An Evaluation Study Of The National Free Pre-pregnancy Health Examination Project

Objectives: To investigate the implementation status of the National Free Pre-pregnancy Health Examination(NFPHE) project and to assess whether the work has been carried out in accordance with the national technical standards and management regulations and rural residents' knowledge and satisfaction of the project in order to summarize experiences and find out problems and gaps so as to put forward recommendations for the better implementation of the project in the new context of the combination of health and family planning system.Methods: We selected Laishui County in Hebei Province and Nanjian County in Yunnan Province as the study site and employed multiple research methods including questionnaire survey, interview, observation and collection and analysis of secondary data. For the evaluation of project management and service provision, we employed the methods of interviews, observation and collection and analysis of existing data in Nanjian County and Laishui County, the contents under evaluation include project fund management, laboratory management, information collection and use, and the provision of 19 health examination service items. We also undertook a questionnaire survey in Nanjian County to assess the results of the project. The questionnaire survey was divided into two parts: the general public questionnaire and the questionnaire for those who have received the pre-pregnancy health examination services aiming at evaluating the knowledge of the general public and satisfaction of the service receivers on the project.Results: For the project management, both Nanjian County and Laishui County have managed the project according to the national technical service standards and fund management documents, which ensure the smooth implementation of the project. However, there are still problems and gaps in some aspects of the project management. Although the two county family planning service stations are equipped with independent laboratories and complete examination equipment and professional medical staff, but the laboratory arrangements does not meet the "Pathogenic Microbial Laboratory Biosafety Management Standards" and some laboratory testing methods do not meet the technical service standards. For the information management, health examination data was not entered into the computer information system timely and there is a lack of information sharing mechanism,which lead to the large investment in network management and the information utilization is insufficient. the couples were not timely informed with their health examination results and the results were not provided in written format.For the project service provision, based on the actual situation of the two counties,Nanjian County adopted the mode "County and township jointly provide thepre-pregnancy health examination" while Laishui County adopted the model "county provides the pre-pregnancy health examination services", both counties have provided the 19 health examination items stipulated by the NFPHE policy. Based on the health examination results, risk assessment was conducted and counseling wasprovided to couples who have needs.For the project outputs, the evaluation reveals that both Nanjian and Laishui Counties can successfully complete the NFPHE targets set by the government each year and the project coverage has increased yearly. The questionnaire survey in Nanjian County found that couples welcomed the project and 92.1% of the residents are willing to accept the examination. The satisfaction rate of each service item was higher than 90%. Fifty percent of the surveyed rural residents know about the NFPHE and people in different age groups and living with different distances to county town have different knowing rates of the NFPHE,the differences are statistically significant (?2=27.881,p <0.05 ; ?2=20.437,p<0.05). Laishui County puts marriage registration, pre-marital health check and NFPHE into one place to provide "one-stop service" in 2015, which significantly increased the number of NFPHE by 62%.Conclusions: Both Nanjian County and Laishui County has completed NFPHE targets set by the government and provides convenient pre-pregnancy health examination for couples. However, there are still problems and gaps in the project management and service provision, which need further improvement. In addition,only 50% of the surveyed rural residents know about the NFPHE,which is lower.The rural residents' acceptance to the project is high, but there is room for improvement in technical equipment and postpartum follow-up. We should improve the management measures and information dissemination strategy and strengthen the implementation of relevant policies and regulations,and enhance the service quality so as to increase knowing rate of the general public and the service utilization by couples.