| In order to improve standardization and sustainable development of CHS and equity in community health care for the urban poor and vulnerable, this study is designed to focus on CHS operating status, health workers' understanding and expectation to CHS, and medical relief to vulnerable groups, among 4 urban districts of two cities_Chengdu city from Sichuan provivce and Shenyang city from Liaoling province.1. Objectives1.1 To analyze the present allocation and change tendency about health resources in CHS facilities, CHS financial sources and structures of income and expenditure1.2 To assess the content, process, service quality, management, referral and information system of CHS, particularly to the poor and vulnerable, to identify the determinants and barriers that impede CHS development.1.3 To know the support to health service for the vulnerable, including policy strength from related organizations, agencies in communities (government, street, neighborhood commission, policy agency etc.)1.4 To understand the health providers' comments, suggestion, satisfaction, etc., to find out the factors affecting health services provision.2. MethodologyBased on present data collection, combined quantitative and qualitative method to carry out supplementary survey. Qualitative survey included in-depth interview, focus-group discussion and document review. Quantitative survey investigated health resources in facilities, service provider's understanding and expectation to CHS and prescription behavior. Analysis depends on the traditional SPSS software.3. TargetsResearch targets and sample number: 9 community health centers (CHC) are selected from 4 urban districts in Chengdu city and Shenyang city (2 districts from each city ,2 or 3 CHC for each distric), 7 community health stations(CHCs) from 9 CHC(50% of all CHCs selected).4. Findings4 . 1 Community health services is recognized by urban people gradually,which is coming out of the earliest stage of development ,moving to a new stage with more chances and challenges.4. 2 There is still a long way to go to perfect the finance mechanisms of CHC, while now the main soure of income of CHC comes from fee for services.4. 3 Primary facilities are selected first when outpatients enrolled in Basic Medical Insurance systems(BMI)see doctors for chronic diseases.4. 4 Lack of basic medical equipments especially in convalescence is still a problem in CHC development.4. 5 Special CHC services should be enhanced while medical services are now main services in CHC.4. 6 The most important way up to now on fulfilling human resources of CHC is training the health workers on gard.4. 7 Community health facilities are prepared to be the platform of medical alleviation on urban poor and vulnerable people in the future ,which should have to be enhanced by now for lack of systemized5. Suggestions on policy5.1 To redefine the components of the community health service network.The major part of this network is community health centers that undertake a great number of public health responsibilities and have the function of providing comprehensive services. CHC could be set up either by the government or any other institution. However, the public health services CHC undertake should be purchased by the government. For setting up CHC, governmental department monopoly and ownership limitation should be lifted by encouraging medium and large sized medical institutions, community enterprises and institutes, associations and organizations, and individuals etc to take part in. Components of community health servicenetwork should also include special care homes that provide special services for community residents, and private (individual) clinics and drugstores.5. 2. To put forward strategies of fund-raising for community health services in two aspectsA. To optimize the distribution of existing health resources-health funds at all finance levels should give priority to the development of commun... |
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