| Objectives: Community health service (CHS), one of the important act for city health service system innovation, ensures equality and availability of providing health service to all inhabitants. The CHS has obtained great achievements in recent years in Fuzhou. However, at the same time, a lot of problems have appeared, such as management and operating system, manpower, financing and compensation, health resources allocation, which prevent the CHS from further development. Based on the data collected from the CHS in Fuzhou, this paper presents analysis on the current operating situation in details and a comprehensive evaluation on the operating performances of CHS, in order to find out the common problems in the development of CHS and their causes, at the same time to summarize experience and identify the limitation. This paper also provides some strategies and recommendations for the further development of the CHS.Subjects, Instruments and Contents: This study takes 28 community health service centers (CHSCs) of 5 municipal districts, related departments, 944 staff of CHSCs and the 1100 inhabitants as the subjects. Based on the results of a mass survey, sampling survey and focus group discussion (FGD) with 29 principals of related departments , this study aims to investigate health resources and the current status of service of the CHSCs, human resource, health service demands of inhabitants and its utilization. Achievements, problems and suggestions to CHSCs are presented as well.Methods: Quantitative and qualitative methods are applied to carry out supplementary surveys. The descriptive and analytic methods, including descriptive analysis, Chi-square test, Spearman correlation analysis, logistic regression, Data Envelopment Analysis, Fuzzy Comprehensive Evaluation, TOPSIS and RSR method, SWOT analysis, are employed to analyze the data.Results: This study obtains the following findings which are presented in section 2-5. Section II: The evaluation of demands, utilization, patients'satisfaction and responsiveness of CHS among inhabitants. 1. Primary frequent visitors of CHS are the middle-aged and old person, inhabitants with lowest income, chronic patients.2. CHS is not well known which will affect inhabitants to treat CHS as their favorite.3. Inhabitants have relative higher demands of health service, however the CHS is not fully utilized. Only the utilization of the clinical service is relative high, while the utilization of public health service should be improved.4. Staff skill, service attitude, and treatment are the primary factors that affect inhabitants'satisfaction.5. The responsiveness of CHS has got relatively good evaluation except the availability, communication and respect for the dignity should be improved.Sectionâ…¢:Evaluation on the human resources of the CHSCs.1. The configuration of the specialty and quality of the staff are unsatisfying, it is difficult for them to provide comprehensive service.2. The ratio of general practice training is low for all staff, only doctors have received relatively sufficient professional training. There is a high demand for general practice training among staff, however the expected training effects are not satisfying.3. The general job satisfaction is not high enough, which focuses on salary, benefit, occupational environment, some staffs have the idea to leave from the community health center.Sectionâ…£:The current operating situation of CHS1. All related departments have provided fully support to the development of CHS, especially the assistance from community officers are more important and effective.2. There is not much difference on the management of the CHSCs. Their enthusiasm prompts focus on substantial encouragement.3. Financial assistance by the government is increasing year by year, however most CHSCs are still in deficit without the support from the government.4. The quantity of health service is increasing gradually, comprehensive service capacity has enhanced to a certain extent. However, the whole function is required to be further transformed and two-way referral system should be improved.5. There are the following problems for information management: low utilization of the colleted information, poor information management technique and equipment.6. DEA shows that: low efficiency commonly exists among more than 50% of CHSCs which is due to poor configuration of manpower, insufficient basic medical facility and un-standardization of the medical market.Sectionâ…¤:Evaluation on the CHS performances.1. The performance of most CHSCs is satisfying, however there is a great difference between the best one and the worst one.2. The performance of the CHSCs is related to active changing service idea and mode, management, professional investment, local government's assistance.Sectionâ…¥:Strategies and suggestions of the CHS sustainable development. Based on the above research findings, SWOT analysis is applied, six strategies and suggestions are put forward as follows:1. To establish and consummate professional in/out and training system, improve the skill of staff of the CHSCs.2. To establish reasonable encouragement system, prompt enthusiasm of staff of the CHSCs and encourage them to work there as long as possible.3. To intensify the duty of the government, prompt system renovation and make sure that the role of the government is changed from the owner to supervisor.4. To establish the information platform of the CHS, enhance the management and efficiency, make sure the health management can be improved more and more.5. To consummate the function of"six in one", improve CHS awareness, encourage inhabitants to visit CHS as much as possible.6. To establish internal effective operating system of CHS, increase the competition to serve the inhabitants better and better. |
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