贫困地区的妇幼卫生服务指标—我们可以相信多少?

MCH Indicators for Productivity in Poor Areas-How Can We Rely on?

目的 发现妇幼卫生服务数据的质量问题及其严重程度,探讨数据质量问题的主要原因,提出卫生评价和管理激励机制的改进建议。资料与方法 重庆市三峡库区的2个贫困县为研究对象,采用定性研究和定量数据分析相结合的研究方法。结果 定量数据描述显示法律实施前后的指标值变化与法律本身似乎关系并不明显,但贫困地区妇幼卫生服务的总体发展趋势是很好的,而且达到了很高的水平。但定性研究暴露了数据质量的严重问题,机构数据与实际情况差距很悬殊。基层统计和信息工作者和卫生服务提供者的知识和经验、统计数据的敏感性,过高的目标要求,以及管理制度和激励机制均是影响数据质量的重要因素。结论 贫困地区不适宜仅用机构数据中的工作指标值作为评价法律实施效果的指标,建议采用定性为主定量为辅的原则进行评价。“考核与奖惩”相结合的管理措施只实用于大多数人可以达到管理目标的情况。建议加强对基层妇幼卫生人员的技术指导。

OBJECTIVE To describe and analyze quality issue of MCH information! to discuss major detrminants which affecting quality of data, and to provide recommendations for improvement of health evaluation and managerial incentive mechanism. MATERIALS AND METHODS Two poor urual county of Chongqing were selected. Institutional data survey was conducted based on design of Second National Health Survey as well as supplementary data enquires. Key person interviews were conducted in provincial, county and township level. RESULTS The description of institutional data showed that MCH indicators have less linkage with implementation of the Law. But overall development of MCH service was satisfied and reached to higher level. But, qualitative analysis showed another story. For the less qualified data provided by MCH statistics, significant over estimated of MCH care outcome was demonstrated by instituional data.There are some determinants discussed in this reports i. e. knowledge and experiences of information processors and service providers,sensitivity of indicators,extortionate working targets,as well as unappropri-ate incentive method. CONCLUSIONS Performance indicators may be use solely for evaluation on MCH services,especially for that of poor areas . Quantitative and qualitative integrated approach would be that of recommended. Rewards and punishment , linking with result of operating assessment, should be used in case of that most of staff can reach the challengeable target. Professional supervision for basic MCH staffs should be strengthened.