Study On The Development Of Integrated Service Delivery Model For Woman And Children's Health In Minority Areas Of China

Women and children account for two thirds of the population. They are not only the largest population group in the society, but also the precondition and basis of human continuity and development. In the international community, the mortality of children under 5 and the maternal mortality are not only used to measure the health level of women and children, but also taken as comprehensive indicators of various countries'social, economic and cultural development. Nearly half of the eight Millennium Development Goals promulgated by the United Nations in 2000 directly or indirectly involve health. Among them, Goal 4 "reduce the mortality of children under 5" and Goal 5 "improve maternal health" are more closely associated with the field of maternal and child health. China has made great progress in lowering the maternal mortality and the mortality of children under 5, but the situation of maternal and child health in ethnic minority regions is still grim. China is a multi-national country; the population of 55 ethnic minorities accounts for 8.6% of the total population. Improving the maternal and child health level of ethnic areas is not only the requirement of realizing Millennium Development Goals, but also the requirement of maintaining ethnic unity and building a harmonious society.â… . Research objectiveOn the basis of analyzing the conditions of maternal and child survival in ethnic minority regions, explore the obstacles at the level of the provision of maternal and child health services, build an optimal fundraising mode and service provision framework under the current resource restrictions, and provide women and children with continuous, systematic, complete, accessible and ethnic-region-specific maternal and child health services. In this framework, relevant resources and service networks are integrated. The provision of services is no longer "centered on projects" but "centered on service recipients" based on the objective needs of women and children at different stages of the life cycle. â…¡. Research methodThe method of combining theoretical research with empirical analysis is adopted for the research, and methods such as literature research, questionnaire survey, interview and statistical analysis are used to conduct research. The method of literature research is adopted to fully review the existing research literature and policy documents and build the literature basis and theoretical foundation of the research topic; the method of questionnaire survey is adopted to carry out field survey through scientifically designed and standardized questionnaires and learn about information on the utilization, provision, etc. of maternal and child health services in sample regions; the method of interview is adopted to visit local county, township and village health workers, learn about the actual situation and further explain the results of quantitative data analysis obtained by the questionnaire survey.â…¢. Main research resultsThe following main research results are yielded according to the theoretical basis of government intervention in the provision of goods, the nature of maternal and child health services as public services and the theoretical research and review of the mode of government provision in combination with the actual conditions of ethnic minority regions.1. Analysis of maternal and child survivalThe factors affecting maternal and child deaths are many-sided at many levels. Figure 4-1 clearly shows these affecting factors and the mutual relationships among them. According to the mode of solution, these factors can be classified into three categories:the first category is factors that cannot be overcome through integrating resources (health, family planning and communities) and adjusting the service mode and can only be solved through major changes in the health system, i.e. problems at the level of systems such as unsound maternal and child heath networks and the government's insufficient health input, which is also the root cause affecting the conditions of maternal and child survival in the field of health; the second category is adverse factors caused by insufficiency at the level of systems, i.e. problems of human resources, technologies and equipment, which can be overcome to a certain extent through integrating resources and adjusting the service mode; besides, the adverse influences of the lack of nutrients, anemia and children's diarrhea and pneumonia can be improved significantly through adjusting the contents of basic service packages; the third category is adverse factors at the level of social and economic development, e.g. traffic inconvenience, poverty, etc., whose thorough solution of course relies on the improvement of the level of social and economic development, but a good health service mode can still alleviate their negative influence on maternal and child survival to a certain extent.2. Analysis of the current strategy of maternal and child service provisionThe current strategy of maternal and child service provision is not region-specific; in terms of the management system, grassroots service providers are managed by two departments respectively. Despite their overlapping institutional setup, staffing and scope of service provision, they do things in their own ways and have no mutual coordination mechanism. This situation makes it impossible to consider the use of human resources, technologies and equipment as a whole and restricts the efficiency of using existing resources; under the situation of insufficient human resources, the role of rural village communities'power and communities'participation is not brought into full play; the state's maternal and child health service packages ignore intervention measures that are very specific to ethnic minority regions and proved to have definite cost effectiveness; the service provision mode with projects playing a dominant role is neither conducive to bringing the efficiency of existing resources into full play nor conducive to the obtainment of full and systematic services by service recipients because the service contents are divided among several service projects.3. Integration framework of service provisionThe purpose of integrating resources is to go beyond the health intervention mode that is decentralized, singular, independent and targeted to a certain health problem or disease, realize resource integration and resource sharing of service provision, center on service recipients (women and children), and provide comprehensive, sustained, systematic and accessible maternal and child health services. We use the concept of integration in a relatively broad sense, i.e. adjusting the existing mode of payment for health services and the mode of provision, ensuring that pregnant women and children under 5 can obtain continuous, all-sided and convenient maternal and child health services under the existing resource restrictions through a comprehensive mode of payment and a comprehensive mode of service provision, and improving the level of their accessibility to and use of maternal and child health services. Through integration, we can overcome and alleviate the influence of some adverse factors on maternal and child survival, and meanwhile, through integrating projects and redesigning the mode of health fundraising and payment, we can effectively overcome the shortcomings of the project-centered mode of service provision, especially the problem of scattered and inefficient use of funds. The integration framework includes four parts. The first part is integrating service projects:integrating funds for different sections and making package payments; the second part is establishing ethnic minorities' comprehensive packages of maternal and child health services; the third part is effectively integrating maternal and child health service networks and family planning service networks; the fourth part is adopting the mode of providing "additional services", emphasizing village communities'power and communities'participation while providing services, and establishing a "four-in-one" organization, mobilization and patient transfer team.