Research On The Effect And Mechanism Of A Comprehensive Intervention Project For Children’s Health In Nujiang Prefecture,Yunnan

Objectives:This study aims at seeking the comprehensive intervention models of child health and its working mechanism which fits for the western poverty and ethnic minority areas through the evaluation of the comprehensive intervention project for children’s health in Nujiang Prefecture, Yunnan. The target is divided into three aspects. First of all, estimating the comprehensive intervention in specific environmental conditions of Yunnan. Secondly, exploring the mechanism of the comprehensive intervention project and cracking the process of "black box". And finaly, proposing some suggestions based on the above conclusions.Contents:Combed the evaluation theory in the domestic and overseas and the situation of evaluation on children’s health which adopts comprehensive interventions. Compared the change of child health in Yunnan Province before and after the implementation of the comprehensive intervention. Summarized the effect of the comprehensive interventions in Yunnan Province which depends on different levels, generalized the mechanism which intervention made the difference. Giving suggestions on intervention which fits poverty and backwardness of the west areas according the above conclusions.Methods:This study useed the literature research method combing the child health interventions and theirs evaluation methods in the domestic and overseas. Experts’ advices about the evaluation scheme as well as the scientific, conduct and suitability of the evaluation indexes are also important to this article, and then adjustment should be implemented on the basis of experts’opinions. Descriptive statistical analysis was carried out before and after the comprehensive interventions’commitment. Method of induction was also utilized in this study by summarizing the effect of the mechanism of the comprehensive interventions at different levels in Nujiang, Yunan Province.Results:1. Some models of the health influence factors were introduced which are widely used in the world. On the based of the outcome above, the influence factors of children’s health were summarized which include the economic, social, policy, culture and religion, etc in macro level, and the status, behavior factors of social support, community, etc in medium level, then the level of education, occupation, nationality in micro level. In view of the above factors, the intervention aimed at improving children’s health including:An integrated child nutrition intervention improved growth of younger, more malnourished children in northern Viet NAM, Effectiveness of an educational interbention delibered through the health services to improve nutrition in young children:a cluster-randomised controlled trial and so on. Before and after contrast, with and without policy contrast are the main evaluation methods adopted.2. Based on the Social Determinants of Health and the realistic evaluation theory, the analytical framework involves Macroscopic scale and Microcosmic was structured which contains context, mechanism and outcome.3. Infant mortality and under-five mortality were13.14%o and16.35%o, and pneumonia, premature birth, birth asphyxia and accidental injury were the main causes of death. The rate of children’s growth retardation and low weight are36.13%and25.81%. Nutritional diseases account for93%of the total incidence, which become the main factor affecting the first children’s health.13.14%o and16.35%o Poor living environment, shortage of medical service ability, and low levels of health literacy played an important role in child’s health intensely in Nujiang, Yunnan Province on the basis of baseline survey. The children live in Nujing were out of condition, especially the nutritional disease.4. Under-five mortality declining, Nutritional disease prevalence growing slowly, and Infant mortality rates fluctuating show from the result of the comprehensive intervention in Nujiang province.5. Policy and leader development, mechanism of project coordination, infrastructure facilities, teaching staff training, expert support and personnel training, health education, and children’s nutrient supplement had been strengthening, but there still exist problems.Discussion and Analysis1. The children’s health was improved in Nujiang Province, but the infant mortality rates is fluctuated. Stpe by step training and further study improved the medical personn’s professional quality. Health education gradually improves the parents’health consciousness. The subsidy of giving birth in hospitals had a certain effect on under-five mortality reduction. The propulsion of children’s nutrition supplement project. The system management of basic public health services for children’s health and the promotion of health education had a certain role in promoting children’s nutritional status. Lacking of health knowledge insufficient attention to children’s health and accident harms led to the fluctuation of infant mortality.2. Related policies payed more attention to Nujiang children’s health. Medical institutions Equipped with facilities could improve the ability and quality of the supplier. Maternal and child health staff improve professional quality through training and education. The health education materials which suit of Njiang Province made children’s parents easier to receive relevant information. The children’s nutrition supplement project could improve children’s health to some extent.3. There were some problems in the process of project implementation, to some extent, limit the effect of the comprehensive intervention. The ability of development localization policy was insufficient, which limits the maternity and child health development. Responsibility was not clear in the process of coordination and execution. Lacking of infrastructure affects the development of related services. The shortage of maternal and child health personnel limited the service capacity. The imperfect of step by step training mechanism, training contents lacks of pertinence and practicability. The lacking of health education personnel and their insufficient ability as well as avoidance of local resources to carry out health teaching activities limit the effect. The insufficient promotion and training of the nutrition project, unsound incentive mechanism reduce the effectiveness of the project.Conclusions and suggestionsBased on the above research results, this study summarizes the following conclusions and Suggestions.1.There exists an improvement of the child’s health in Nujang by carrying the comprehensive intervention.2. Guided by the local policy, Supportting the infrastructure construction and personnel capacity building in health agency, improving the staffs’service consciousness and work enthusiasm at all levels, and carrying out the working funds can promote project smoothly.3.Lacking of infrastructure and medical personnel, whose ability is limited, lacking of service awareness and the inperfection work incentive mechanism limit the outcome of the project output.4.Improving the directorate generals’consciousness, to ensure the policy development reasonable and suitable.5. Perfecting the three-way working mode and coordinating mechanism, straightening out institutional responsibilities.6. Supervising the process of purchasing the equipments and relocating the equipments according to the local needs.7. Perfecting the operation modes, optimizing the supporting contents, integrating the step by step training and selecting the trainee for forther study strictly.8. Developing the local religious resources for health education rationally.9. Providing compensation independently, increasing the propaganda about the child nutrition elements project and completing the related works.