A Evaluation On The Improving Effect Of The Health XI Project On The Capacity Of Maternal And Child Health Service In Rural Areas Of Gansu

Objectives To evaluate the improving effect of the health Ⅺ project on the capacity of maternal and child health service in rural areas of Gansu, to analyze the success and failure of the maternal and child health services in the project areas so as to spread the successful experiences of the project among none-project areas in whole province and provide basis for developing strategies and policies concerning the maternal and child health services in Gansu Province.Methods A series of indicators were selected and confirmed to evaluate the ability of the maternal and child health services through querying literatures, consulting experts and in combination of some monitoring indicators used in the baseline survey, mid-stage evaluation and terminal assessment of the health project Ⅺ. Some statistics methods such as estimating annual percent change (EAPC),χ2test, Wilcoxon rank sum test were used to statistically describe and analyze the annual changes in the major indicators in the five areas where the health project XI had been undergoing between2008to2013, and compare these changes in indicators with the that in other areas of Gansu Province, in combination of the evaluation indicators concerning crowd’s satisfaction in order to discuss the impact of the project intervention on the capacity of maternal and child health service in the project areas.Results1. The evaluation indicators relevant to women’ health careIn women’s health care indicators, the rate of prenatal examination, postpartum house call and maternal system management increased to some extent at the end of the project in the five project areas, especially in Jingning, the EAPC of the above indicators were5.68%,7.40%and8.64%, respectively. The rates of hospital delivery in five project counties were almost close to100%in2013. Among five counties, one of the fastest growing rate of hospital delivery was Gangu, the EAPC was9.65%. The screening rate of gynecological diseases increased faster in Gaolan than in other project areas, the EAPC was31.22%. In addition to few areas in which each index in the baseline value was higher than that of Gansu Province, the changes in these indicators in the rest of the project areas were higher than or in parallel with the average trends in Gansu Province.The maternal mortality rate, a women’s health outcome indicator, showed a decrease trend in five project areas from2008to2013, among them Kangle declined faster, the EAPC was-15.47%. The descent speed of the rate of maternal mortality was faster in Huining, Gangu and Kangle than that in Gansu Province.2. The evaluation of the indicators relevant to children’s health careIn indicators of children’s health care, the system management rate of children under3years increased faster in Kangle compared with the other four project areas, the EAPC was30.92%, and the EAPC in Gaolan, Jingning and Kangle counties were higher than the average level of Gansu province. Vaccination coverage rates in Gangu, Jingning and Kangle increased to some extent with the statistical differences.In indicators of children’s health outcomes, compared among five counties, neonatal mortality, infant mortality and child mortality under5drop faster in Kangle, the EAPC of these indicators in Kangle were-26.04%,-26.38%and-26.38%, respectively. In addition to few areas in which the baseline value of each index was lower than that of Gansu Province, the changes in these indicators in the rest of the project areas were all much more than or in parallel with the average trends in Gansu province.3. The evaluation of the crowd’s satisfactionThere was a similar trend in the satisfaction rate both in sick people with medical care within two weeks and the persons with hospitalization within one year. Compared the data of terminal assessment with the data of baseline survey, the crowd’s satisfaction for the healthcare environment and healthcare service was improved to some extent in the five project areas. The constituent ratio of the "very trusted" to our medical staff increased. In maternal and child health services, the number of person considering "insufficiency of the medical equipment","low-tech of medical technology" and" the high fee for service" constitute a relatively large share. The constituent ratio of people who consider the female doctors service "available" increased. All the above differences were statistically significant(P<0.05).ConclusionsTo some extent, the project of health XI improves the maternal and child health service capacity in the project areas. The project results in some short-term and long-term social benefits. Based on the project experience, the key in the future development in the field of maternal and child health care is to increase investment and rationally allocate health resources.