Research On Performance Assessment Of The National Basic Public Health Services Project

ObjectiveSince the launch of the national basic public health service project,government invests lots of human resources,material resources and financial resources to promote it.A scientific performance assessment would help to summarize the experience,find the problems,thus to promote the sustainable development of the project.This study aimed to define the design of the assessment,to establish a performance assessment indicator system,and to summarize the experience and the disadvantages,thus to provide a basis for the assesement mechanism pefection to governments,and to provide a direct path to evaluate the project by the Health Administrations,as well as to provide recommendations for primary health units to carry out the national basic public health services system normatively.Methods1.Literature review was conducted to define basic concepts such as performance,performance evaluation of basic public health,and to compare the different approaches of performance assessment.Expert consultation was conducted to screening the basic public health service indicators.Ahp was conducted to determine the index weights.Cronbach’s alpha and Spearman correlation analysis was used to test the reliability and validity of the indicator system.2.The baseline survey was conducted to understand the district(county)to collect background data of the project in Hubei.The postal questionnaire survey was conducted to collect data about population and health status,economic development and health spending,the basic public health services funding and distribution,the basic public health services management and disbursement of funds from 32 sample district(county)health management department.And to collect the population and institution setting,the basic public health services management and disbursement of funds from 413 sample basic health services.The interview was conducted to collect the key points about the program effect,problem existed and the solutions.Field survey was conducted to collect satisfaction data from 408 primary health service workers,as well as 360 general population and 360 patients with chronic disease.3.The weighted accumulation was conducted to evaluate the performance indexes of the 32 sample districts(counties)on each dimensionality at 2013.The weighted accumulation,Topsis and RSR were conducted respectively to evaluate the whole performance of the 32 samples districts(counties),and the results were assembled with mean value method and fuzzy Borda method.The grounded theory method was conducted to analysis the field interview data.Results1.A three level,four dimensions basic public health services project performance evaluation system of "input-process-effect-output" was constructed,which includes 4 first-level indicators,13 second-level indicators,and 44 third-level indicators.All third-level indicators weighting coefficients were between 0.0038 and 0.0816,where "residents per capita funding for basic public health" entry weighting of most,0.0816.The consistency index weight coefficient CI < 0.1,Cronbach Alpha reliability coefficient was 0.889,the Spearman correlation coefficients were all between 0.703-0.935.So the evaluation indicator system has high internal consistency and good construct validity.2.The urban and rural sample areas have no significant difference on input(0.1343,0.1060,P = 0.056),process(0.1198,0.1198;P = 0.50)and output(0.2475,0.2443,P = 0.30)dimensions.Among all urban samples,Wuhan and the other samples have significant difference(0.2031,0.1067;P < 0.001)on investment.The urban areas surpassed the rural areas on effect dimension(0.3520,0.2725;P < 0.001).The overall performance index of the urban areas is 0.8354,and the performance index of the rural areas is 0.7426,which is at well level.And the two levels are significantly different(P = 0.004).3.Comprehensive performance evaluation results show that the weighted accumulative method,Topsis and RSR method three different kinds of evaluation method and the results of the Spearman correlation coefficients between 0.446 0.622,the result has a good consistency.With the result of comprehensive evaluation are combined,combination evaluation results more stable than single evaluation results.4.Service awareness and service capability,which were influencing by the policies,financial guarantee,construction of standards,the appropriate way of funding,the responsibility,facility construction and rule system establishment of the primary health units,and the satisfaction degree of spiritual needs and material needs of the medical staffs,determine the project performance level.Conclusions1.The performance assessment system for the national basic public health project constructed in this study has high reliability and validity,and is an effective tool to evaluate the project.The combination of multiple evaluation methods evaluation results more credible,and qualitative and quantitative research methods of the joint should be the development direction of research.2.The Hubei project performance was at a relatively high level.Continuous implementation of the national basic public health services project benefits the construction and social status of primary health units,transformed the primary health care model,protected the resident health,and the mechanism of fund appropriation and performance assesement was basically mature The relative lack of project funding and funding management,human resources,and the low quality of project,the poor situation of the the informationalize level and other issues still restricting the project performance.The further policy should be considered from the point of funding and management,team construction,sevices model,propaganda,and the construction of information system,to promote the project performance continuously.