| BackgroundBasic public health services are mainly used to address the basic health problems of residents.China's basic public health services have been officially implemented since 2009.They are under the charge of primary health care institutions and are free for all residents.Some achievements have been made,but there are still many shortcomings failing to achieving the expected effect.As the main supplier of basic public health services,primary health care institutions have some problems in the process of service provision,which seriously affects the results of services and the improvement of residents'health.Therefore,from the perspective of primary health care institutions,this study uses qualitative research methods to analyze the current situation of providing basic public health,identifying existing problems and obstacles,and and proposing targeted and constructive comments.ObjectiveThe author collects information about basic public health services provided by primary health care workers through interviews,learning about the current situation of basic public health services provided by primary health care institutions,analyzing existing problems and difficulties,and discussing solutions to existing problems,and providing corresponding policy recommendations.MethodsThis study mainly adopts he method of qualitative research,and uses the purpose sampling,selecting 12 counties of Liaocheng,Qingdao,Zibo and Heze in Shandong Province as the survey sites.Semi-structured interviews were conducted with the directors of township hospital/directors of community health service centers,chiefs of public health departments,village doctors and health personnel of community health service stations.101 people participated in the final interview,consisting of 30 directors,21 chiefs of public health departments,and 50 village doctors and health personnel of community health service stations.The interview records were transferred to text data and imported into Nvivo11.0 for management,coding and categorization,and analysis in depth by means of subject analysis method.Results(1)The shortage of primary health care personnel is a common problem reflected by interviewees.There are fewer full-time staff,professionals and highly educated staff in the township hospitals,and the current level of professionalism is low.There are very few young village doctors,highly educated personnel,professionals in the village clinic.And there is gender imbalance among village doctors.Insufficient personnel make the problem of large basic public health workload and heavy burdens outstanding.Therefore,the quality of primary health care services is reduced.(2)Funding for the project can be fully placed in time,for the use of township hospitals and village clinics.The proportion assigned to village doctors varies from 30%to 50%.Insufficient funds,especially the use of strict restrictions,and the inability to issue performance pay are the main problems reflected by most interviewees,making people lack enthusiasm.The use of surplus funds varies widely among hospitals.(3)The basic public health supervision incentives mainly adopt the form of performance appraisal.The survey areas have established corresponding appraisal systems,which are mainly divided into the evaluation of township hospitals by higher authorities,the appraisal of village clinics by township hospitals and the appraisal of personnel of township hospitals.The problems found in the interviews are:the assessment criteria are not flexible;the authenticity is neglected,especially the telephone calls back to the residents for investigation are mostly criticized by most people;the assessment criteria are not uniform,and lack of objectivity and fairness.Although the assessment is related to the wages or subsidies issued,the amount is small?and the incentive effect is general.Some health centers have no personnel to supervise the implementation of the assessment system.(4)Basic public health services have various forms of publicity.This study found that:publicity excessively depends on primary health care institutions,while the effect is not satisfactory;the publicity intensity is small and the publicity methods are limited,and lack of attraction;the publicity content is not targeted,and the residents do not understand the type of service that they could enjoy.(5)Basic public health services are carried out in an orderly manner,but the service]evel is still not high.Basic public health services are separated from medical services.In some areas,various projects are divided and no integration.The main problems in specific projects are:residents'health records falsification,update not timely problems exist from time to time,and residents'health records basically did not use up and play a role;It is difficult to recruit residents to participate in health education,health education work has become a form,and the content is not deep and no targeted;Patients and their families with tuberculosis and severe mental illness fear discrimination,rejection,lack of professionals at the grassroots level,and limited service levels.(6)At present,basic public health services are gradually recognized by residents,and their satisfaction is improved,which plays a role in disease prevention.The main problems are:low level of education,low awareness of residents' health and mobility of the population.Some residents are worried about leaking information increases the difficulty of basic public health services.(7)The treatment of primary health care personnel affects their enthusiasm and initiative,which in turn affects the quality of service.The current low income and large workload are common complaints from grassroots personnel.The interview found that:the difference in income of performance appraisal part is not obvious,and it loses its incentive effect;basic public health work is cumbersome and takes up a lot of time,and some people think that it affects business income and put more energy on medical care;village doctors lack medical insurance and endowment insurance,therefore they have worries and influence the enthusiasm for work.Conclusions and SuggestionsSince the implementation of basic public health services,the work has progressed smoothly and achieved certain results.However,there are still many problems in the specific implementation.Insufficient human resources at the grassroots level,low income security for personnel,and inadequate training are important reasons.Meanwhile,the number and quality of primary health care personnel cannot meet the needs of primary health services.At the same time,the organizational model for basic public health services needs to be improved.Funds can be paid in full and on time,but the funds are insufficient,and the problem of“dare use,can not use”is present.The performance appraisal system is relatively complete,but some assessment methods are not appropriate,the feedback mechanism is lacking,and its incentive effect is limited.Residents gradually recognize basic public health service,but there is a widespread problem of poor cooperation.In general,basic public health service projects are being carried out in an orderly manner,but the quality of service needs to be improved.It is necessary to improve the quality of service from various aspects.Suggestions:1)Take effective measures to strengthen the construction of primary health care personnel,improve their business ability and professional quality,change the personnel organization model.and explore the team model to carry out basic public health;2)Improve funding guarantees,and establish reasonable funding standards,increase the ability of independent allocation of primary health care funds;3)Improve the performance appraisal system,enhance the authenticity,objectivity and fairness of the appraisal system,establish a communication feedback mechanism.and effectively exert the incentive and guidance role of appraisal and supervision;4)Strengthen publicity and enhance the sense of identity of residents to increase residents'compliance;5)Combine basic public health service with basic medical services to ensure that all services are useful and relevant. |
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