| 1. Research Objective and Significance To meet he need of disease prevention and control system reform and constructionSARS (Severe Acute Respiratory Syndrome), broken out in 2002, attacked 266 counties of 24 provinces in China resulting in 5327 cases and 349 ones died of SARS. This epidemic disease disaster threatened the people health and life safety seriously, influenced the economic development, social stability and external intercourse. That made the Central Government and common people realized that Chinese disease prevention and control system is weak and it is indispensable to rebuild the system. Therefore, the State Council put forward the objective of rebuilding Chinese disease prevention and control system in about 3 years. In order to realize this objective, experts in policy research, policy makers and practicers of disease prevention and control developed the strategetic research on building the system of disease prevention and control in China. Firstly, taking the public health product as the yardstick, to define the functions of Chinese disease prevention and control system and the concrete functions of CDCs at nation, province, city and county levels and the health prevention and care organizitions at grass roots. Secondly, using the advanced administrative mode of the developed countries for reference, to refom the current administrative system of disease prevention and control and bring forward the suggestion on establishing Disease Prevention and Control Bureau in China. Finally, in order to fulfill defined public functions and projects, to measure the allocation criteria of manpower, expenses, material resource and institution construction for disease prevetion and control institutions at all levels.At present, Chinese disease prevention and control system was perfected step by step, the institution functions were defined, and the research of organization construction was completed, the allocations of manpower, expenses and material resource and the work conditions were improved to a certian extent. But how to allocate the definite manpower, expenses and material resource for one project of disease prevention and control rationally? How to fulfil the defined functions in the whole institution, some sections or one concrete project? All above questions need to be resolved through making a systemic and standardized technology and management procedure which instructing us in allocating the resources of disease prevention and control reasonably, among of them including manpower, expenses and material resource. To carry out the management on three administrative levels which are the whole institution, section and project to fulfil the public functions of disease prevention and control in deed. The progress and mission of preventing and controlling schistosomiasis in ChinaIn 1987, World Health Organization (WHO) issued that there are 54.1 million people threatened by schistosomiasis in China, ranked the second in the world. Presently, because floods resulted in oncomelania snails' pervasion and preventing work didn't catch up with the epidemic situation, the number of patients suffering from schistosomiasis has been increasing, schistosomiasis prevailed again in some areas, where this disease had been eliminated, and even spreaded to from the countries to cities in some places. In 2003, there were 1114 acute cases, increased 22% over the corresponding period in 2002. In recent 5 years, oncomelania snail areas has been increasing, increased 268 million square meters in 2003 over the same time of 2002. Among 20 survey points throughout the country, there were 17 points where oncomelania snails infected by schistosomes were found, that increased the chance greatly human and domestic animals were infected. That schistosomiasis epidemic situation are more severe than before doesn't suit to the fast economic development, social progress, national power strong, people living level and health demand increasing. It is in great need that reducing schistosomiasis damage to people throughoutthe country. Preventing and controlling schistosomiasis should become one of important disease prevention and control missions yet.The paper focused on every disease prevention and control project and selected schistosomiasis prevention and control as a objective to develop a frame and essentials of a workbook on how to preventing and controlling schistosomiasis in China, and to study the method and procedure in developing the workbook, with which guidance other preventing projects' workbooks except for schistosomiasis could be developed. The paper selected the disease preventing and controlling institutions at city and country level as its study objevtiveto develop the workbook, which engage in preventing technical work and preventing and controlling administration. Thus, with the workbook guidance, others institutions' workbooks at nation, province level that dealth with preventing and controlling administration only and these at grass roots, including communities and villages and towns, could be writed.2. Material and methodTo apply "Structure-process-outconme" of "A Macro-Model of Health System" to develop a frame and essentials of a workbook on how to prevent and control schistosomiasis in China. With the frame and essentials guidance, to use the method of "Qualitative and Quantitative Multidemonstration" to develop and demonstrate all contents of the workbook. To ues the methods of "Benchmarking" and '"action-timing measurement" to study human, expenses and equipment demand of preventing and controlling schistosomiasis in China, and create a method and procedure, formulae and approaches to measure human, expenses and equipment demand of preventing and controlling schistosomiasis account to services target number that a institution have to complete. The paper also used the method of "Gap analysis between practice and ideal" to analysis the difference between ideal condition in practice and the requirement of the workbook.Data-collected methods include literature induction and analysis, institutions' willingness and basic condition surevy, Focus Ggroup Discussion and Brainstorm, routine statistic data collection and the worknook simulation and operation in practice, etc.This paper selected 6 provinces including Hu Bei, Hu Nan, Jiang Xi, Jiang SU, Zhe Jiang and Guang Dong as the surveyed sample in 12 epidemic provinces throughout the country. Fron these provinces, to selected 35 institutions at city level and 29 at county level assuming schistosomiasis prevention and control.During developing the workbook of preventing and controlling schistosomiasis in china, the paper consulted 540 person-times of 102 experts to perfect it again and again. To survey 64 sample institutions to pecfect and demonstrate it. Besides this, the study applied it to 3 institutons at city level and 2 ones at county level to demonstrate its applicability. The paper collected suggestions put forward by 5 institutions from July to December in 2005 and pecfect the workbook further again. To collect routine statistic data on schistosomiasis prevention and control from 1987 year to 2004 year.3. Main resultsThe significance that develop a workbook how to preventing and controlling schistosomiasis in China In China, prevalent counties increased 434 in 2004 from 378 in 1989; there were 56 newly epidemic counties. The prevalent counties had been increased ceaselessly by 1.19% every year.. During 17 years from 1987 to 2004, the total number of patiects, chronic and terminal ones suffering from schistosomiasis had been increasing by 1.30%, 1.31% and 1.25% respectively every year. The acute patients occurred evey year incessantly. Oncomelania snail areas had been increasing by 1.17% every year. The newly found areas increased to 9600 million square meters in 2004 from 1471.4 million square meters in 1987. This severe epidemic situation reveals that the mission of preventing and controlling schistosomiasis is heavy and the challenge preventing work faces is huge.The proportion of patient treatment decreased to 44.7% in 2004 from 83.8% in 1987, that of oncomelania snail areas were sterilized to all increased to 27.1% in 1996 from 12.4% in 1987, but in 2004, that decreased to 17.2%. Domestic animals were examined accounted for 46.1% in 1987, but 38.4% in 200L These results show that with the patient and oncomelania snail areas increasing, the preventing mission has been increasing, absolute value of preventing work has been increasing, but the speed of preventing work increasing couldn't catch up with that of mission.That schistosomiasis epidemic situation are more severe than before doesn't suit to the fast economic development, social progress, national power strong, people living level increasing and their health demand. It is in great need that reducing schistosomiasis damage to people throughout the country. The preventing and controlling schistosomiasis should become one of important disease prevention and control missions yet.All these hint that the mission of schistosomiasis prevention and control is more and more heavier, we should pay more attention to this work and preventing and controlling schistosomiasis effectively, even if other work like hypertension, diabetes, cardiopathy, malignancy are becoming primary diseases do harm to people in China.To develop a workbook on preventing and controlling schistosomiasisTo form principles on how to develop the workbook —Legitimacy—Assignment is assignted according to responsibility —Giving emphasis to work procedures, work approaches and work evidence —pay more attentong to the work can not noly guide work practice at present but also accord to and meet the work development needThe frame and essentials of preventing and controlling workbookSummarization of preventing and controlling workbookSummarization of preventing and controlling workbook is preface of the book, it synthetically generalizes some contents, including—To simply introduce schistosomiasis and its damage to people.—To introduce achievement has been achieved at acpect of precenting and controlling Schistosomiasis from the foundation of People's Republic of China.—To simply illuminate the aim and significance of preventing and controlling Schistosomiasis. to develop general preventing and controlling objective.—To describe all preventing items that have to performed in order to realize the general preventing and controlling objective.—Taking general objective realization as center, to develop preventing and controlling items flow chart according to the principle of tertiary prevention on the basis of work experience and theoretic knowledge.Detailed part of preventing and controlling workbookTaking a preventing item for example health education as center, the detailed part of the workbook expatiates its work target and task, work contents measure and method, work procedure and approach, technical document that could guide practise of preventing and controlling Schistosomiasis, procedure quality index and Keyes of quality control, work amount and frequency criteria and work performance assess index.Workbook on Preventing and Controlling Schistosomiasis in ChinaSee to see Appendix 1 .Gap analysis between current preventing and controlling work and workbook criterion and influence factors researchThe rate of achieving procedure quality index and its criterion of the workbook at present is 69.9%, IPCS at city level higher than that at county level, but even if IPCS at county level, its reaching rate is just 72.7%. The rate of accomplishing work amount and frequency criteria of the workbook at present is 67.9%, regardless of IPCS' level, the accomplishing rate is identically low. Tow rates above in Schistosomiasis prevail area are higher than ones in Schistosomiasis spread-control area, but even if in Schistosomiasis prevail area, the higher rate isn't exceed 75%.Why two rate doesn't reach to 100%? Making influence factors analyse to find that there are common influence factors result in the low degree of quality reaching and quantity accomplishing. The first nfluence factor is short of preventing and controlling expenses, the second is insufficiency preventing and controlling humanpower, and the third is absence of apparatus and equipments. Other nfluence factors are social institutions concerned aren't pefect, assignments and tasks aren't definite and cooperation between social institutions or departments centerned isn't smoothly.Sustaining System study of the workbookOrganizational guarantee, Institutional guarantee researchSee to see Appendix 1 . Organizational guarantee, Institutional guarantee developed were agreed with by 97.1% and 98.9% of sample institutions respectively.Preventing and controlling humanpower demand researchAll preventing and controlling staff for per IPCS at city level is 238 at present, the staff demand by model operation measurement method is 356, which need to increase 49.6% over present, the ideal staff demand to complete the workbook is 408, increasing 71.4 % over present. All preventing and controlling staff for per IPCS at county level is 1245 at present, the staff demand by model operation measurement method is 1837, which need to increase 47.9% over present, the ideal staff demand to complete the workbook is 2032, increasing 64.6 % over present.According to 2005 the stsff's income preventing and controlling schistosomiasis, expenses of all staff preventing and controlling schistosomiasis at city and county level thoughout country 43,606 thousand Yuan (RMB), the demand by model operation measurement method is 64,500 thousand Yuan (RMB), which need to increase 47.9% over present, the ideal staff demand to complete the workbook is 71,765 thousand Yuan (RMB), increasing 64.6 % over present.Preventing and controlling expenses demand researchOn the basis of 2005 IPCS' work expenses, including direct material expenses and indirect overhead cost, preventing and controlling expenses for all IPCS at city level is 7,309 thousand Yuan (RMB), the demand by model operation measurement method is 9,109 thousand Yuan (RMB), which need to increase 24.6% over present, the ideal work expenses demand to complete the workbook is 11,750 thousand Yuan (RMB), increasing 60.8% over present.preventing and controlling work expenses for all IPCS at county level is 44,476 thousand Yuan (RMB), the demand by model operation measurement method is 58,801 thousand Yuan (RMB), which need to increase 32.2% over present, the ideal work expenses demand to complete the workbook is 13,381 thousand Yuan (RMB), increasing 54.2% over present.Apparatus and equipment demand researchInstitutions of Proventing and controlling Schistosomiasis (IPCS) at city level need 40 kinds of apparatus and equipments including a portable computer, water quality labouratory test apartments, Global Position System and photomicroscope, etc. Institutions of Proventing and controlling Schistosomiasis (IPCS) at county level need 38 kinds of apparatus and equipments including a portable computer, domestic animals dejection labouratory test apartments, telescope, camping tent and small survey boat, etc.There are 680 in all IPCS at city level at present, the demand by model operation measurement method is 1,190, which need to increase 75.0% over present, the ideal work demand to complete the workbook is 1,700, increasing 147.5% over present. There are 3556 in all IPCS at county level at present, the demand by model operation measurement method is 6,604, which need to increase 85.7% over present, the ideal work demand to complete the workbook is 10,668, increasing 209.6% over present.According to 2005 price index, all IPCs' purchase expenses at city level at present is 10,642 thousand Yuan (RMB), depreciation of all apparatus and equipments every year is 1,326 thousand Yuan (RMB). The purchase demand by model operation measurement method is 20,978 thousand Yuan (RMB), every year need to incease 2,516 thousand Yuan (RMB) as depreciation cost, which need to increase 96.3% over present; the ideal purchase demand to complete the workbook is 28,492 thousand Yuan (RMB), every year need to incease 3,536 thousand Yuan (RMB) as depreciation cost, which need to increase 167.6% over present.According to 2005 price index, all IPCs' purchase expenses at county level at present is 46,482 thousand Yuan (RMB), depreciation of all apparatus and equipments every year is 5,842 thousand Yuan (RMB). The purchase demand by model operation measurement method is 147,574 thousand Yuan (RMB), every year need to inceasel7,272 thousand Yuan (RMB) as depreciation cost, which need to increase 215.0% over present; the ideal purchase demand to complete the workbook is 207,772 thousand Yuan (RMB). every year need to incease 25,146 thousand Yuan (RMB) as depreciation cost, which need to increase 345.1% over present.Social departments and institutions concerned and their responsibility and basic assignmentsThere are 14 social departments and institutions concerned to prevent and control Schistosomiasis. They are disease prevention and control institutions for example CDC at city and county level, street committees of community and town, villages and towns governments and villages committees, all kinds of schools at all levels, all kinds of popular media at all levels, all kinds of hospitals and health care institutions at all levels, patriotic health campaign committee and its office at all levels, agriculture, forestry and water conservancy departments at all levels, engineering construction units concerned, information Stat. and health information Stat. departments at all levels, animal husbandry departments at all levels.Anyone preventing items wasn't completed by any single department or institution, but one or more departments or institutions together. The leading department or institution that takes charge of a preventing item is different account preventing items differ.In preventing and controlling Schistosomiasis practice, average rate of function and assignments of social departments or institutions cerntered above were accomplished is 70.9%. Thereinto, disease prevention and control institutions for example CDC at city and county level highest (the rte is 77.9%), the second is engineering construction units concerned (the rte is 70.3%), the third is patriotic health campaign committee and its office at all levels, the lowest is all kinds of popular media at all levels, it only accomplished 59.2% of its health education assignment. In a word, all these institutions or departments should improve their work, try their best to accomplish their assignments and basic tasks, especially others ones cerntered except for disease prevention and control institutions.Prospective effect evaluation and analysis of the workbookThe newly developed workbook is more systemic, logical and comprehensive on the whole, the content of that more detailed and elaborate than the old workbook of 2001 year editiont. Among 299 frame essentials of 23 proventing and control work items, there are 12 ones preserved an, 48 complemented and perfeced, 213 newly creased. As for as work performance assess indexes, the workbook increased 67. In a word, the new workbook is more advanced than old one.From the willingness of surveyed technical personnel engaged in preventing and controlling Schistosomiasis, a series of procedure quality index and quality control keyes of the workbook was enough to graspe and control the quality of preventing and controlling Schistosomiasis (95.4% agreed of all). A series of amount and frequency criteria of work was enough to complete corresponding work task and realize corresponding work target (93.2%agreed of all). A series of work performance assess indexes was enough to comprehensive corresponding work effect and performance (93.5% agreed of all).The agreed rate of items' content could achieve thieir according objective varied from 100.0% to 90.3% between service items, but it exceeded 90%. 92.2% of sample institutions agreed that newly developed workbook could realize its objevtive. 95.0% considered that the new bookwork more normative than the old. 82.7% think that the workbook could put in practice in their institutions on the condition of staff, work expenses and Apparatus and equipment demand is met. 97.5% considered that the workbook could improve their present work and effectively proventing and controlling schistosomiasis.In conclusion, the newly developed workbook could achieve good result and effect if it was put in practice and prevent and control Schistosomiasis spread effectly and better people health remarkablel. 4. Innovation and applicationTo apply "Structure-process-outconme" of "A Macro-Model of Health System" to develop a frame and its essentials of workbook on how to prevent and control Schistosomiasis in China. This paper consulted 22 experts to perfect, demonstrate and define the frame and its essentials. The the frame and its essentials of workbook could help to develop many workbooks on many others work except for prevent ing and controlling Schistosomiasis in the filed of disease prevention and control. All these will make for disease prevention and control system standardization and make a great progress in the future.During developing a workbook of preventing and controlling schistosomiasis in china, the paper consulted 540 person-times of 102 experts to perfect and demonstrate it, surveyed 35 institutions of preventing and controlling schistosomiasis at city level and 29 institutions at county level to pecfect and demonstrate it and applied it to 3 ones at city level and 2 ones at county level to demonstrated its applicability and pecfect it further. In conclusion, "Qualitative and Quantitative Multidemonstration" was adopted during the course of developing the workbook to make sure its acceptability and feasibility. Meanthile, prospective effect evaluation and analysis of the workbook make sure its effect.The paper developed a systemic technical workbook on how to prevent and control schistosomiasis better for the first time, which presents specific work goal and task, detailed work contents, work measure and method, logical work procedure and approach, a series of procedure quality index and keyes of quality control, a series of amount and frequency criteria of work, a series of technical document that could guide practise of preventing and controlling schistosomiasis and a series of work performance assess indexes. The workbook put forward a criterion and lay the foundation for the preventing and controlling schistosomiasis project management.From two phases of ideal allocation and present highest allocation, to ues the methods of "Benchmarking" and "action- timing" to study human, expenses and equipment demand of preventing and controlling schistosomiasis in China. The paper created a measure method and procedure, trandlated these into formulae and approaches to measure human, expenses and equipment demand of preventing and controlling schistosomiasis account to services target number that a institution have to do. These formulae and approaches was demostrateed through simulation measure of a single institution. The paper used these to measure human, expenses and equipment demand to preventing and controlling schistosomiasis of all institutions at city level and all institutions at county level countrywide. These outcomes bring forward a criterion and lay the foundation for the preventing and controlling schistosomiasis project management.The paper make clear organizational guarantee, institutional guarantee social departments and institutions concerned and their responsibility and basic assignments, these could help the workbook be put in practice successfully and smoothly.
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