广西壮族自治区乡镇卫生院严重精神障碍健康管理人员现况调查

背景　乡镇卫生院严重精神障碍健康管理人员（精防人员）是农村精神卫生工作防治网络的坚实基础，是保障农村精神卫生防治工作顺利进行的基本力量，了解其现况具有重要意义，但目前鲜见相关文献报道。目的　了解广西壮族自治区乡镇卫生院精防人员人力资源概况及其存在的问题。方法　2018年1—6月按广西壮族自治区地理位置将其分为5层，每一层按经济发展水平（人均GDP）好、中、差的标准随机抽取3个县，每个县采用系统抽样的方法抽取3个乡镇，每个乡镇卫生院选取当天在岗并且从事精防工作半年及以上的 精防人员为调查对象。采用自制调查问卷调查乡镇卫生院的基本情况、严重精神障碍健康管理工作开展情况以及精防人员的基本情况、工作情况和薪酬情况等。结果　本次调查的45所乡镇卫生院中，服务人口4 274~110 043人，平均（34 328.2±20 135.4）人。每家乡镇卫生院服务覆盖行政村数4~29个，平均（12.2±5.8）个。45所乡镇卫生院均未设置精神卫生专业科室，但95.6%（43/45）的乡镇卫生院建立了精神疾病管理办公室，负责辖区严重精神障碍健康管理工作，其余乡镇卫生院由公共卫生科负责。本次共调查精防人员102名，其中男44名（43.1%），女58名（56.9%）；年龄20~55岁，平均年龄（34.3±8.9）岁；职称：副高级以上8名（7.8%），中级22名（21.6%），初级或待聘72名（70.6%）；学历：本科17名（16.7%）、大专50名（49.0%），中专或高中35名（34.3%）；受教育专业：临床医学42名（41.2%），护理学26名（25.5%），药学14名（13.7%），预防医学4名（3.9%），非医学专业16名（15.7%），无精神医学专业人员；从事精防工作年限0.5~10.0年，平均（4.8±6.3）年。专职从事精防工作人员27名（26.5%），兼职从事精防工作人员75名（73.5%）。45所乡镇卫生院共投入精防人员培训经费10.5万元，平均0.23万元。精防人员每周平均工作时间为（43.6±6.0）h，52.0%（53/102）的精防人员每周工作时间>40 h。45.1%（46/102）的精防人员对承担工作很满意或比较满意。精防人员月均收入2 500~6 500元，平均（3 380.5±1 004.9）元。7名（6.9%）对薪酬很满意，18名（17.6%）比较满意，49名（48.1%）一般，19名（18.6%）不太满意、9名（8.8%）很不满意。结论　乡镇卫生院精防人员职称学历不高，专职人员缺乏，人员流动性大，人力配置不足，人员专业结构有待进一步优化。精防人员培训经费少，缺乏专业进修学习；工作时间长，工作满意度低；工资收入不高，薪酬满意度低。

Situation of Health Managers for Severe Mental Disorders of Township Health Centers in Guangxi Zhuang Autonomous Region

Background The severe mental disorder health manager(SMDHM)of Township Health Centers(THCs)in Guangxi Zhuang Autonomous Region is a solid foundation for the network of rural mental health prevention and treatment(MHPT),and is the most basic force for ensuring the smooth progress of rural MHPT.So the investigation of the SMDHM has positive practical significance.And there are few related references and reports at present.Objective To understand the general situation and existing problems of SMDHMs in Guangxi THCs.Methods Forty-five THCs in Guangxi were selected by stratified random sampling.A self-designed questionnaire was used to investigate 102 SMDHMs in THCs.Results In the 45 THCs surveyed,there were 4274 to 110043 people in service,with an average of(34328.2±20135.4).The number of villages served by each THC was 4 to 29,with an average of(12.2±5.8).None of the 45 THCs had set up mental health department,but 95.6%(43/45)of the THCs have set up mental disease management office,which is responsible for the management of serious mental disorders in their jurisdiction,and the rest of the THCs let the public health department in charge of it.In this survey,we investigated 102 SMDHMs.Of them,44(43.1%)were males and 58(56.9%)were females.Age rang was 20-55 and the average of age was(34.3±8.9).For title,8(7.8%)had senior professional title,22(21.6%)were intermediate level and 72(70.6%)were primary or to be employed.For education background,17(16.7%)were undergraduate,50(49.0%)were junior college,35(34.3%)were secondary or high school.For education major,42(41.2%)were clinical medicine,26(25.5%)were nursing,14(13.7%)were pharmacy,4(3.9%)were preventive medicine,16(15.7%)were nonmedical specialty,and there were no psychiatry professionals.The working life of MHPT was 0.5 to 10 years,with an average of(4.8±6.3)years.There are 27(26.5%)full-time workers and 75(73.5%)part-time workers for MHPT.A total of 105000 yuan was invested in training SMDHMs in 45 sample THCs with an average of 2300 yuan each.The average working time of SMDHMs was(43.6±6.0)h per week,and 52.0%(53/102)SMDHMs worked more than 40h per week.45.1%(46/102)of the SMDHMs were satisfied with their work.The average monthly income of SMDHMs was 2500-6500 yuan,with an average of(3380.5±1004.9)yuan.7(6.9%)SMDHMs were very satisfied with the salary,18(17.6%)were relatively satisfied,49(48.1%)were average,19(18.6%)were satisfied,and 9(8.8%)were very dissatisfied.Conclusion SMDHMs in THCs are mainly young and middle-aged,with low professional titles and low educational background,lack of full-time staff,high mobility and inadequate manpower allocation.The professional structure of personnel needs to be further optimized.The training funds are low and there is a lack of professional further study.Working hours are long and job satisfaction is low.The salary income is not high and the salary satisfaction is low.