Research On Promotion Strategy Of Contract Service In Rural Left-behind Families

[Purpose]Improving the quality and efficiency of the supply of family doctors’ contract service in rural area is the key to strengthening the basic health service network,promoting the realization of hierarchical diagnosis,and ensuring the health of rural residents.In this study,the left-behind families,a key vulnerable group in rural areas,were taken as the research object.Based on the AGIL functional model framework,this paper analyzed the multiple practical reasons behind the problems in the quality and efficiency of contract services for rural left-behind families,and accordingly put forward the strategies to promote the development of contract service for rural leftbehind families.[Method]1.Literature research methodSummarize the domestic and foreign research results on the theory and practice of contract service for left-behind families,and understand the current actual progress and existing problems of contract service for left-behind families,which lays a foundation for this research.Draw lessons from domestic and foreign research results of health service supply of left behind families and vulnerable groups and AGIL functional model framework,this paper proposes some strategies to promote the development of contract service for rural left-behind families.2.On-site investigationSelecte a total of 4 townships and 15 villages of Zhijiang city,hubei province to carry out field investigation,,and obtain relevant information of left-behind family contract service through questionnaire survey and interviews with key informants.Supplier level: interviewed the government and health administrative department personnel to understand the relevant policies and centralized feedback in the implementation process of the contract services for rural left behind families;interviewed the contract service providers in the county,mainly the township health centers and the village health office personnel,to understand the current situation of the contract services for rural left behind families and their understanding and practical experience of the contract services for rural left behind families;interviewed village health organizations,such as village committee,women’s Committee and other staff,to understand the health problems faced by rural left behind families and the real demand for contract services from the perspective of suppliers.Demander level: a questionnaire on the utilization and demand of contract services for rural left behind families was designed.A total of 338 people from 166 left behind families were surveyed to understand the basic situation,family functions and actual utilization and demand of contract services for left behind families.3.Statistical MethodsUse Epidata 3.2 to organize data and SPSS22.0 to descriptive statistical analysis,chi-square test,and one-way analysis of variance.[Results]1.Theoretical analysis of contract service demand of rural left-behind families.Compared with ordinary families,left-behind families have damaged family structure and weakened family functions,and belong to the health vulnerable group,which requires family doctors’ contract services to make up for their health.In the new era,the theoretical demand of contract service for rural left-behind families is analyzed from four aspects:(1)Left-behind families need to be included in the key groups of contract services;(2)The supplier requirements of contract service for rural left-behind families;(3)The content requirements of contract service for rural left-behind families;(4)The promotion for contract service for rural left-behind families.2.Analyze the situation of rural left-behind families and members in the sample area.Among the 166 left-behind families,there are about 2 left-behind members in each family on average,among which the left-behind elderly are the majority,accounting for 76.04%.3.Analyze the family structure,function and health status of rural left-behind families in the sample area.The left-behind families in the sample area are mainly empty-nest families,accounting for 68.7%.There are differences in the three major functions of active communication,non-egoism,and problem solving among different types of left-behind families.The health status of nearly half of the left-behind members are not optimistic.4.Analyze the two kinds of gaps of contract services demand for rural left-behind families in the sample area.(1)The gap between the theoretical demand and actual demand of contract services for left-behind families.In general,the theoretical demand of contract services for left-behind families was higher than the actual demand in the survey;(2)The gap between the actual supply and actual demand of contract services for left-behind families.The gap was shown in the facts that the rural left-behind families were not included in the key population of contract,the providers of contract service for left-behind families were insufficient,and the supply of contract services content and frequency for left-behind families did not consider actual demand.5.Analysis of problems and reasons in the supply of contract service for rural leftbehind family.The main problems are:(1)The lack of the concept of contract service for rural left-behind family;(2)The unclear cognition of left-behind families on signing services policy;(3)The insufficient of the providers of contract service for left-behind families;(4)Difficulties in realizing the demand of contract service content and frequency for rural left-behind families.The reason analysis draws on the framework of the four functions of AGIL model,and summarizes as follows: A: poor adaptability of rural economy,G: no special policy plan,I: weak role of the social community,and L: low attention of family and society.[Conclusions]Based on the analysis of the root causes of the problems existing in the contract service for rural left-behind family under the AGIL model framework,the following countermeasures and Suggestions are put forward to promote the signing work of rural left-behind family: 1.Multi-funding: the economic adaptation of contract service for rural left-behind family;2.Establishment System: standardized implementation of contract service for rural left-behind family;3.Integration of power: multi-cooperative supply of contract service for rural left-behind family;4.Maintaining stability: support from family and social cultural values.