基层和公共卫生人员工作行为影响因素分析

目的：分析我国城乡基层和公共卫生人员工作行为影响因素,为建立合理有效的基层和公共卫生人员激励机制提供依据。方法：对样本村卫生室、乡镇卫生院、县疾病预防与控制机构、社区卫生服务机构所有在岗医生、护士、公共卫生人员进行问卷调查,共调查1020名城乡基层卫生人员。结果：基层和公共卫生人员除了看重经济收入和福利等经济激励因素外,对工作条件、职业发展状况、群众的认可和尊重等非经济激励因素也非常重视。不同属性的基层和公共卫生人员具有不同的行为影响因素偏好。结论：在保证基层和公共卫生人员收入和福利改善的基础上,重视提供良好的工作环境和职业发展平台,并且加强执业保护和医德建设。     

绵阳市涪城区基层医疗卫生机构人力资源调查

目的了解绵阳市涪城区社区卫生服务中心和乡镇卫生院人力资源现状,为合理建设基层医疗卫生机构提供依据。方法通过问卷调查的方式对绵阳市涪城区全部社区卫生服务中心和乡镇卫生院的人力资源情况进行调查,采用统计软件SPSS13.0对数据进行统计分析。结果绵阳市涪城区社区卫生服务中心卫生人员平均55名,乡镇卫生院卫生人员平均21名。社区卫生服务中心、乡镇卫生院卫生人员主要以女性为主占62.8%,25～35岁卫生人员占35.6%。结论绵阳市涪城区基层医疗卫生机构人力资源缺乏、专业结构需要调整、学历有待提高、配置需要改善。     

2015 重点任务关键词

<正>基本药物制度与基层运行新机制有序推进非政府办基层医疗卫生机构和村卫生室实施基本药物制度,完善基层用药管理。启动实施社区卫生服务提升工程,制定进一步规范社区卫生服务管理的指导意见。扩大全科医生执业方式和服务模式改革试点。深入推进乡镇卫生院综合改革,扎实开展建设群众满意的乡镇卫生院活动。加强村医培训,推动地方出台养老等政策,稳定和优化村医队伍。     

四川省城乡基层公共卫生人力资源现状研究

目的 通过调查四川省城乡基层公共卫生人力资源的现状,分析其存在的问题,为促进四川省城乡基层公共卫生人力的发展提供参考建议。方法 通过现场调研、个人及小组访谈、数据统计分析等定性研究与定量研究相结合的方法分析现状及问题。结果 四川省基层医疗机构中具有公共卫生执业医师资格的人员仅占1.16%;防保公卫科人员在社区卫生服务中心、中心乡镇卫生院和一般乡镇卫生院人员中所占的比例分别仅为19.02%、9.56%、10.70%;从事公共卫生服务工作年限在5年以上的人员仅占18.17%;社区卫生服务中心、乡镇卫生院公共卫生主题培训人次数分别仅占所有培训人次数的6.32%和9.66%。结论 四川省城乡基层公共卫生人力资源配置有待完善;四川省城乡基层公共卫生项目培训需求不一;四川省公共人员卫生经费政策有待进一步完善。建议从营造环境、稳定人才,重视培训、提升能力,完善人员经费管理方面改善现状。     

湖州市乡镇卫生监督协管工作情况调查

目的了解湖州市乡镇卫生监督协管工作模式,为乡镇基层卫生和计划生育行政执法职能的整合提供依据。方法采用问卷调查和定性访谈相结合的方式,对湖州市5个县(区)的39个乡镇的卫生监督协管工作现状进行调查和分析。结果 39个乡镇均在乡镇卫生院(社区卫生服务中心)设立卫生监督协管站;卫生监督协管人员88人,平均每个乡镇2.26人,均为卫生院(社区卫生服务中心)公共卫生科兼职人员,其中45人持卫生监督协管证上岗,协管员配备0.49人/万人;共配备乡镇计生机构计生管理员188人,平均每个乡镇4.80人,其中164人持行政执法证上岗,计生执法人员配备1.79人/万人。各乡镇卫生监督协管站均在各县(区)卫生计生局领导下,由各县(区)卫生监督所安排具体的年度卫生监督协管服务工作。结论湖州市乡镇卫生监督协管人员队伍建设有待加强;应进一步整合乡镇基层卫生和计划生育两个系统的监督执法资源,健全乡镇基层卫生监督执法网络。     

应用加权TOPSIS法综合评价甘肃省基本公共卫生服务质量

目的应用加权TOPSIS法评价甘肃省2016年基层医疗卫生机构基本公共卫生服务质量,为提高基本公共卫生服务质量提供参考。方法采用两阶段随机抽样法,抽取甘肃省12个县(市/区),再从每个县(市/区)中随机抽取4~5个基层医疗卫生机构作为样本点进行现场调查,对健康档案、健康教育、预防接种、重点人群管理、中医药健康管理、传染病及突发公共卫生事件报告和处理、卫生计生监督协管管理、家庭医生签约情况等21项工作进行评价,应用加权TOPSIS法综合评价样本点的基本公共卫生服务质量。结果共纳入44家基层医疗卫生机构作为研究对象(Y1~Y44),其中Y4、Y8、Y11、Y13、Y20、Y23、Y25、Y34、Y37和Y41为社区卫生服务中心,其他34家为乡镇卫生院。44家基层医疗卫生机构的Cj值平均为42.81,社区卫生服务中心和乡镇卫生院的Cj值平均数分别为39.44和43.80;Y18的Cj值最高,为68.02;Y23的Cj值最低,为26.31;排名前五位的机构为Y18、Y1、Y40、Y35和Y33,均为乡镇卫生院;排名后五位的机构为Y16、Y31、Y24、Y13和Y23。结论 2016年甘肃省基层医疗卫生机构国家基本公共卫生服务工作质量存在差距,乡镇卫生院总体优于社区卫生服务中心。     

成都天府新区直管区乡镇卫生院/社区卫生服务中心卫生资源配置公平和效率分析

目的分析成都天府新区直管区乡镇卫生院/社区卫生服务中心卫生资源配置情况,为成都天府新区直管区卫生行政部门进一步优化基层医疗机构卫生资源配置提供可靠依据。方法使用洛伦兹曲线、基尼系数对天府新区直管区2015年乡镇卫生院/社区卫生服务中心卫生资源按人口和地理的公平性进行评价,使用数据包络分析(DEA)对天府新区直管区2015年乡镇卫生院/社区卫生服务中心进行效率分析。结果天府新区直管区乡镇卫生院/社区卫生服务中心执业(助理)医师、注册护士、床位按人口配置的基尼系数分别是0.05、0.10和0.17,按地理配置的基尼系数分别是0.38、0.42和0.20。产出按2015年基本医疗和基本公共卫生服务总量计算,2所机构卫生资源配置总体DEA有效;按基本医疗服务计算,5所机构的卫生资源配置DEA总体有效;按基本公共卫生服务计算,2所机构卫生资源配置DEA总体有效。结论成都天府新区直管区乡镇卫生院/社区卫生服务中心卫生资源配置总体比较公平,卫生资源按人口配置优于按地理面积配置;基层医疗机构基本公共卫生服务卫生资源配置效率有待提高。     

补偿和激励政策变化对乡镇卫生院人员收入和医疗服务提供的影响

目的:分析基层卫生综合改革以后补偿与激励政策变化对乡镇卫生院卫生人员收入和医疗服务提供的影响。方法:资料来源于安徽省3个县的机构调查和关键知情者访谈,利用描述性方法分析数据。结果:2009～2010年,样本地区乡镇卫生院财政补助收入构成比平均从10.93%增长到44.37%;卫生人员人均年收入环比增长11.03%,同时收入差距在减少;医疗服务提供的数量明显下降,其中门诊服务量降幅较小,住院服务量降幅较大。结论:基层卫生综合改革以后,虽然卫生人员收入有所提高,但政府全额补助下的绩效工资制度缺乏足够的激励作用,乡镇卫生院服务量出现了不同程度的萎缩。     

吉林省基层医疗卫生机构卫生资源配置情况分析

目的分析2011~2015年吉林省基层医疗卫生机构卫生资源配置现状,发现当前存在的问题、不足,为建立系统完善、高效灵活的基层医疗卫生机构资源配置体系提供理论依据。方法采用普查的方法,对吉林省基层医疗卫生机构2011~2015年卫生资源配置现状展开调查,利用Excel2010进行数据二次处理,通过SPSS18.0软件进行统计分析。结果物力资源配置方面,各类基层医疗卫生机构数、平均床位数趋于平稳。平均万元以上设备数量中,社区卫生服务中心(站)和乡镇(街道)卫生院逐年增长;人力资源配置方面,社区卫生服务中心和乡镇(街道)卫生院及各类人员配置较多,增长明显;卫生经费配置方面,社区卫生服务中心(站)和乡镇(街道)卫生院财政补助和上级补助中最多且逐年增长,村卫生室上级补助增长明显。结论卫生资源配置情况2012年明显增长,2013年至2015年平稳增长。社区卫生服务中心(站)和乡镇(街道)卫生院在物力资源配置、人力资源配置、卫生经费配置方面明显优于其他基层医疗卫生机构。村卫生室卫生服务工作量大,卫生资源配置尚不能满足卫生服务需求。     

中西部基层中医药人员现状调查及政策建议

目的分析中西部4个典型地区的基层卫生服务机构中医药人员结构情况,对今后中西部地区中医药人员队伍发展提出建议。方法全样本问卷调查4个典型地区独立核算的乡镇卫生院和社区卫生服务中心,访谈机构管理者和医生。结果社区卫生服务中心和乡镇卫生院的中医药服务人员总量偏少,中医药服务人员的职称和学历层次偏低,基层卫生服务机构的年轻中医药人员技术不过硬。结论应充实并稳定中医药队伍,加强基层中医医生的在职继续教育,提高基层年轻中医医生的医疗服务水平。     

The Organizational Structures and Human Resources Allocation of Infectious Disease Surveillance System in Rural China

Objective

To understand the structure and capacity of current infection disease surveillance system, and to provide baseline information for developing syndromic surveillance system in rural China.

Introduction

To meet the long-term needs of public health and social development of China, it is in urgency to establish a comprehensive response system and crisis management mechanism for public health emergencies. Syndromic surveillance system has great advantages in promoting early detection of epidemics and reducing the burden of disease outbreak confirmation (1). The effective method to set up the syndromic surveillance system is to modify existing case report system, improve the organizational structures and integrate new function with the traditional system.

Methods

Since August 2011, an integrated syndromic surveillance project (ISSC) has been implemented in China. Before the launching of the project, a cross-sectional study was carried out in Fengxin County and Yongxiu County of Jiangxi province during October 11 to 18, 2010. Institution information were investigated in the county hospital, township hospital and County Center for Disease Control and Prevention (CDC) to understand the performance of existing case report system for notifiable infectious diseases with regard to its structure, capacity and data collection procedure. Health care workers from each township hospital and village health station were questionnaire interviewed for information on qualification of human resources, basic healthcare delivery condition, hardware and software needs for ISSC.

Results

An internet-based real-time (quasi real-time) case report system for notifiable infectious diseases, based on the three-tier public health service System, had been established in these two counties since 2004. The farthest end of net user in case report system was township hospital. Blood routine test, urine routine test, B ultrasound and electrocardiogram were available in all township hospitals. There was no laboratory equipment in village health stations in these two counties. All the township hospitals in these two counties were equipped with land-line telephones and desktop computers. The internet covers all township hospitals in both counties. Most clinical doctors in township hospital(TH) and village health station(VHS) were male. The age of doctors ranged from 21 to 72 years old, with the average at 42 and median at 40 years. The village health workers were significantly older, less educated and served in health care longer than the township hospital doctors. In Yongxiu County, 95.6% of the village health stations were equipped with computers, including private-owned computers, and 80.7% of them had access to the internet; while in Fengxin County, 66.5% of the village health stations possessed computers, among which most were private property of village doctors, and only 44.2% of them had access to the internet.

Conclusions

The current case report system, with full coverage and stable human resource, has established a solid basis for developing syndromic surveillance system in rural China. The syndromic surveillance system could play its role in early detection of infectious disease outbreaks in rural area where laboratory service for infectious disease diagnosis are not available. However, the lack of computerized patient registration in village and township health care facilities and incomplete internet coverage in rural area and relatively low quality of human resource in village level should be taken into consideration seriously before establishing the syndromic surveillance system in rural China.     

大学生村医定向培养有效提升山区基层卫生服务能力

基层卫生服务能力薄弱是阻碍农村卫生发展的关键。湖北省宜昌市五峰土家族自治县以当地基层卫生发展问题为导向,实施大学生村医定向培养项目。通过本土化、系统性和可持续性的村医定向培养,不仅能稳定基层卫生人才队伍,还能定向培养乡情因素、针对性的培训指导、畅通的晋升渠道和稳定的收入保障,让大学生村医能够安心基层工作。基层卫生服务能力在大学生村医的补充下,得到显著提升,群众获得感更强。     

乡村一体化制度下村医薪酬与待遇定性研究

目的：了解乡村一体化制度下村医的薪酬与待遇现状。方法：使用定性调查,同时结合文献和政策文件,进行典型案例分析。结果：宁夏回族自治区和江苏省的乡村一体化管理模式各有特色。宁夏村医收入来源主要为政府补助和公共卫生经费;江苏省则以业务收入为主。在宁夏,乡镇卫生院对村卫生室的各项工作考核后发放政府补贴与公共卫生经费;江苏省村医的收入统一上交给乡镇卫生院管理,经考核后按照统一比例返还。两省村医收入水平在村里属于中等水平,大多数村医仍处于半农半医状态。两省村医都参加了当地的新型农村合作医疗;江苏省已解决村医的养老问题,而宁夏仍然没有解决。两省村医都以中老年为主,年轻人流出较多,流入不足,稳定性不高。讨论和建议：尽快明确村医身份,保障村医的合法权益;因地制宜,采取多种方法,提高村医收入;推进村医养老问题的解决,避免人才流失和村医空白。     

农村基层医疗卫生机构视力检查服务提供与利用

目的:分析农村基层医疗卫生机构视力检查服务的可及性对居民视力检查服务利用的影响。方法:利用医疗卫生机构和农户调查数据,采用描述统计和多元回归分析。结果:样本中33.2%的居民自报告视力不良,22.1%的居民曾做过视力检查,86%样本乡镇的卫生院和44%样本村的村卫生室可以提供视力检查服务;回归结果显示,乡镇卫生院提供视力检查服务将显著增加居民进行视力检查的可能性,但村卫生室是否提供视力检查服务对居民视力检查的利用没有显著影响。结论:农村居民对视力检查服务需求很大,但是利用率低。基层医疗卫生机构服务供给不足可能是导致农村居民服务利用率低的重要因素。建议国家继续推进基本公共卫生服务,加强基层医疗卫生服务机构开展基本视力检查的能力,促进农村居民对视力检查服务的利用,改善农村居民视力健康水平。     

欠发达地区门诊患者就诊机构选择及影响因素——基于我国西部地区县级医院及乡镇卫生院的实证研究

目的:调查西部农村地区医疗机构门诊患者治疗常见病的就诊机构选择,并分析其影响因素。方法:研究收集我国西部11省的县级医院和乡镇卫生院门诊患者常见病就诊机构选择情况,采用非条件无序多分类logistic回归和卡方检验分析就诊选择的影响因素。结果:共纳入4 233名样本,其中45.5%选择乡镇卫生院。样本来源机构、省份和受访者性别、教育程度、职业、月收入、医保类型等自身因素对患者的选择意愿有显著影响。就诊机构的"距离"、"收费的合理性"、"医务人员服务态度"及"医务人员技术水平"是就诊选择的主要外部原因。结论:男性、务农务工群体、教育程度较低、收入较低的患者,倾向于在级别较低的医疗机构就诊;农村居民对村卫生室的医疗需求多为方便、及时,对较高级别的医疗机构(如县级及以上医院)的需求则定位于更好的服务态度和技术水平,因此村卫生室、乡镇卫生院应更注重提高基本医疗服务的可及性,而县级及以上医疗机构应着眼于提升医疗服务水平、改善患者的可负担性及满足患者较高层次的卫生服务需求。     

How much is not enough? Human resources requirements for primary health care: a case study from South Africa

OBJECTIVE: To quantify staff requirements in primary health care facilities in South Africa through an adaptation of the WHO workload indicator of staff needs tool. METHODS: We use a model to estimate staffing requirements at primary health care facilities. The model integrates several empirically-based assumptions including time and type of health worker required for each type of consultation, amount of management time required, amount of clinical support required and minimum staff requirements per type of facility. We also calculate the number of HIV-related consultations per district. The model incorporates type of facility, monthly travelling time for mobile clinics, opening hours per week, yearly activity and current staffing and calculates the expected staffing per category of staff per facility and compares it to the actual staffing. FINDINGS: Across all the districts there is either an absence of doctors visiting clinics or too few doctors to cover the opening times of community health centres. Overall the number of doctors is only 7% of the required amount. There is 94% of the required number of professional nurses but with wide variations between districts, with a few districts having excesses while most have shortages. The number of enrolled nurses is 60% of what it should be. There are 17% too few enrolled nurse assistants. Across all districts there is wide variation in staffing levels between facilities leading to inefficient use of professional staff. CONCLUSION: The application of an adapted WHO workload tool identified important human resource planning issues.     

北京某郊区县卫生防疫系统现况调查

目的了解基层卫生防疫系统的现状，为完善卫生防疫体系以应对今后可能的突发公共卫生事件提供依据。方法采用机构考察、个人访谈、问卷调查等定性与定量研究相结合的方法，于2003年5—6月，对北京市某郊区县疾病控制中心(CDC)及17所乡级卫生院的卫生防疫系统现状进行调查。结果防保科承担本辖区内的儿童保健、计划免疫、精神卫生、传染病防治、流行病学调查、卫生宣教等日常工作；防保人员70％左右的工资需单位自筹。防保人员占总业务人员比例5％及以下的占41．2％；各乡卫生院防保人员占服务人口的比例为平原乡平均1．7人／万人，少或半山乡1．6人／万人，山区乡2．6人／万人；平原乡防保人员年纪轻、学历高、多受过相关专业训练．山区乡防保人员年龄偏大、均为中专学历，57．1％为非预防医学专业毕业、42．9％为非医学专业毕业人员经培训后从事防保工作。结论该地需要进一步明确区、乡两级预防保健系统的职能，工作中急需得到政府部门的理解与配合；区、乡两级预防保健系统资金及防保人员不足、专业人才匮乏问题有待解决。     

Utilization of maternal care in rural HeBei Province, the People's Republic of China: individual and structural characteristics

PURPOSE: To study the effect of individual's socio-economic characteristics and the structure of the health services in the village on utilization of maternal care in rural HeBei, the People's Republic of China (PRC). DATA: Data were collected from 4273 women who gave birth to one child at least, living in a stratified sample of 288 villages in HeBei Province. FINDINGS: 54.8% of the women had at least one pre-natal care visit, 27.5% gave birth in a health care facility, and 18.1% had post-natal check-up. Utilization was inversely related to age and parity and positively to education. Occupation was related to use of pre- and post-natal services, but not to home birth. Per-capita income and living arrangement are not related to utilization. MCH worker in the village promote pre- and post-natal care, but also home delivery. Village doctors promote pre-natal care and hospital delivery but do not promote post-natal check-up. Women tend to avoid the maternal services in the township health centers but some are ready to travel to city hospitals for delivery and post-natal care. CONCLUSIONS: Health education programs regarding the importance of all three maternal care services are clearly needed. These programs should address not only women of child bearing age but also care providers, MCH workers in particular. Township health center should reach-out and motivate women to use their accessible services.