| ObjectiveTo understand the situation of children health service capabilities provided by county-level maternal and children health (MCH) institutions, analyze the disparities in and determining factors with capacity provided by institutions according to the level of urban and rural, and regions, establish preliminarily an evaluation framework for the county-level MCH institutions to assess their ability to providing services,giving scientific basis and policy suggestions for planning and reasonably allocating resources, constructing and building standardly of children health clinic in county-level MCH institutions, enhancing the ability of providing children health care,which laying a foundation for further studies.Methods232 county-level MCH in China were selected by using multi-stage stratified sampling method, investigated the situation of children health services in 2012 through cross-sectional study,analyzed the differences between urban and rural,and the differences between regions. Multi-level model was used to analyze the influencing factors due to the hierarchical structure data.In order to establish evaluation framework, qualitative and quantitative research methods were combined to select and weight indicators. Using the methods of literature review and expert consultation to select indicators first; then the methods of coefficient of variation and cluster analysis were used to select indicators secondly.Normality standardization method and linear interpolation were used to standardize the original index value, and CRITIC method was used to weight the evaluation indexes.Results1. The situation of children health service capabilities provided by county-level MCH institutions1.1 In whole 232 county-level MCH institutions, each had 2 children health clinics averagely,indicating a low children health clinics setting proportion,each clinic had 2 rooms with a total area was 100 square meters.1.2 Each institution carried out 8 children health service items averagely, of which the proportion of carried out the growth service was highest among all the services. And the proportion of deployed related equipment was the same way.1.3 There were 1.7 staff members in MCH institutions providing services for every ten thousand children, children health care staff members had participated in professional training lasting more than 3 months in 28.8% institutions , the proportion of faculty who attending children health care training courses was 66.67%, most of them had college degrees or above and were physicians.1.4 3 times training sessions were organized for subordinate health care institutions,and 1 time for childcare institutions; 81.3% of the institutions gave on-site business guidance to subordinate health institutions more than 2 times per quarter, and 70.7% of the institutions gave on-site business guidance to childcare institutions at least once every six months.2. The differences between city and countryside, and the differences between regions.2.1 Services: the proportion of carried out growth service in county-level institutions was higher than district; the types of service and the proportion of carried out psychological and behavioral developmental testing and counseling services in eastern and central China were higher than those in the western China.2.2 Out-patient clinics: the number of children health clinic rooms in district-level institutions higher than the county-level institutions, and in eastern higher than the western; the number of clinics in western was lower than central and eastern,while the setting scale of listening care clinics in central was higher than its counterpart in western.2.3 Staff members: the staff members in county-level institutions mostly got college degree, while most of them had bachelor degree or above in district-level; the proportion of staff members who participated in children health care training courses in eastern higher than the western.2.4 Equipment: the proportion of configuring NBNA in county-level institutions was higher than district-level; the proportion of configuring the portable hearing assessment instrument in district-level institutions were higher than county-level institutions, and in eastern higher than the western; the number of hearing and vision screening equipment and the proportion of configuring dental care equipment in eastern institutions were higher than the central and western.2.5 Population health: the number of children health care staff who trained in subordinate health care institutions the district-level institutions was higher than county-level institutions and western was higher than the eastern; the number of children health care staff who trained in childcare institutions the county-level institutions was higher than district-level institutions, and central and eastern were higher than the western.3. The influencing factors of children health service capabilities in MCH institutions in our country3.1 The factors which affect the number of children health services as follows:regional distribution, children health equipment, the number of children health clinic, the total area of children health clinic and rooms.3.2 The factors which affect the number of children health clinic were the number of children health services, children health clinic rooms, children health clinic staff and psychological and behavioral assessment tools.3.3 The factors which affect under-seven children health care coverage proportion as follows: regional distribution, urban or rural, the number of children health staffs in institutions per ten thousand children, physical examination equipment,and the frequency of business guidance on the childcare institutions.4. The evaluation framework of children health service capabilities in county-level MCH institutions in our countryThe indicators framework was composed of investment, content and consequence indicators. The investment indicators were consisting of infrastructure,equipment and staff. The content indicators included population health and individual health. The consequence indicators contained working indicators and disease indicators. These 13 indicators were merged in 3 levels and 7 degrees. The top 4 weight of indicators were the proportion of children health clinic staffs, the number of children health clinic,rooms and children health services. These were also the main influencing factors of children health service capabilities in MCH institutions.Conclusions1. The situation of children health services and clinics in county-level MCH institutions in China was not optimistic, with single service content, and lack of high-level services. The number of the clinics and rooms, the total area and the proportion of settings clinics were both low. These told us our county-level MCH institutions should improve their children health services and construct children health care clinic further.2. The capabilities of children health care software and hardware provided by county-level MCH institutions should be strengthened, with serious insufficient of children health care clinic staff members, with education and training need to be strengthened. The number and the proportion of configuring equipment were low except the growth service. It can be concluded that the quantity and quality of staff members, the number and the proportions of configuring equipment all need to be further improved.3. There were varying differences between urban and rural and different regions on children health care service capabilities. With the support of various projects and policies, the county-level and the western institutions needed to attempt to reduce the gaps with district-level and eastern and central institutions constantly. The district-level MCH institutions should confirm their positions clearly, and extend the range of services in order to be not weakened. |
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