An Evaluation Research Of Improving Primary Health Care Through Community Health Service In Depressed Areas

Objective: To evaluate the effect of rural community health services implemented inChongyi County of Jiangxi Province, and propose a relevant and appropriate ruralcommunity health service mode for reference of other underdeveloped areas in China.Methods：Chongyi County was selected as the intervened county. Seven townshipswere randomly selected within the county. And then all seven township hospitals and49randomly selected village clinics in the seven townships were surveyed.30households in each of the49villages were also interviewed with a questionnaire.5842people from1474households were interviewed in the baseline survey, and3879people from980households were interviewed in the follow-up survey. Luxi Countyserved as the controlled county. Three township hospitals and nine clinics wererandomly selected from three townships for institutional survey, and20householdsselected from each of the three townships for household survey.2232people from587households and2315people from628households were investigated in thebaseline survey and follow-up survey respectively. SPSS was used for data analysis.Comparisons between baseline and follow-up data in each county and betweenintervened and controlled counties at each time point were made in terms of thedemand side and supply side of community health services.Results：1) In Chongyi County, the number of health workers, physicians, nurses perthousand population increased from2.88,1.24,1.19to3.27,1.49,1.31respectively,and the infant mortality rate decreased from9.53‰to7.90‰. However, there wereno statistically significant changes in these indicators in Luxi County.2) Supply-sideevaluation results: after one year’s implementation of the program, all seven townshiphospitals (or Community Health Centers) in Chongyi County had area of floor spaceoccupancy up to set standards. Equipment coverage increased from90.5%to94.3%.And the number of township hospitals delivering public health services and thenumber of service items both went up. But most of township hospitals in Luxi Countydidn’t provide public health services, and had little change in equipment coverage.Among the49village clinics (or Community Health Station), percentage of clinics with area of floor space occupancy meeting standards increased from55.1%to71.1%; percentage with treatment room, observation room and duty room increasedfrom95.9%,91.8%,75.5%to97.8%,95.5%,88.9%perceptively; and full equippedrate increased from65.3%to84.4%; under-3child management rate, post-natalmaternal visit rate and chronic disease patient management rate also increased from53.1%,51.2%,46.9%to77.8%,73.3%,71.6%. In Luxi County, percentage with dutyroom decreased from88.9%to75.0%, and there were no statistically significantchanges in equipment rate and number of public health service items delivered invillage clinics.3) Demand-side evaluation results: after one year’s implementation ofthe program, in Chongyi County, proportion of patients needing but failing to accesshospitalization went down sharply by17.71percentage points from26.76%to9.05%.However, in Luxi County, two-week prevalence rate, two-week consultation rate,proportion of patients needing but failing to access hospitalization in the past twoweeks were all went up, but there was no statistically significant change in admissionrate. Rural residents’ levels of satisfaction with consultation and admission wereimproved in Chongyi County, higher than in Luxi County. Proportion of Childrenimmunized in village clinics rose from42.5%to59.2%in Chongyi County.Percentage of senior residents (of60years and over) having received health care intownship hospitals or village clinics went up in both counties, but higher in Chongyi.Conclusion:1) Implementation of community health services in Chongyi Countyfacilitated functioning of rural community service package of “Six in One” andenhanced accessibility of primary health care. Strengthening primary health care wasincluded into the government work report in Chongyi County, resulting inimprovement of infrastructure and equipments in township hospitals and villageclinics. Public health services delivered at township and village level (such asNon-communicable disease management and maternal and child health care, etc.)greatly increased, and residents’ level of satisfaction with outpatient and inpatientservices were also significantly elevated.2) Though pilot implementation, it seems tobe feasible to promote primary health care by conducting community health servicesin underdeveloped rural areas. However, there are some challenges, such as making officials at all levels aware of the benefit of this model and use it to achieve their goalunder restraint government investments into this field.