Study On Mechanism Of Chronic Non-communicable Diseases Control In Rural Area

BACKGROUNDThe prevalence rates of chronic non-communicable diseases are getting higher and higher year by year in rural areas in China,generating poor health to rural habitants as well as a heavy economic burden to NCD patients and their families.In addition,it seems that there are more and more poor families in rural areas caused by NCD.Even some families in rural areas are at the edge of bankrupt without efficient NCD control measures.So,it becomes more and more necessary to build control consummate mechanism of chronic non-communicable diseases in rural areas to reduce the prevalence rate of NCD.According to the literature review,the developed countries,especially the aging countries in western world have built relative consummate diseases control system covering NCD,which have put many emphasize on NCD cnontrol as well as studies in these fields with specific responsibilities of government and health organizations. However,there is few studies on NCD control in our country,especially in rural areas, while the present studies focus on communicable diseases.The current studies on NCD control often focus on clinical treatment,while some are involved NCD prevention without systematic analysis,especially are lack of systematic design of NCD control.AIMSThe objective is to find the problem of present mechanism of chronic non-communicable diseases control in rural areas in China,based on the systematic analyses of actuality of NCD control.Provide the suggestions on reasonable allocating resources and advancing qualities of NCD control people,in order to consummate the NCD control system in rural areas.The detailed purpose includes:1) calculate the economic burden of NCD and risk of families with NCD patients,and analyze the ability of providing NCD control services of health institutions in rural areas;2) analyze the present situation of NCD control in rural areas to definitude the problems in the mechanism;3) point out the works those need to be strengthened by analyzing the weak progress and problems;4) based on the analysis of present situation and reference to the successful experience of foreign countries,advance some proposals on improving the health security system for rural residents with chronic diseases control for goal-oriented.RESOURCESThe datum of the study roots in baseline investigation of Luxemburg-WHO-Shandong rural health workers training and chronic non-communicable diseases control program,and macroscopical health statistic database and health service investigation.The study methods include systematic analysis,literature review,and informational interview and so on.Univariate analysis and Logistic regression with SPSS software are used to address the data.RESULTS AND FINDINGSThe investigation on township hospitals and rural cliniques shows some problems, which are health workers with low quality,unstable health human resource team and out-dated equipments of the two level health service providing institutions.With the progress of integrated management of township and rural health,the township hospitals and rural cliniques have been standard constructed,but there are still many problems,especially with the duties of public health rural health workers should take. County,township and village health institutions are lack of works for chronic diseases control,with no mechanism.The proportion of chronic diseases control crew in county hospitals,county center for diseases control and township hospitals are 5.23%, 6.91%and 4.46%respectively;carried out health education 6.7,7 and 5 times with leaflets as the main method in county,township and village clinical organizations; chronic diseases managements are carried out only in several township hospitals and village cliniques,which establish health files with information from health physical examination,but that the files are not used enough results in weak works of home visits and community healing;grass-rooted doctors over emphasize clinical measures in healing with neglect of psychological and functional healing,which due to their qualities.By investigation,we found the main reasons why three level health institutions weakly carry out chronic diseases control are short of financial and policy supports,which result in the institutions and people being lack of incentives to develop NCD prevention jobs.There are less supervision on chronic diseases control and some NCD control policies does not work;new rural corporative systemedical scheme has little investment in chronic diseases control,especially the prevention with no warning mechanism for chronic diseases control;rural chronic diseases patients get less compensations from new rural corporative health system for clinical and grass-rooted organization expenditure,which are not good for leading they to see grass rooted doctors.Based on the studies chronic diseases burden of rural residents,we find that 32.9% of rural families in Shandong province have run into debt with 2500 Yuan per capita, 22.38%of who get into debt because of chronic diseases treatment.The diabetes and hypertension prevalence rates of older than 25 years old people are 37.19%and 3.49%respectively,with spending 787.67Yuan and 1545.67 Yuan per year,accounts for 19.06%and 33.78%of their yearly family economic income.24.34%of hypertension patients,24.9%diabetes sufferers and 26.0%other chronic diseases sufferers got compensations from NCMS in 2006,and the amounts are 40.00yuan(M), 526.84yuan(mean) and 150.0yuan(M) respectively.Rural residents in Shandong province,48.8%of who get 0 points in knowledge test,acquire less knowledge on chronic diseases.There are only 33.0%of inhabitants to aquire health knowledges actively,and they most want to know prevention knowledge by reliable ways,such as consulting doctors,reading books and newspaper,and listening radio.The analysis of status of NCD control in rural areas of our country demonstrates that:the districts with NCD control program supporting performance better than no program supporting districts,and there are many problems to extend the experiences to other regions without programs:1) no policy environmental,no health financial mechanism;2) the policies of employment,promotion,training of rural NCD control workers needed to be deeply explored;3) professional institutions for controlling NCD are not well equipped,and their functions are not very efficiency;4) the health service providing system covering rural and urban'areas is not perfect enough to build "gate keeper" and "two-way referrable system",the community functions of NCD control cannot play well;5) the professional teams' abilities of controlling NCD need to be improved,preventive and therapeutical criterions and technologies are not integrated.That the professional people's incomes depend on charges for services which leads they negative in providing preventive and health care services,is the key reason why NCD prevention and therapeuty plans can not be well played.The corresponding institutions have been almost rationalized,but there is lack of supportive policies;there are also a long distance between rural and urban NCD control systems,of which the treatment,identity,ability and duty of clinical doctors are the points;information systems are been exploring while be lack of criterions and technologies,human resources supports;health education,the best cost-benefit way of controlling NCD,is still very weak,lack of emphasize,which have strong relationship with institutions setup,rural residents' health consciousness and rural health workers' abilities.SUGGESTIONSContraposing the problems we found,the study gives the following areas need to be strengthened:1) forward control measures:by constructing the public health system, increasing investment,consolidate the health education and health physical examination systematic construction and so on,to implement the equalization of basic public health services;2) subsidence control measures to grass-rooted organizations, intensify the grass-rooted health and healing organizations construction;3) advance the basic health security for rural residents,set up chronic diseases control foundation in new rural corporative health system to compensate the expenditure at grass-rooted cliniques.From our analysis,in accordance with the current realities in our country and with referring from developed countries' experiences,the study proposes the concepts of improving the health security system for rural habitants with chronic diseases control goal-oriented.Adding harmonize functions for chronic diseases control,coordinating both within and outside the health system resources to carry out chronic diseases control;turn the incline of "attention to medical care,neglect of prevention", definitude the duties of organizations involved in chronic diseases control; consummate the function of chronic diseases control information system,setting up chronic diseases databases,taking classified management strategies;establish chronic diseases fund within new rural corporative health system to compensate the expenditure occurring in grass-rooted cliniques with leading forwarding and subsidizing control measures.Based on the systematic analysis of NCD control systems in rural areas,firstly,the thesis definitude the weak links of current NCD control measures and the distance between situition and goal,while bringing forward the measures need to be strengthed. Secondly,the thesis definitude the integrated procedures of chronic diseases control from prevention,clinical care and healing,giving a specific goal for NCD control mechanism building in rural areas.Thirdly,the procedures and methods of leading chronic diseases control in virtue of NCMS are advanced for the first time.Fourthly, the thesis foucus on the etiology control as the key points of NCD control system building,and propose consummating the health systems in rural areas with improving NCD control measures as goal oriented,giving an specific goal for intensify NCD prevention and grass-rooted health system.