上海市七个示范区结核病防治体系关键要素分析与评估

Analysis and evaluation on the principal components of health system for tuberculosis control in seven demonstration districts of Shanghai

目的:评估上海市结核病防治体系关键要素的现状,分析大城市加强结核病防治体系的可行政策和措施。方法:以上海市7个结核病防治示范区为调查对象,采用定量和定性研究相结合的方法,应用世界卫生组织卫生系统关键因素框架进行分析。结果:示范区建立了结防领导组织体系,加大了患者减免和补助力度,建立了多层次质量考评机制;实施了整合区域卫生资源、提供综合防治服务的改革;2009年区均配置专兼职结防人员约24名;各级财政专项经费投入96.8万元,其中区级占55.6%;各示范区进一步开发了结核病管理信息系统功能,均具备痰涂片和痰培养检测能力。结论:上海市结核病防治系统在政府治理、服务提供、人力资源、经费投入、信息系统和技术等关键要素方面都取得了一定的成果,但在人力配置、经费使用和监管、信息系统建设等方面应加强政策开发,使其更加合理化和具有可持续性。

Objectives： To study the status of the principal components in TB prevention and to explore the effective strategies on health system strengthening for TB control in Shanghai and treatment system, ~ Methods ： Seven TB control demonstration districts in Shanghai were chosen as the study fields. Qualitative and quantitative research methods were adopted in the study. The WHO health system strengthening framework was applied as the analysis framework. Results： The demonstration districts have set up a leadership system on TB control, extended the policies on medical expense reduction and assistance, and established the multi-level quality evaluation system. These regions also have implemented reforms on integrated TB control services provision. In 2009, an average of 24 professional or part-time TB control staffs were allocated in each district. Simultaneously, the government special funds were 968 000 Yuan in each district, of which 55.6 percent was supported by district-level. Every district has developed the func- tion of TB management information system and improved the capability of testing including the sputum test and bacte- rial culture. Conclusions： The efforts on governance, services delivery, health workforce, financing, information sys- tem, and medical technologies all contributed to the effect of the TB control in Shanghai. It is suggested that policy improvements should focus on the allocation of human resources, more reasonable and sustainable financial distribu- tion and supervision, and the development of health information system in the next step.