Impact Of DM&N Project On Maternal And Children Health Service System

The Maternal and Children Health Service System(MCHSS) provides the basic healthcare services to meet the different periods of women and children' s healthy need.The system is considered as one of foundations of the harmonious society. However,this system is faced with various challenges.For example,healthcare is ignored by institutions at all levels,there are many barriers on the communications between the institutions of healthcare and other institutions,the foundation of the system in the remote and rural areas is very poor,and etc.. The health demands of maternal and children cannot be met with the system.These situations in our country have endangered the commitment to international community.Since 2000,Ministry of Health and National Working Committee on Children and Women under the State Council cooperate with Ministry of Finance to carry out the Decreasing Maternal Mortality Rate and Neonatal Tetanus Morbidity Project (DM&N Project).The project has been implemented for six years.The authority need to know the effect of the project.Our study is required by the authority to give the feedback and suggestion on the future of the project.The situations of the current system and effects of the project on the system in the areas covered by the project are investigated.The strategy on the development of the system and the relating measures are also given in this study.Objective:To understand the current situation of Maternal and Children Health Service System in DM&N Project areas;To evaluate the impact of the structure,the process and the result on Maternal and Children Health Service System in DM&N Project areas;To explore the methods which can improve Chinese maternal and children' s health and to find the development strategy of Maternal and Children Health Service System; Methods:1,We select 11 provinces randomized and stratified.In each province,we select 2 cities randomized.In each city,we select 1 county randomized from counties where are doing the DM&N Project and 1 county where is not doing the DM&N Project. We interview the staffer who is in charge of maternal and children health in these total 44 counties by using the questionnaires and collect the statistical forms in maternal and children health field.2,We select one country randomized in each county that we visit.We copy 10 systematic healthcare records for children under age 3 and 10 records of planned immunity for children when they were under age 1.And we also interview some doctors who are in charge of planed immunity unsystematically in the country.3,In all the counties that we visited,we select 2 countries randomized in each county where is doing the DM&N Project and 1 country randomized in each county where isn't doing the DM&N Project.We select 2 villages in each country and we interview 3～5 mothers who have child under age 5(include pregnant women) through filling out the questionnaires.Totally,we interview 475 women.Results:1,DM&N Project promoted the development of MCHSS and achieved good results in improving mothers and children's health.The projects achieved good results in improving service coverage and accessibility.2,In the impact of the structure,DM&N Project promoted the communication and collaboration between all levels of agencies through establishing relevant policies and management bodies;The analysis,which are combined with 34 indexes, displays that in the aspect of resource allocation there is no difference between the counties where are doing the DM&N Project and the counties where are not doing the DM&N Project.3,In the impact of process,DM&N has achieved remarkable success through doing all kinds of activities.4,In the impact of result,from 1999 to 2005,the main indexes and support indexes which evaluate the effect in DM&N Project areas have improved significantly. Policy recommendations:1,the suggestion to the development of the MCHSS(1) Maternal and child health institutions are irreplaceable in the maternal and child health service system.Institutions at all levels should strengthen the construction of the service system.(2) Institutions at all levels should pay attention to the public health nature of the MCHSS.The compensation system should be improved.(3) The rural doctors should be payed for their service by the institution.The team servicing for the maternal and child health in the rural area should be constructed, which is the most important for improving the maternal and child health service system.2,the suggestion to the development of DM&N Project(1)The institutions are suggested to develop the health education with the face-to-face formation.MCHSS should be integratd with other projects.Free services for the poor maternal would be the target(2) The regulation on women and children health service institutions should be standardized.The method of fund distribution should be adjusted according to the requirement of the different area.(3) The loss according to the delay to the hospital can decrease with establishing the reasonable process of first aid and distributing the obligation to the appropriate status.