| Objective:To understand the present situation of health service in AHeqi County and Wuqia County of Southern Xinjiang,and analyze the problems of accessibility,and put forward the corresponding countermeasures and suggestions to provide scientific basis for local adjustment and improvement of basic health policy.Methods:From July to August 2016,a questionnaire survey was conducted among primary medical institutions,health personnel and herdsmen in research sites using a multi-stage sampling method.First of all,through the typical sampling method,AHeqi County and Wuqia County in Kezhou were selected as sample counties.(1)In the census area,14 township health centers and 56 village clinics were selected as investigation organizations.The questionnaire of township health center and the questionnaire of village health center were used to investigate the basic situation,building construction and bedspace setting,equipment allocation,financial expenditure and income,and the development of health service project.Then the questionnaire of health human resources was used to investigate 456 health workers in institutions,including their bas ic condition,academic background and professional title,establishment and employment,training and salary.(2)Random sampling method is used to collect samples from sample counties,townships and towns(Sumutash Township,Sababayi Township,AHeqi Township in AHeqi County,and Jigen Township,Heiziwei Township,Gilto Kuayi Township,Tuoyun Township,Bayin Kuluti Township in Wuqia County),and then sampled 26 sample villages randomly.Finally,a simple random sampling of 743 herdsmen was conducted.The residents'health service questionnaire was used to investigate its basic situation,the prevalence of two weeks of disease and chronic diseases,and the status of visits and non-visits.(3)In the same period,23 key insiders were selected by objective sampling method and interviewed in depth.Quantitative data were analyzed by SPSS17.0.Qualitative data were sorted out and analyzed by content analysis method.Results:1.Condition of health human resources:Among 456 health personnel,86.8%were the Khalkhas,61.4%were technical secondary school degree,94.6%were junior professional titles and 46.7%were not qualif ied to practise,66.0%were on the job,and 419 persons have participated in training,61.1%were basic public health service training.The average monthly income of health workers in township hospitals and village clinics was(4251.3±1513.3)yuan and(1173.3±690.5)yuan respectively.2.Condition of financial income and expenditure:The average annual total income of township health centers was 250800 yuan,which mainly came from the medical income of 45.0 yuan,and the aver age total expenditure in the same year was 185600 yuan,which was mainly used for the drug expenditure of 47.70.The average annual total income of the village clinics was about 6500 yuan.The income mainly comes from the higher financial subsidy income of 61.6%,and the average total expenditure of the same year is about 2500 yuan,which is mainly used to carry out the expenditure of basic public health services(63.7%).3.Condition of infrastructure equipment configuration:the operational area of 11 tow nship health centers is greater than or equal to 800 m~2.The average number of beds per township health center is 17.4,and the actual number of beds is 16.3.The average allocation rate of basic equipment is 36.4%(14.2/39).56 village clinics'average area for business use is(119.1±118.7)m~2.The average equipment equipping rate is 70.0%(20.3/29).4.Condition of health service development:Township health centers and village clinics have carried out 11basic public health services as stipulated by the state.The average development rate of basic medical services in township health centers,that was laboratory examination,diagnosis and treatment of common diseases,and family diagnosis and referral,was 80.0%(16.7/21)?75.0%(24/32)?56.0%(2.8/5)respectively.The development rate of village health basic medical service project is more than 70.0%.5.Needs and utilization of health services for pastoralists:Residents'two-week prevalence was20.6%(153/743),prevalence of chronic diseases was 32.3%(240/743),two-week consultation rate was9.2%(68/743),the new rural cooperative medical insurance coverage rate was 91.8%,and the percentage of the residents with illness but without medical consultation in two-weeks was 17.6%(27/153)in the population.The two weeks prevalence rate of herdsmen was related to gender and age.The prevalence of chronic diseases was related to gender,age and marital status.6.Interview results:In-depth interviews have extracted 11 thematic groups in four categories.(1)Health personnel:Lack of professional health technical personnel,poor quality of health personnel and lack of training opportunities for medical personnel;A public health worker has multiple duties and a heavy workload;Qualification examination is difficult;Having low wages,heavy work tasks and heavy financial burdens.(2)Material resources:Lack of essential drugs and imperfect drug delivery mechanism.(3)Health services:There are still many obstacles in developing mobile medical service at grass-roots level in pastoral areas;The level of herdsmen's self-health awareness is low,and the public health work is difficult to carry out;Strict inspection and no reward system.(4)Needs and access to health services for pastoralists:Selection of Township Hospitals for first visit;Heavy medical burden.Conclusion:The present situation of health service resources and the accessibility of different resources in the agricultural and pastoral areas of Kezhou are still far from the requirements of the state.At the sa me time,they are facing with more regional and climatic problems than those in other rural areas.The government should construct a differentiated policy of attracting talents suitable for farming and pastoral areas according to local conditions,and strengthen the skills and business training of specialized technicians.Continue to implement the system of essential drugs in village clinics and improve the mechanism of drug distribution.Strengthen the infrastructure construction of primary medical institu tions,and improve the level of basic equipment allocation,and gradually improve the accessibility of basic health services. |
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