| [Objective] Through the investigation of the three-level network of public health in Qinling - Dabashan rural poor areas in Sichuan, to analyse the changes of the public health service of the Center for Disease Control, township hospitals and village health departments from 1998 to 2005; to understand whether the changes are adaptable the local economic and cultural development and find out the problems of public health in this area; finally find the breakthrough for Sichuan public health service system.[Methods] 8 Centers for Disease Control, 24 township hospitals and 72 village health agencies in 8 poor counties of Qinling - Daba Mountains region of Sichuan(Langzhong, Jialing, Guang'an, Cangxi, Wangcang, Nanjiang, Xuanhan, Quxian) were selected by the method of cluster sampling. The data of Manpower, financial resources and material resources of these institutions were collected with questionnaire of institution. Meanwhile, 782 residents in this area were investigated with questionnaire of individual and in-depth interviews were conducted with administrators of the rural public health system.[Results] (1) The total health expenditure of the 8 counties was 34.72 million yuan and the proportion accounting for the total fiscal expenditure is 3.9% in 1998. In the year of 2005, the expenditure was 76.76 million yuan and the proportion wass 2.2%. Compared to the year 1998, the health expenditure in 2005 increased by 1.2 times and the proportion accounting for the total fiscal expenditure declined by 1.8%. From 1998 to 2005, the total income of the Center for Disease Control had increased. In 2005, 8 CDCs accepted higher authorities' financial allocations of 7.5674 million yuan in 2005 and were three times of the allocations of 1998. The total health outlay in villages increased from 10,000 yuan in 1998 to 65,000 yuan in 2005. Per capita public health investment was 2 yuan in 1998 and 3 yuan in 2005. The income used in prevention accounted for 2.3% of total income in 1998 and 3.4% in 2005. The proportion of prevention-related expenditure accounting for total expenditure reduced 0.2%. The fixed assets of village health departments increased 1720.5 yuan from 1998 to 2005, and the area of house increased 10.59 m~2.(2) Each CDC had 50.8 technicians on average in 1998 and was almost on the same in 2005. The proportion of staffs with college degrees or higher increased 18.6 %. The proportion of public health doctor was 9.7% in 1998 and was 8.7% in 2005. The educational level of village doctors did not change and more than half of them received the education of high school or special secondary school.(3) Compared to 1998, the immunization coverage rate of 2005 was increased. The highest incidence rate of infectious diseases appeared in 2005 and it was 3.953‰, and the lowest was 2.083‰in 2001. From 1998 to 2005, incidence of Hepatitis and Tuberculosis increased quickly. The incidence of Measles fluctuated greatly in theyears of 1998 to 2005 and the incidence of Pertussis and Tetanus keeped a low level.(4) When falling ill, the rural residents preferred the Village health departments. 310 residents know Iodine Deficiency Disorders (IDD) , 73.8% of investigated school-age children had ever took parasiticide. The incidence rate of intestinal parasites was 28.5%.[Conclusion] From 1998 to 2005, the public service capacity of Qinba rural areas has improved. However, the government needs to allocate the public health resources more rationally, change Village health departments' work focus, enhance the quality of public health personnel, and control the incidence of infectious diseases. A new rural public health services system should be established to lower the market-based impact and strengthen the leading position of the government.
|
PDF Full Text Request