Preliminary Research On The Evaluation Indexes System Of Public Health Service Capability Of Village Clinics In The Poverty Areas

Purpose: To establish the evaluation indexes system of public health service capability which is suitable for the development status and convenient for the practical application of village clinics in the poverty areas; to lay out the indexes and the weight value of each index; to demonstrate how to use the evaluation indexes system and lay the foundation of how to evaluate the public health service capability of village clinics.Methods: Use the focus group discussion to ascertain the principle and through the meta analysis and Delphi to establish the elementary evaluation indexes system; through social research methods to collect the related data and use the methods of cluster analysis and nonparametric test to screen out the ultimate evalution indexes system;throuth the Analytic Hierarchy Process(AHP) to calculate the weight value of the index and judge and analyze the consistency by CR; through Delphi to balance the weight value and determine tht final weight value;choose two village clinics to demonstrate how to use the evaluation indexes system.Results:1. Adopt the methods of stratified random sampling and cluster sampling to investigate 103 village clinics in four poverty counties of Guizhou province.most of the village clinics are in the mountainous areas(96.3%),and there are 368 households in one village.the mens population is 1,441. the village clinics set up by private is 61.6% and set up by village is 27.4%. the village clinics is the branch of township health center is 46.4% and owned by private is 33.6%.2. Ascertain the principles and the problems must be considered of the evaluation indexes system: we should follow the principle of scientific, objectivity, practicability, dynamic and comparability to establish the indexes system,meanwhile,we should also consider the function of the village clinics, the contents of the public health service of the village chinics and the capability of public health service of the village clinics in the poverty areas.3. Establish the elementary evaluation indexes system of public health service capability of village clinics in the poverty areas which is composed of input indexes,outcome indexes and outcome indexes.the input indexes includes the funds,medicines,equipments,staffs and infrastructures;output indexes includes the prevention control,women and children health,health education and public health;the outcome indexes including children health and women health.the evaluation indexes system is made up of 45 indexes.4. Filter the indexes of the elementary evaluation indexes system: consult the experts and the scholars that research on the rural public health and some village doctors, combine with the quarter-digit standard of mathematics, there are thirteen indexes are reduced and some indexes have been united, for example, the index of "the number of personnel of village clinics" combined with "the total population of village" in the questionnaire of the village to form the index " the number of the doctors per 1,000 population in rural areas." The filtered evaluation indexes system is made up of 26 indexes.5. Establish the ultimate evaluation indexes system: determine the ultimate evaluation index system by cluster analysis and Delphi. The input indexes including 11 indexes of the funds,medicine and equipments,staffs and infructures;the output indexes of prevention control,children health,health education and monitor of the infectious diseases including 5 indexes;the outcome indexes of children health and women health including 3 indexes.6. Calculate the weight value by the method of Analytical Hierarchy Process and Delphi.eg, the weight value of the index "the subsidy of the village clinics"is 0.25,the weight of the index " The number of doctors per thousand people" is 0.09.7. Demonstrate how to use the evaluation indexes system by two typical village clinics.8. Compare the public health service of the village clinics in poverty areas and non-poverty areas to test if there has significant difference and find that the most indexes of the syetem can distinguish the village clinics in difference areas.Explanation of the evaluation indexes system:1. Point out the definition of the public health and the public health service capability in the research: the public health in this research contain the basic medical treatment, but play emphase on the prevention control, womenl and children health, infectious diseases control and so on. The capability of public health service is mean the capability of the village clinics to complete the above works.2. The necessity of establish the evaluation indexes system of village clinics in poverty areas: the population of the rural areas especially in the poverty areas need a health insurance system urgently, and in this system the public health service is the foundational work.the village clinics is the basic health institusions that offer the health service and we need a tool to evaluate the capability of them.3. The comprehensiveness and the representative of the indexes system: using the methods of cluster analysis and significant test. Divide the evaluation indexes system of public health service capability of village clinics in the poverty areas into three aspects and use cluster analysis to classify the indexes to different clusters.then test the significant difference between the indexes and pick out the most representative index.the combination of the cluster analysis and significant test can ersure the comprehensiveness and the representative of the indexes system mostly.4. Determine the weight value of each index in the evaluation indexes system by the combination of Analytical Hierarchy Process and Delphi.during the course of lay out the juding matrix of the Analytical Hierarchy Process, some authorities'opinions may affect the other experts'and lead some correct opinions could not be released.but Delphi can exert the full play of each expert and let the bifurcations of their to be released.so, the combination use of Analytical Hierarchy Process and Delphi can make the evaluation indexes system more scientific, accuracy and consistency.