Study On The Index Of Performance Evaluation Of The Community Health Service System At District Level

ObjectiveAccording to the goals and basic principles of the development of community health services and based on the objectives and functions of community health services system, this study was designed to use theoretical analysis and empirical studies methods to define community health service system and its performance ,identify performance evaluation and dimension, then we proposed a performance evaluation index in the community health service system at district level which is appropriate for our national conditions and the practical of CHS.The index also is very maneuverability and it provides a theory basis for the government to develope a standardization work and decision-making.By using the index, the reform of CHS will be developed in the correct direction and the health of community residents will be improved.Methods1.Literature researchCommunity health service policy and literature were collected through Academic journals domestically and abroad,the Ministry of Health and the World Health Organization, and other related websites. Combining with the community health services evaluation indicators which from healthⅧ/ sanitationⅧsupport projects and urban community health services and poverty relief projects (H8/H8SP,UHPP),the evaluation indicators were collected extensively, then reserved indexes will be formed.2.Delphi methodTwice specialist consultation of the reserved indexes were carried out by experts who are engaged in health service research, especially research in community health service or the manager of CHS.In the process of specialist consultation, the evaluation indexes were selected considerately, and the weights of the indexes were confirmed, finally, we proposed the performance evaluation index of the community health service system at district level in theory. 3.Scene investigationScene investigation was used to acknowledge the situation of the development of CHS in 7 districts of Wuhan. All the data relevant to the indexes were collected by questionnaires which used to survey health administration,the institution of CHS,the patient and the residents. We also interview the manager of health administration for collecting the opinions of the indexes.4. Statistical analysis methodThe results of specialist consultation and the questionnaires were inputted in computer by Microsoft Office Excel 2003,and were calculated by software of SPSS12.0.According to the nature of the data, all the data were analyzed through description Statistic,nonparametric tests,reliability analysis. We also compute the value of standardized indicators and performance index.Results1.The community health service system is designed to handle the main health problem as well as to fulfill the demand of basic medical service requirement in the community. This system is the sum of the human resourse, the organization and other resources. The system should provide more effective, more available and more equal service. Also this system should include three department: the government, the medical health service system, other social and community resource.2 The target of the community health service system should previously ensured the public profit,to fulfill the health service demand of the people and to maximize the function effection."Six in one"function of community health service must be pursued totally, so as to optimize the service quality,equality,efficiency,and availability and improve the health of the people in community.3.The four function of the community health service system: providing CHS, resource generation of CHS (human resouce,building and equipment), financing and management of the community health service.4.The performance of CHS is part of the total performance of the health system.The perforance of CHS should be defined as the degree of achievement of the target and function of the CHS under certern community health resource.The function is the base of performance definition,on the other hand, the performance would provide guildline for the function.Performce dimensionality is including input, progress,outcome.Performance dimensionality,measurement and indexes, the way for performance evaluation, the main body and objective body of evaluation as well as the surrounding are comprised the performance evaluation system.5.Index of performance evaluation in the community health service system at district level should be divided into three department. The fist part including input,progress and output.The second part is the secondary index. Among them, the input index including the policy,fund, organization,human resource. The progress index including quality and efficience. The outcome index including the responsiveness and satisfacty. The third part is the performance index, 35 indexes for all.6.In the first turn of expert consultation, The coordination coefficient of the specialists of importance of the three first indexes and total index are 0.292,0.202,0.161,0.271.The value of P is less than 0.05 by Chi-square test. In the second turn of expert consultation , the coordination coefficient of the specialists of importance of the three first indexes and total index are0.422,0.312,0.230,0.328,The value of P is less than 0.05 by Chi-square test.The degree of the coordination coefficient in the second turn is better than in the fist turn.The result is appropriate.7.The outcome of the evaluation show different value in diverse samples which can reflect the real condition of the CHS development.Through the reliability and validity analysis of the index system , the total Cronbach'sαcoefficient is 0.6224. So the reliability is available. The content validity is 7.29, comparativley ideal result.Conclusion1.The perforance of CHS should be defined as the degree of achievement of the target and function of the CHS under certern community health resource. Performce dimensionality is including input, progress, outcome.2.Index of performance evaluation in the community health service system at district level possess comparatively good reliability and validity which make it a good way to evaluate the performance of the CHS.3.Index of performance evaluation in the community health service system at district level is feasible, and the related data can be collected conviencely. In the same time, the calculation can be easily done. So depend on the evaluation table, the horizontal and vertical evaluation can be pursued.4.This index system can refect the level of total performance, also can analysis the performace outcome in three partial including input, progress and outcome which provid evidence for the management of performance.