Study On The Service Ability Of Maternal And Child Health Care Institutions In Gansu Province

ObjectivesTo establish an evaluation index system of service ability of maternal & child health care institution by using the comprehensive empowerment approach with combination of subjective and objective methods,based on the situation analysis on the service ability of maternal and child health care institutions in Gansu Province.Other aims of this thesis are to understand the development status and trend of maternal and child health care institutions,find out the weak points and regions of the service delivery and the key factors restricting the improvement of service ability so as to provide evidence-based evidence for the formulation of policies to improve maternal and child health.Through the distribution of index weight value,it intends to provide references for the improvement of service capacity of maternal and child health care institutions,and ensure maternal and child health care institutions develop toward the correct direction.Methods1.Situation analysis on service capacity of maternal and child health care institutions in Gansu Province: 98 maternal & child health care institutions were selected as research objects.Under the item of “Institutional Monitoring System” in the main menu of the National General Information Platform on Women and Children Health Entries,the related monitoring data on the development and operation of maternal and child health care institutions at the provincial,municipal,and district levels in Gansu Province from 2008 to 2017 was collected,including general conditions,in-hospital services,human resources,facilities and equipment,medical quality,and health management of jurisdictions and department setting,etc;A descriptive analysis of the data and a comparative study of indicators reflecting the development trend of maternal and child health care service capacity in 2008-2017 were conducted.2.Service capacity evaluation of maternal & child health care institutions in GansuProvince: The dimension and alternative indicator pool of service capacity evaluation of Gansu province maternal and child health care institutions were initially determined through literature review and expert argumentation.The Delphi method was used to determine the final indicator system,and the CRITIC method was used to weight the indicators.The subjective scoring results of the maternal and child health care institutions selected by the systematic sampling method and the evaluation results of this study were verified by the evaluation system.The scores of the service capacity was compare among maternal and child health care institutions from 2013 to 2017.Results1.the results of situation analysis showed that the service capacity of maternal &child health care institutions at all levels developed well with an improvement trend year by year.Of these 98 maternal & child health care institutions,93 belonged to the full allocation public institutions,95 institutions provide outpatient services,and there were76 institutions providing hospitalization services.As for the allocation of human and material resources in these institutions,there was a big increase in 2008.Along with increasing of the total health technician number in maternal and child health care institutions,the doctor-nurse ratio became more reasonable.The number of health technicians with high academic qualifications,high professional titles and the number of health care department staff also increased at the same time.Among them,the growth rate of high-level personnel at provincial and municipal(state-level)institutions increased faster with a balanced allocation characteristics.Although the number in the county-level institutions also increased,the growth rate was relatively small.In terms of facilities and equipment,the numbers of equipment worth more than 100,00 RBM and hospital beds increased rapidly,especially at the county-level institutions.In terms of business room,the average area of business space per institution was ranked from large to small as the municipal,district and county levels.Some institutions rented business room in order to meet their own business needs.As for service ability,the coincidence rate between admission diagnosis and discharge diagnosis decreased from the provincial level to the county level.Among them,the coincidence rate of gynecological diagnosis was higher than other departments.The number of hospital infections in the pediatric system,especially in the neonatology department,was relatively high.As for the performance of the public health function,institutions at each level could provide various health careservices,and timely accomplish mandatory tasks and objectives from the health administrative department.In the mass health care service,independent Health education section was set up in 53 institutions.In 2017,series of health education activities were organized by various institutions to improve awareness of health care for women and children.A series of training and technical instruction were perennially organized for technical staff at the basic level.The scientific research capacity of provincial institutions was higher than that of municipal,district and county levels;in terms of informatization construction,the number of information systems and information equipments owned by the provincial instructions were more than that owned by the municipal,district and county levels.72 maternal and child health care institutions set up the information management departments,and there were 204 full-time health information management personnel,with an average of 2 to 3 people per institution.2.Five dimensions such as human resources,facilities and equipment,hospital services,medical service quality and health management were select to screen the evaluation indicators of service capability,and constructed an evaluation system through reasonable empowerment.There were 5 first class indicators and 21 second class indicators for institutions that provided inpatient services;there were 3 first class indicators and 13 second class indicators for institutions without in-patient services;the KAPAA coefficient of verification results and subjective evaluation results 0.233.The evaluation result was consistent with the actual situation.the results of the evaluation service capacity showed that the service capacity of maternal and child health care institutions in Gansu Province is uneven.There were big differences in the service capacity among institutions at the same level and at the different level in the same area.The service capacity of maternal and child health care institutions in the areas with good economic foundation,good social development and large population developed well.Conclusion1.An evaluation index system of service capacity for the maternal and child health care institutions in Gansu Province has been constructed by using a series of scientific methods.Combined with comparative analysis between the actual situation and indicator verifications,it is demonstrated that this indicator system is perfect,the index weight is reasonable,and it can be used for the service capacity evaluation of the maternal and child health care institutions in Gansu Province2.Maternal and child health care institutions at all levels in Gansu Province have developed steadily and their service capabilities have increased year by year.However the human resources indicators in whole province are still below the national average.There are unfair resource allocations and unbalanced development of service capabilities among different regions of our province and among various maternal and child health care institutions at all levels.3.The results of service capacity evaluation indicate that the level of institutional service capacity can be divided into three levels.The institutions with high service capacity are concentrated in the central regions with high level of economic and social development and relative dense population.The institutional service capacity in the eastern region is the second echelon,and maternal and child health care institutions in the western and minority areas have the worst service capacity.