The Study On Strategy Of Improving On CHS Public Health Function

Aim: It is one of main approaches to achieve harmonious society, improve health status and health equity by developing community health services. So it is essential to improve public health function of community health services. Through analysis the implementation of public health and factors that influenced public health function implementation in CHC, The study will make some advices on management system, operation system and resource allocation, which would spur CHC to implement public health function. To explore the system harmony among departments and among health system, and gain the ends of improvement in CHS function in a district area; Under current system condition, To explore re-combination health resources and clarity function and services contents in different level public health departments, and gain the ends that achieve the function join in different level departments, improve CHS public health function, enhance health resource utilization efficiency, and promote CHS development.Methods: After collection relative literatures, the study surveyed on site, surveyed the departments of health, Center of Disease Control, Women And Children Health Care Center in municipal and district level, Community Health Center in ten different district and different size and different economics level cities. The survey use qualitative analysis study(investigate, group debate focus on special, group debate on selection ) and quantitative analysis study(general statistic description, one-way analysis, x~2 test, multi-factors correlation analysis, multi-factors LOGISITIC regression), to explore main factors which influence CHS accomplish public health function. And through systemic analysis the data, aim at these influence factors, put forwards advices and strategy to improve the public health function in CHS.The study approved: It makes great progress since the government decided to develop CHS in 1999. At the same time, it is poor in accomplishing the public health function in CHS. Embody: (1) In quantity level, the public health function in CHS did not extend from "six function" to others, did not achieve the network base function of public health system. (2) In quality level, it has limitation in achieving the public health function in CHS, it is not enough in the profundity of public health. (3) The people in departments of health, public health organizations and CHS all think that basic public health function should be achieve in CHS, and it shows the feasibility from the resource needed to achieve public health function; (4) Many factor restricted the implementation of public health function, the main influence factors: (1) The national devotion is deficiency; (2) The policies fulfilled is not good; (3) The government did not attach enough importance to CHS; (4) The function orientation was clear in health system; (5) society worked in bad coordination; (6) Poor understanding in resident.Through the study, we think: Under the background of putting development CHS as an breach of health system reform in cities, to improve the CHS public health function, the government should charity the CHS function orientation, exert macro-regulation, make positive policies to utilize health resource efficiently and promote CHS development. Through the systemic analysis on the implementation of CHS public health function and the influence factors, we make four recommendations to improve CHS public health function: 1,Make CHS function frame:①Put CHS into public health system. To achieve CHS development aim is a availability ways that the government perform its health responsibility, maintain health equity, meet basic health demands. So to development CHS, the most important thing is to make the CHS character clear, and put it into public health system. ②Make CHS function frame. The CHS public health function should not only include prevention and care, it should extend function in line with traditional public health.2,CHS size and structure model: CHS should reach to a size. There should be set up a CHC per 30～50 thousand, 7～10 missionary, including 3 general practitioners and community nurses at least. 3,Management model:①To set up an CHS management department and make its function and duties clear.②To make it clear of departments of public health in different level: CHS is operation level of basic public health, and senior departments is management level and operation level of basic public health .③To make CHS admittance rule: Making a admittance rule including setting, site, stuff and falling into disuse rule.④To make CHS evaluation standard: Making a evaluation standard based on workload, the quality and quantity of implementation on public health , satisfaction degree of resident.⑤To make an community participation and democracy monitoring mechanism. 4, Financing model :①To make multi-channels financing ways, government and societypower both can conduct CHC.②To carry out the management ways that put "income and expenses in two lines "in CHC by government conduct, which may cut off the advantage chain from people income to operation income. To carry out the ways that government purchase public health in non-government -conduct CHC.③ To exert government and market to ensure utilization efficiency of resources. To carry out interior market operation in CHS including setup invite applications rule and performance evaluation scheme based on workload, resident satisfaction and implementation of public health. ④To implement resource reconformity between departments of districts public health and CHC, including personnel distributary, resource share etc.⑤Based on the making CHS basic public health items and measure manpower cost, to make it clear of devotion standard in different economic and different size cities. To setup national and provincial finance transfer payment mechanism based on different economic level.