| ObjectiveThe township health center, as the important organizer and service provider of new cooperative medical system (NCMS), is hinge of the three-level rural health network in our country, promoting the construction to new socialism countries and bringing up peasants of new type. Due to the shortage of government long-term inputs, some township health centers are always in poor conditions. Not adequate to local economic development, considerable rural poor township health centers even cannot satisfy local peasants'basic health needs. Therefore, the Rural Health Promotion Project funded by the Ministry of Health and Kadoorie Charitable Foundation was started in 17 poor townships in Xinjiang and Anhui province in 2005. So far, the project has finished after two-year running.A third-part and participatory evaluation was used to provide a systematic research on the input, process, outcome and impact of the project, in which improvings of the township health centers'building facility, operation level and service ability were assessed, as well as advances in peasants'health information and behaviors and available health services. The deep impacts on rural community and health agency developments and social values of the project were probed into, success experiences and problems existed in the project summarized, so as to provide policy evidences and references for implementing succedent project and other rural health programs. In the meanwhile, additional researches on theories and methods of the program evaluations offered reference theoretic and methodological evidences on program assessments in our country. MethodsFounded on evidence-based principles, essential theories and methods of program evaluations were introduced on the basis of positive research, to give a systematic review on the project from health services demander, provider and manager sides, by combining quantity and quality analysis. In the study, efforts were afforded to pursue scientific and reasonable methods according to the evaluation contents and data characteristics. In details, multiple factor analysis such as linear regression and logistic regression were adopted to study staff satisfaction and stability at work, analytic hierarchy process (AHP) to determine the deans'competency, case study to investigate the participatory health promotion theoretically, data envelop analysis (DEA) to evaluate the township health centers comprehensively.ResultsFindings as below were obtained from the program evaluations above.①In the project, the buildings of the 17 township health centers received programming constructions, with the total area of newly constructed buildings 12864.14 square meter, accounting for 57.72% of the total health center area. All the new buildings were of high-quality brick concrete structure. The rate of dangerous building clearance reached 25.00%. The mean area of buildings increased per health center was 472 square meter.②More than 170 pieces of medical equipment of various kinds were supplied to the 17 township health centers in the project. So far, each of township health centers owned more than one piece of medical equipment such as X-ray machine, ultrasonic scan machine, electrocardiogram machine, semi-automatic biochemical analyzer and so on. The percent of township health centers that owned the new five pieces of medical equipment increased from 5.88% to 58.82%.③Superior hospital helping, experts coaching on spot and so on were adopted to emphasize the operation ability construction of health centers in the project. During the project, 27 new departments came into being at the health centers, including 6 clinical departments and 21 medico-technical departments. More than 93% diverse medical staff received trainings. The percent of doctors attended in advanced studies in superior hospitals was account for 16.47%.④The service efficiency of health centers was elevated in the project, which compared with those of year 2004, the prevalence of outpatients and inpatients at health centers increased by 19.81% and 16.85% respectively, controlling for confusions of NCMS. The bed occupancy rate increased from 48.59% to 71.95%. After the project's implementation, number of"the DEA is effectual"township health centers increased from 10 to 13, with the proportion increased by 17.65%.⑤Findings from financial analysis suggested that all of the 17 township health centers were run with an increased services earnings at present, which changed from 1243.51 million yuan in 2004 to 1787.79 million yuan in 2006 (by 43.77%). Thanks to the improved service efficiency and ability, the perspectives of township health centers are optimistic, although there are 35% of township health centers run to the bad for the moment.⑥As a result, the maximum threshold competency score of township health center deans was 10, while the minimum was 7.970; the maximum differentiating competency score of the targeting health center deans was 10, while the minimum was 7.758. The staff satisfaction at work was found to associate with differentiating competency of the health center deans positively (r=0.532, P<0.05), but have no association with threshold competency of the deans in the meanwhile.⑦Participatory health promotion was adopted in all the 17 township health centers, so that more community residents knew health information and formed healthy behaviors. The prevalence of diverse health behaviors, such as antenatal examination, breastfeeding, and teeth brushing increased significantly. Part of unhealthy life style was changed. The residents gradually realized that eating too much salt and pickled food were harmful to health.⑧In the project, 91628 people were involved in derating medical cost strategy, including 28011 (30.57%) poverty-stricken population, with average derating of 10.57 yuan each person. The health centers released almost all medical cost of patients from especially poor families and households enjoying the five guarantees, alleviating economic burden of the local poor population to some extent.⑨The present score of the township health center staff satisfaction was 83.3. The score of health centers'staff satisfaction was 89.7 in Xinjiang province, while it was 75.5 in Anhui province. They were both at a moderate level, but the score of staff satisfaction at health centers in Xinjiang province was higher than that in Anhui province, and less health center employees in Xinjiang province tended to resign compared with those in Anhui province.ConclusionsModerate satisfying results were observed after the third-part evaluation.①The external images of township health centers were totally changed, whose construction designs and environmental sanitations matched the requests of township health centers.②The Participatory health promotion held by township health centers enhanced more residents knowing health information and forming healthy behaviors.③The foundational medical equipment of township health centers was supplied, with a great increase to the owning of"new five pieces"and usage of basic equipment.④The constructions of township health centers from both hardware and software dimensions boosted moderately the advances in township health centers'service ability and efficiency.⑤The integral development status of township health centers turned better, and the whole level of management was elevated step by step.⑥Low price shared medical service provided by township health centers helped the poor population and weak population in health to ues health services to some extent, which improved the social equity.⑦C onstructions of township health centers increased the staff satisfaction at work, and decreased staff resignation intentions, which redound to accelerate developments of township health centers.Innovation①The third-part independent evaluation was used in the study. Focusion on the evaluations about input, process, outcome and impact as baseline in the research, adding the impact and performance assessments, ensured the integrality and emphasis of assessment system and impersonality of evaluation conclusions, which is a valuable reference example of health program evaluations in our country.②Although there are so many researchs on rural health services, some contents in our evaluation research are novel, with some conclusions obtained firstly. Quantity analysis of township health center deans'competency was performed for the first time. And positive association between the staff satisfaction and deans'differentiating competency was observed firstly, which provides evidences for selecting deans. As an addition, a systematic review on the popular participatory health promotion was performed in this study, which is infrequent in domestic health service fields.③The theories and methods of program evaluations were explored in this research, with novel and partly difficult statistical methods applied to the assessments, providing methodological references for kindred evaluation investigations.
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