Study On Performance Evaluation Indicators Of Public Health System In Rural China

With the socio-economic development and people's increased expectations of health, performance of public health system will play an increasingly important role in promoting people's health. At present, situation of public health system in rural China is unsatisfied. Performance evaluation is an important step to establish perfect public health system. So, it is an urgent to establish performance evaluation system of public health system in rural China.Objective:(1) To construct simple performance evaluation indicator system and proper evaluation way for public health system in rural China;(2) To test feasibility of performance evaluation indicator system and identify main problem of public health system in rural areas;(3) To provide scientific basis for improving performance and determining future focus work of public health system.MethodsBased on fully understanding of basic function of public health system, qualitative research was used to develop appropriate performance evaluation framework, indexes and rapid evaluation method. In addition to this, delphi method was carried out to construct simple proper performance evaluation system for public health system in rural China. Field survey was used in areas with different economic status to test feasibility of performance evaluation system.All the quantitative data were entered into the database created through Epi-data 3.1, and were analyzed with SPSS 11.0. Qualitative data were analyzed with Maxqda2.0.Results(1) Framework of performance evaluation for public health systemThe units involved in assessment were County Health Bureau, County Centre for Disease Control and Prevention, County Health Authority and County Maternal and Child Health Hospital. Evaluation was conducted by Self-evaluation from the following three aspects:health resources, policy support, health services.133 specific indexes were involved in the initial simple performance evaluation system for public health system in rural China.(2) Simple indicator system of public health system in rural areasTwo rounds consultations were carried out in 60 experts from the areas of disease prevention and control, health service management and public health administration. The positive coefficients in two rounds consultations were 65.00% and 84.44% respectively. The judgment coefficients of 81.08 percent of all experts were beyond 0.9 and the authority coefficients were 0.847.Finding from the consultation, weights for necessity, feasibility, stability and sensitivity of indicator were 0.4979,0.2725, 0.1394 and 0.0901 respectively. After two rounds consultations, harmonious coefficient was 0.41 and had statistics significance.Finally, a simple evaluation system of public health system in rural China was composed of 37 evaluation indexes involving input and output.In the evaluation system,12 indexes reflect input of public health system from the following 4 aspects: human resource, funds, instrument and equipment, policy and system, the remaining 25 indexes reflect output of public health system from the following 9 aspects:health status of residents, lab tests, disease control and prevention, response to public health emergencies and assessment, occupational safety, food hygiene and safety, maternity and child hygiene, health education and promotion, health inspection and supervision, environmental health, vulnerable population health.(3) Application of simple evaluation system of public health system in rural ChinaAll the fields have response plan of public health emergencies and technical program of emergency response at county level; Only 5 fields have designed performance evaluation system of public health organizations; The average ratio of licensed physician assistant and licensed physician to total physicians who provide services in towns and villages was 29.69% and the average participation rate of skill training among public health workers and epidemic prevention workers in villages and towns in a year was 87.67%.All the fields have developed management of specific diseases (TB, HIV/AIDS, endemic diseases, etc.); Infectious Diseases Reporting System in medical institutions of villages and towns has covered all the sample fields. The average rate of completing the full vaccination course required by national immunization program was 95.63%. Average percentage of county residents with established health dossier was 42.81% and 16.11% of person with severe mentally ill were under proper management.Performance evaluation score was between 39.26and 78.73 with 60.95 as its average score. Performance evaluation score for Jiangsu Province, Heilongjiang Province and Gansu Province was 73.43,65.59 and 43.84 respectively. Input score was between 8.98 and 27.57, output score was from 20.68 to 53.20.Conclusions37 indexes included in the performance evaluation system for public health system have good representation. Most of the indexes have clear concept and can be obtained from conventional statistical areas. The evaluation indicator system has strong practical application value;At present, the overall performance of public health system among rural areas in China is unsatisfied with significant regional differences; It's an urgent to improve professional quality of public health personnel working in township and village; Routine work of public health system such as vaccination was carried out well. Further improvement is needed in following areas:standardized management of major chronic diseases, establishing health dossier for county residents, management of elder and severely mentally ill.