新疆南疆乡镇卫生院基本公共卫生服务现状及公平性研究

Study on the Status Quo and Fairness of Basic Public Health Services of Township Health Centers in Three Prefectures of Southern Xinjiang

目的:通过分析新疆南疆乡镇卫生院基本公共卫生服务项目实施现状和公平性,旨在找出项目发展现存问题并提出改进意见。方法:从南疆和田、喀什和克州三地州随机抽取80所乡镇卫生院基本公共卫生服务评价项目评价结果以及各项目具体指标完成率等数据,采用构成比、卡方检验和基尼系数对南疆农村乡镇卫生院国家基本公共卫生服务项目实施现状及公平性进行分析。结果:构成比显示儿童健康管理等5项发展“优秀”,健康教育等8项发展为“良好”或“合格”;预防接种等4项各地州乡镇卫生院发展差异无统计学意义(P>0.05),其余9项差异有统计学意义(P<0.05),均是克州和和田发展优于喀什。基尼系数结果显示健康教育处于比较公平状态;中医药健康管理项目处于相对公平状态;其余项目处于绝对公平状态。孕产妇健康管理等3项,喀什公平性略好于和田和克州,其余项目公平性克州优于和田和喀什。结论:南疆基本公共卫生服务项目整体推进良好,部分项目服务水平有待提升,区域间发展存在不均衡现象,同时较高水平公平性有待推进,建议加强人才培养,提高人员待遇,加强基层健康教育,增加投入,同时完善考核机制和体系建设,发挥政府及第三方社会组织的作用,提升项目服务质量,均衡区域间的发展,达到高水平的公平。

Objective: To analyze the current situation and fairness of the basic public health service project of township health centers in three prefectures of southern Xinjiang, so as to find out the problems in the process of project implementation and put forward countermeasures and suggestions. Methods: 80 township health centers were randomly selected from the three prefectures of Hotan, Kashgar and Kezhou in southern Xinjiang. The evaluation results and the completion rate of specific indicators of each project were used to analyze the implementation status and fairness of the national basic public health service projects in rural township health centers in southern Xinjiang by using the constituent ratio, chi square test and Gini coefficient. Results: The constituent ratio showed that 5 items such as children’s health management developed "excellent", 8 items such as health education developed "good" or "qualified".There was no significant difference in the development of township health centers in 4 items including vaccination(P>0.05), but there was significant difference in the other 9 items(P<0.05),and the development of Kezhou and Hotan was better than that of Kashgar. Gini coefficient showed that health education was in a fair state. TCM health management project was in a relatively fair state. The rest of the projects were absolutely fair. For the three projects including maternal health management,the fairness of Kashgar was slightly better than that of Hotan and Kezhou,and the fairness of other projects in Kezhou was better than that of Hotan and Kashgar. Conclusion: The overall progress of basic public health service projects in the three prefectures of southern Xinjiang is good,and the service level of some projects needs to be improved. There are imbalances in regional development. At the same time,a higher level of fairness needs to be promoted. It is suggested to strengthen personnel training,improve personnel treatment,strengthen grass-roots health education,increase investment,and improve the assessment mechanism and system construction,play the role of the government and the third-party social organizations,improve the service quality of the project,balance the development between regions,and achieve a high level of fairness.