;辖区群体保健服务有待提高。结论:政府应加大对妇幼保健机构人力、物力、财力的投入,重视妇幼保健人才队伍的培养,完善妇幼卫生管理机制,促进妇幼保健机构规范化建设。     

Child care in Slovenia: an example of a successful transition

Slovenia is a country which has managed to retain most of its advantages and achievements in preschool child care attained in the socialist period, while, during the transition years, rather successfully reforming services according to principles of the market economy. The female activity rate has been high since the mid 1940s, and female employment has been the main factor influencing the demand for preschool child care services. Slovenian mothers work full-time and after 1 year of paid maternity and parental leave they mostly stay in the labour market. Child care facilities, 70% of them constructed in the period 1971-1985, are sufficient for almost 60% of the preschool population, and just a very small percentage of demand remains unmet. Child care services are traditionally highly subsidised. On average, parents finance up to a quarter of the current costs, so that the average in-kind transfer for a child in child care amounts to about 30% of the average net salary. Social assistance recipients are exempt from paying fees altogether, while the rest of the parents pay from 15% to 80% of the current costs. The highest fee is paid by families with a per capita income > 110% of the average salary in Slovenia. Research into the burden of parental fees for child care in Ljubljana in 1994 has shown that three-quarters of families spent between 5 and 15% of their total net income on child care (for one or more children). For three-quarters of families, the total of fees paid did not exceed 30% of their net income per family member. The lower middle income group was relatively most burdened by child care fees.     

Meeting Children's Mental and Physical Health Needs in Child Welfare: The Importance of Caregivers

Caregivers in the child welfare system are an important element in ensuring that mental and pediatric health services for their children are utilized appropriately. The high prevalence of mental and physical health problems of children in the child welfare system along with the inadequate utilization of health services make the role of caregivers essential for improving health outcomes. This article explores the barriers to meeting the health needs of this vulnerable population of children and how different types of caregivers (unrelated foster, kinship foster, and birth parents) utilize mental and pediatric health services. Child welfare caseworkers need to increase their communication with caregivers, assess adherence to health care recommendations, and help alleviate barriers to care.     

2010-2018年兰州市妇幼保健机构卫生资源配置情况分析

目的评价2010-2018年兰州市妇幼保健机构卫生资源配置的变化趋势,为兰州市妇幼卫生事业的可持续发展提供依据。方法对2010-2018年兰州市妇幼保健院上报的行政报表进行整理分析,计算其增长速度。结果兰州市妇幼保健机构各类资源总体呈增长趋势。床位数、卫生技术人员数和卫生总费用的定基比增长速度分别为218.10%、169.71%和524.07%,年平均增长速度分别为15.56%、13.20%和25.72%;卫技人员学历以本科及以上为主,职称以初级为主;门诊人次、住院人次、每名医生的门诊诊疗人次和承担的入院病人数的定基比增长速度分别为156.37%、242.68%、23.80%和65.47%,年均增速分别为12.49%、16.64%、2.70%和6.50%;每万人口床位数和卫技人员数9年间增长了149.26%、124.41%,年均增长12.96%、10.63%。结论 2010-2018年兰州市妇幼保健工作成绩显著,但仍需增加保健部技术人员,培养和引进高学历和高级职称人才。     

2014—2018年苏州市乙型病毒性肝炎流行病学特征分析*

目的 评价2010—2018年兰州市妇幼保健机构卫生资源配置的变化趋势，为兰州市妇幼卫生事业的可持续发展提供依据。方法 对2010—2018年兰州市妇幼保健院上报的行政报表进行整理分析，计算其增长速度。结果 兰州市妇幼保健机构各类资源总体呈增长趋势。床位数、卫生技术人员数和卫生总费用的定基比增长速度分别为218.10%、169.71%和524.07%，年平均增长速度分别为15.56%、13.20%和25.72%；卫技人员学历以本科及以上为主，职称以初级为主；门诊人次、住院人次、每名医生的门诊诊疗人次和承担的入院病人数的定基比增长速度分别为156.37%、242.68%、23.80%和65.47%，年均增速分别为12.49%、16.64%、2.70%、6.50%；每万人口床位数和卫技人员数9年间增长了149.26%、124.41%，年均增长12.96%、10.63%。结论 2010—2018年兰州市妇幼保健工作成绩显著，但仍需增加保健部技术人员，培养和引进高学历和高级职称人才。     

Imbalances in the health labour force: an assessment using data from three national health facility surveys

Accurate knowledge of the characteristics of the health labour force that can affect health care production is of critical importance to health planners and policymakers. This study uses health facility survey data to examine characteristics of the primary health care labour force in Nicaragua, Tanzania and Bangladesh. The characteristics examined are those that are likely to affect service provision, including urban/rural distribution, demographic characteristics, and experience and in-service training, for three types of providers (physicians, nurses and auxiliary nurses). The profiles suggest a pattern of urban/rural imbalances in Nicaragua and Tanzania. The Bangladesh facility survey did not include hospitals, thereby making concrete conclusions on the supply and distribution of providers difficult to make. Multivariate logistic regressions are used to assess the relationship between the urban/rural placement of providers by health need, population demand and facility characteristics. Health need, as measured by child mortality rates, does not have a significant association with the placement of providers in either country, unlike population size and annual growth rates. The mean number of years providers have worked at a facility is significantly associated with a decreased likelihood of rural placement for the three types of providers in Nicaragua. The mean age and percentage of female providers at each facility has a negative association with the placement of rural providers in Tanzania. The use of health facility data to profile the health care labour force is also discussed.     

流动人口生殖健康公共服务的内涵及政策分析

对我国流动人口生殖健康公共服务的内涵及我国流动人口生殖健康公共服务的相关政策法规进行了分析,并且从人力资源、经费投入及相关政策法规3个方面,分析了当前我国流动人口生殖健康公共服务存在的问题,并提出了促进我国流动人口生殖健康公共服务供给的建议。     

Nutritional interventions through primary health care: impact of the ICDS projects in India

In 1975 the Government of India initiated an integrated approach for the delivery of health care as well as nutrition and education services for deprived populations at the village level and in urban slums through centres, each of which was run by a local part-time female worker (anganwadi) who was paid an honorarium and had a helper. This national programme, known as the Integrated Child Development Services (ICDS), began with 33 projects but, by March 1986, had expanded to 1611 projects covering 23% of the country's population and representing about 50% of the population in the socioeconomically backward areas. The ICDS can therefore be considered to function as a primary health care programme for preschool children (under 6 years old), pregnant women, and lactating mothers. The present study investigated the impact on the nutritional status of the target population after 3-5 years and after 8 years of ICDS interventions, compared with the nutritional status of non-ICDS (control) groups. The results showed that the ICDS nutrition intervention programmes achieved better coverage of the target population and led to a significant decline in malnutrition among preschool children in the ICDS population, compared with the non-ICDS groups that received nutrition, health care and education through separate programmes. This example may lead other developing countries to introduce integrated programmes with certain modifications to suit local conditions. International agencies and national governments should strive to bring about the integration of nutritional services with primary health care and development programmes for children because of the good results in terms of child survival and child development.     

2006～2011年云南省各级妇幼保健机构能力建设现状分析

目的:分析2006～2011年云南省各级妇幼保健机构能力建设发展现状,为新医改进程中云南省妇幼保健机构的建设和发展提供依据。方法:通过全国妇幼保健机构年度监测网络直报系统,连续6年收集云南省各级妇幼保健机构资源与运营情况相关数据信息,采用对比分析的方法对云南省各级妇幼保健机构能力建设进行分析。结果:2006～2011年云南省妇幼保健机构在职职工总数、固定资产、业务收入、年门(急)诊人次及出院人次等方面都有较大的增长,增长率分别为18.8%、97.1%、168.7%、60.8%、72.1%。2011年全省平均每所妇幼保健机构以上指标分别为34.5人、450.1万元、262.8万元、29 338人次、624人次。结论:6年来,云南省各级政府和卫生行政部门不断加大对妇幼保健机构的投入,使妇幼保健机构在物力、财力及服务能力方面均有较大提高,但妇幼保健机构缺乏人才,基础设施相对落后,自身服务能力相对薄弱,妇幼保健特点不突出等问题仍然是阻碍云南省妇幼保健机构发展的"瓶颈"。     

广州市社区卫生服务机构妇幼保健工作现状及资源配置公平性研究

目的 探讨广州市社区卫生服务机构妇幼保健工作开展现状、资源配置情况及其公平性.方法 2010年12月至2011年2月,广州市妇幼保健院采用自行设计的<社区卫生服务机构及镇医院妇幼保健工作基本情况调查表>对广州市提供社区卫生服务机构进行普查,并运用Lorenz 曲线和Gini系数分析法,进行社区妇幼保健服务人力资源配置及其公平性进行评价.结果 广州市10个区及2个县级市,共计195家社区卫生服务机构接受调查,从业妇幼保健的人员共计735位.按照服务人口测算,社区卫生妇幼机构及妇幼保健人力资源配置的Gini系数分别为0.107,0.114;按照辖域面积测算,社区卫生妇幼机构及妇幼保健人力资源配置的Gini系数分别为0.509,0.598.按照辖域面积测算的Gini系数处于公平性配置警戒区域.结论 广州市社区卫生服务机构总体布局基本合理,达到国家覆盖人口设置标准,但公平性尚待改善,社区卫生服务人员结构仍尚待改善.     

Health promotion and disease prevention strategies.

The rapid growth and relative youth of the Latino population of the United States, soon to become the largest ethnic-racial group in the country, presents numerous opportunities and a special challenge to those concerned with the health and well-being of this segment of people. The challenge is to develop and implement efficacious strategies for improving Latino health at a time when the overall socioeconomic profile of this population is in striking contrast to that of the rest of the American people. Much can be done to improve Latino health by implementing health promotion and disease prevention interventions designed to achieve Latino parity in reaching year 2000 national health care objectives. The problems encountered by Latinos in obtaining health promotion and disease prevention services, previous recommendations on how these problems could be addressed, and new strategies for implementing more effective services for Latinos are summarized.     

Early-age mortality, socio-economic development and the health system in Mongolia

Since the 1920s Mongolia has developed an extensive and well-staffed health care system that has made modern health technologies accessible to most of its population. In addition, the country experienced rapid economic and social development whose benefits were equitably distributed among the population. In spite of this progress, infant and child mortality levels are high by contemporary standards and during the past 20 years these rates have remained virtually constant. The modern health care delivery system, externally imposed, failed to take into account the specific characteristics of the Mongolian culture; this fact is identified as one of the major determinants of the unexpected levels of early-age mortality. The excessive orientation toward curative medicine, the lack of health prevention and promotion activities and the lack of community participation have resulted in the people continuing to believe in traditional therapeutic patterns and self-care. They perceive the modern system exclusively in curative terms and not with regard to health preservation and disease prevention. Most Mongolians do not fully understand the health care system, and use its services mainly because they have no alternative, or because of coercion rather than conviction based on the learning and internalization of its basic principles. In practices and ideas of child care, preservation of health and disease prevention, people seem to identify more with the traditional health care system. Like other former socialist countries, Mongolia is experiencing deep economic and social transformations, whose implications for the health care system are discussed. An economic crisis whose end is nowhere in sight, emergent social inequalities, a vague health insurance model with unclear financing sources, and lack of concern by most policy-makers in strengthening the preventive component of the health system, are not positive factors for substantial infant and child mortality decline in the near future. A clear advantage is, however, the fact that there is a wide space for major improvements with existing internal and external resources.     

Equity in access to maternal and child health services in five developing countries: what works

People living in rural areas are yet to have equitable access to maternal and child health services in many developing countries. This article examines selected health service delivery models that improved access to services in five developing countries. The article is based on the review of background papers on Bangladesh, Pakistan, Cambodia, Ghana, and Tanzania, prepared as part of a multi-country study on health systems and maternal and child health. Findings suggest that equity in access to health services largely depends on a system that ensures a combination of facility-based service delivery and outreach services with a functioning referral network. A key factor is the availability of health workforce at the community level. Community-based deployment of service providers or recruitment and training of community health workers is critical in enhancing service coverage and linking local populations to a health facility. Incentive is necessary to keep community health workers' interest in providing services. However, health workforce alone cannot ensure good health outcomes. They must be embedded in a functioning service delivery network to transform structural inputs into outcomes. Moreover, local-level health systems should have the ability to allocate resources in strategic ways addressing the pressing health needs of the people.     

Models of Preconception Care Implementation in Selected Countries

Globally, maternal and child health faces diverse challenges depending on the status of the development of the country. Some countries have introduced or explored preconception care for various reasons. Falling birth rates and increasing knowledge about risk factors for adverse pregnancy outcomes led to the introduction of preconception care in Hong Kong in 1998, and South Korea in 2004. In Hong Kong, comprehensive preconception care including laboratory tests are provided to over 4000 women each year at a cost of $75 per person. In Korea, about 60% of the women served have known medical risk history, and the challenge is to expand the program capacity to all women who plan pregnancy, and conducting social marketing. Belgium has established an ad hoc-committee to develop a comprehensive social marketing and professional training strategy for pilot testing preconception care models in the French speaking part of Belgium, an area that represents 5 million people and 50,000 births per year using prenatal care and pediatric clinics, gynecological departments, and the genetic centers. In China, Guangxi province piloted preconceptional HIV testing and counseling among couples who sought the then mandatory premarital medical examination as a component of the three-pronged approach to reduce mother to child transmission of HIV. HIV testing rates among couples increased from 38% to 62% over one year period. In October 2003, China changed the legal requirement of premarital medical examination from mandatory to “voluntary.” This change was interpreted by most women that the premarital health examination was “unnecessary” and overall premarital health examination rates dropped. Social marketing efforts piloted in 2004 indicated that 95% of women were willing to pay up to RMB 100 (US$12) for preconception health care services. These case studies illustrate programmatic feasibility of preconception care services to address maternal and child health and other public health challenges in developed and emerging economies.     

安徽省县级妇幼保健机构孕产期保健与资源配置的相关性研究简

目的了解安徽省104个区、县妇幼保健机构的孕产期保健和资源配置现况以及两者的相关性。方法运用网络报告系统将妇幼保健机构数据实时填报,描述机构内的孕产期保健服务和辖区内的部分孕产期保健指标现况以及资源配置情况,并进行比较和相关分析。结果区级机构中开展各项孕产期保健服务的构成比均低于80.0%,区、县的孕早期检查率分别为64.7%和55.9%,孕产妇系统管理率分别为61.3%和52.7%。结论县级妇幼保健机构孕产期保健服务整体水平较低,孕产期保健服务水平与人财物资源存在不同程度的相关性。     

Differences in the Use of Primary Care Services Between Spanish National and Immigrant Patients

Knowing what real use is made of health services by immigrant population is of great interest. The objectives are to analyze the use of primary care services by immigrants compared to Spanish nationals and to analyze these differences in relation to geographic origin. Retrospective observational study of all primary care visits made in 26 urban health centers. Main variable: total number of health centre visits/year. Dependent variables: type of clinician requested; type of attention, and origin of immigrants. The independent variable was nationality. Statistics were obtained from the electronic medical records. The 4,933,521 appointments made in 2007 were analyzed for a reference population of 594,145 people (11.15 % immigrants). The adjusted annual frequency for nationals was 8.3, versus whereas 4.6 for immigrants. The immigrant population makes less use of primary care services than national population. This is evident for all age groups and regardless of the immigrants’ countries of origin. This result is important when planning health care resources for immigrant population.     

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。     

Kinderschutz und Frühe Hilfen aus Sicht der Kinder- und Jugendmedizin

Demands for prevention in the areas of child protection, child development and early education are increasingly being discussed in the health care system, social services and the educational and school system. Concepts in health care include health promotion, risk assessment and primary and secondary prevention. Child protection promotes strategies such as early social support services and at-risk screening and educational systems advocate early intervention and concepts to enhance child development. The complexity of children's developmental needs and their living environments require a comprehensive approach of all three systems and integration of services and interventions. Each child's needs must be individually analysed and services tailored appropriately. A case vignette demonstrates and analyses typical problems of interacting systems. A systemic view of systems of care allows planning of efficient and sustainable social and health care policies.     

The service system at the crossroad of demography and policy making--implications for the elderly

In many countries today, there is an ongoing debate regarding health in 'crisis'. Each country seems to experience a crisis regardless of the level of expenditures in the field of social and health services. This article discusses different influences that affect social and health service systems in relation to the elderly, and brings up the controversy concerning the elderly as a threat to available resources in society. Most examples are based on Swedish sources, but some American and British sources are used as well. Borrowing from the age stratification model, the concepts role and cohort are used as analytical concepts. The role concept is discussed in relation to the development of organizations for retired people. The analysis offered little support for the thesis that the elderly would attain a power position. Thus, a demand for societal resources by means of political strength is less feasible. When looking at the elderly from the cohort perspective, the article includes a discussion of the interdependent forms of care for the elderly; self-care, informal care and formal care. Although great challenges await social and health services systems in this respect, the article concludes that any possible crisis in health and social service systems is socially constructed and not a deterministic effect of demography as such.