亚洲发展中国家妇幼保健服务公平性比较研究

Equity of maternal and child health care service in Asia developing countries:a comparative study

目的对比2000-2010年中国、柬埔寨、越南、老挝、菲律宾和蒙古6个亚洲发展中国家的妇幼保健服务公平程度。方法利用差值法和不平等斜率指数测算6个国家的妇幼保健服务差异。结果 2003-2011年每千人口助产士不公平性分析发现,在城乡分层中,菲律宾降幅最大;在教育分层中,柬埔寨降幅最大;在财富分层中,越南降幅最大。产前一次检查率公平性分析发现,在城乡分层中,老挝和菲律宾指标差异降幅最大;在教育分层中,菲律宾的降幅最大;在财富分层中,菲律宾和柬埔寨的降幅最大。产前四次检查率公平性比较发现,中国指标各分层维度的健康差异均较小。新生儿百白破疫苗接种率的公平性比较分析发现,蒙古在各分层维度的指标差异均较小,老挝和菲律宾不公平程度最高。新生儿麻疹疫苗接种率的公平性比较发现,中国在各分层维度的指标差异均较小,老挝、菲律宾和越南不公平程度相对较高。中国和蒙古的妇幼保健服务公平性较好,老挝、越南的妇幼保健服务公平性较差。结论中国和蒙古的妇幼保健服务公平性较好,老挝、越南的妇幼保健服务公平性较差。妇幼健康公平程度应被纳入到妇幼健康绩效的考核中;对发展中国家而言,妇幼健康的公平依赖于国家经济发展和社会稳定;妇幼公平的提升需从妇幼卫生资源布局公平入手,并不断推动妇幼健康服务的深化发展。

Objective To compare equity degrees of maternal and child health care service in China, Cambodia, Vietnam, Laos, Phil- ippines, and Mongolia from 2000 to 2010. Methods Difference method and SII index were used to calculate the differences of maternal and child health care service among the six countries. Results Inequity analysis on midwives per thousand population from 2003 to 2011 showed that the decreasing amplitude in Philippines was the largest in urban and rural stratification, the decreasing amplitude in Cambodia was the largest in education stratification, the decreasing amplitude in Vietnam was the largest in wealth stratification. Equity analysis on prenatal ex- amination rate for one times showed that the decreasing amplitudes in Laos and Philippines were the largest in urban and rural stratification, the decreasing amplitude in Philippines was the largest in education stratification, the decreasing amplitude in Philippines and Cambodia were the largest in wealth stratification. Equity analysis on prenatal examination rate for four times showed that the differences of different health stratification dimensions in China were small. Equity analysis on vaccination rate of neonatal DPT vaccine showed that the differences of dif- ferent stratification dimensions in Mongolia were small, the degrees of inequity in Laos and Philippines were the highest. Equity analysis on vaccination rate of neonatal measies vaccine showed that the differences of different stratification dimensions in China were small, the degrees of inequity in Laos, Philippines, and Vietnam were relatively high. Equity of maternal and child health care service in China and Mongolia was high, while equity of maternal and child health care service in Laos and Vietnam was low. Conclusion Equity of maternal and child health care service in China and Mongolia is high, while equity of maternal and child health care service in Laos and Vietnam is low. The de- gree of equity of maternal and child health care service should be included in maternal and child health performance appraisal. For the devel- oping countries, the equity of maternal and child health care service depends on national economic development and social stability. The im- provement of equity of maternal and child health care service should be conducted from equitable distributions of maternal and child health care service resources, the deep development of maternal and child health care service should be promoted continously.