Water, Sanitation and Hygiene in Lower-Level Health Care Facilities of Dar es Salaam Region in Tanzania: Status towards Achieving the Sustainable Development Goals and Way Forward

Background: Improving Water, Sanitation and Hygiene in health care settings is a critical prerequisite for achieving national health goals and Sustainable Development Goals (SDGs). The World Health Organization (WHO) has set a target for each United Nations member state to reach by 2030. Each member state is required to reach by 2022, 2025 and 2030 at least 60%, 80% and 100%, respectively of basic level of service of the five elements which are water, sanitation, hygiene, waste management and environmental cleaning. Methods: This study aimed to evaluate and document the current state of basic water, sanitation, and hygiene services in all lower-level health care facilities in the Dar es Salaam region of Tanzania as of July 2022. A cross-sectional study was conducted in 99 public dispensaries in the Dar es Salaam region’s five councils: Ubungo, Kigamboni, Kinondoni and Temeke Municipalities, and Ilala City. The interviewee form and observational checklists were both digitalized using the Kobo tool software. The respondents were health care facility in-charges or nurse in-charges. Data were downloaded, validated, and imported to Stata version 15 for analysis. Results: The basic WASH level per JMP is far below the target in 2022. Each member state by 2022 is required to reach at least 60% of the basic level of service of each element. We found a low coverage of basic WASH in the 99 dispensaries included in this study. The basic WASH coverage was met in only 10 (10.1%) of the dispensaries, while the remaining 89 (89.9%) dispensaries fall on limited WASH services. Conclusion: This study revealed lower coverage of basic WASH services in dispensaries. An urgent need is required to improve the status of WASH in all the dispensaries and facilitate the provision of quality health care services, patient safety and reduce health care associated infections.

Knowledge and Skills Gap of Midwives to Conduct Obstetric Ultrasonography Screening in Primary Health Care Facilities in Kajiado and Kisii Counties, Kenya

Background: Ultrasound remains a tool of much importance in maternity care with midwives regarded as key health professionals when it comes to care of pregnant mothers. There is however limited study on the knowledge and skills gaps of midwives in conducting obstetric ultrasonography screening. The purpose of this study was to assess the specific obstetric ultrasonography knowledge and skills gaps among midwives based in primary health care facilities. Methods: A cross-sectional study employing both qualitative and quantitative method was conducted between July and August 2019 with 274 midwives. A structured questionnaire was used to collect data while Focus group discussion and Key Informants Interview were used to collect qualitative data. Descriptive statistics were used to summarize the data test associations between variables while the qualitative data were used to compliment the questionnaire data in eliciting more information on the gaps. Findings: Almost all (94.5%) the midwives had never been trained on any basic obstetric ultrasound while six of those that had been trained in early stages by the project lacked equipment to practice the acquired skills. More than three quarters of the respondents opined that they wished to provide personalized care services to mothers/clients seeking Antenatal Care Services (ANC) in their community at a fee while only 13.9% had knowledge that obstetric screening should be done before 24 weeks gestation. Four out of ten of the respondents scored themselves a one (1) on the level of confidence they have using an ultrasound machines or technology. Conclusion: There still remains a huge gap as far as training of midwives on basic ultrasound screening is concerned. The lack of basic obstetric ultrasound screening skills is a barrier to rolling out Point of Care Ultrasound (POCUS) screening services. However, midwives are motivated and willing to learn basic ultrasonography skills to further the objectives of Universal Health Coverage (UHC). Concerted efforts should be made to train midwives on basic obstetric ultrasonography skills in addition to availing mobile/hand held ultrasound technology in Primary Health facilities for them to apply the transferred skills. A sustainable business model to enable mothers continuously afford the services is critical as well.

Nurse Mentor Training Program to Improve Quality of Maternal and Newborn Care at Primary Health Centres: Process Evaluation

Quality of maternal and newborn care could be improved if health care providers’ knowledge and competencies as well as system level constraints are addressed. However, due to several barriers staff nurses who form the frontline of health care workforce have limited access to enhancing their clinical knowledge and competencies. To address this gap, a new cadre of nurse mentors (NMs) for the public health system were trained by specialists from a teaching hospital in a special 5-week training course. This included 54 hours of theory and 110 hours of practical in clinical obstetric and newborn care, apart from mentoring, quality improvement and health systems issues. The nurse mentors were assigned to support staff nurses in the primary health care centres (PHCs) in eight northern Karnataka districts. Each NM covered 6-8 PHCs monthly for 2 - 3 days and thus a total of 385 PHCs were reached. They received support in the field through supportive supervision visits done by the specialists who had trained them, as well as by refresher training and clinical postings to the district hospitals. This paper presents impact of the training program on change in immediate and long term knowledge and competency scores of nurse mentors. Their baseline knowledge scores changed from 44.3 ± 12.7 to 72.1 ± 13.8 immediately after the training in obstetric and from 18.2 ± 19.1 to 66.4 ± 14.9 in newborn (p p p > 0.05). Skills score soon after training increased from 62.2 ± 13.2 to 69.6 ± 12.5 in obstetric after a 1 year period and from 52.6 ± 9.3;63.5 ± 14.4 in newborn (p < 0.001) content areas respectively. These findings have implications for those interested in improving quality of maternal and child care through nurse-dependent health delivery systems.

基于SHA 2011的天津基层医疗卫生机构基本公共卫生服务开展情况分析

[目的]强化经常性卫生费用核算数据政策分析,为基本公共卫生服务项目后续开展提供依据。[方法]以天津市2016-2019年基层医疗卫生机构预防服务费用核算结果为基础,分析基层医疗卫生机构基本公共卫生服务项目开展情况和存在问题。[结果]2016-2019年,天津市基层医疗卫生机构预防服务费用呈逐年增长趋势,由2016年的14.25亿元增加至2019年的18.04亿元。预防服务费用主要流向预防接种项目、慢性病管理和老年人健康管理项目;预防服务费用筹资来源仍以政府筹资方案为主,但家庭卫生支出占比呈快速增长趋势,主要是由于二类疫苗接种费用的快速增长所致。[结论]天津市基层医疗卫生机构预防服务费用流向与其基本公共卫生工作重点一致,但基层医疗卫生机构传染病防控投入程度与其职能不匹配。基层医疗卫生机构二类疫苗接种服务家庭卫生支出负担过重。

加强乡村医疗卫生体系建设提升基层医疗卫生服务能力

2023年中共中央办公厅、国务院办公厅印发《关于进一步深化改革促进乡村卫生医疗体系健康发展的意见》提出了构建紧密型县域医共体,致公党辽宁省委会、大连市委会成立了专门课题组,对大连地区县以下医疗卫生体系建设情况进行调研,梳理出问题所在,并提出了具体建议与解决方案。

新生儿早期基本保健技术在新生儿护理中的应用价值

目的 探究在新生儿护理中应用新生儿早期基本保健技术的效果和价值。方法 选取2022年3月至2023年2月在我院正常分娩的128例新生儿作为研究对象,遵循随机数字表法分组原则,将其分为参照组与试验组,各64例。参照组新生儿给予常规护理干预,试验组新生儿则开展早期基本保健技术干预。比较两组新生儿干预后的脐带脱落时间、啼哭持续时间、觅乳时间、出生后90 min体温和出生3 d后的体重增长情况、护理不良事件发生率以及家长满意度。结果 干预后,试验组新生儿的脐带脱落时间、啼哭持续时间、觅乳时间短于参照组,试验组新生儿出生后90 min体温、出生3 d后的体重增长高于参照组,试验组新生儿护理不良事件发生率低于参照组,试验组新生儿家长对护理工作的满意度高于参照组(P均<0.05)。结论 新生儿早期基本保健技术用在新生儿护理中的成效十分显著,不仅能够有效改善新生儿的啼哭行为,缩短其觅乳时间,加快其体重的增长速度,还能预防和减少一系列不良事件的发生,提高家长满意度,促进新生儿预后。

新生儿早期基本保健脐带护理法对脐带感染和脱落发生率的影响

目的分析新生儿早期基本保健脐带护理法对新生儿脐带感染和脱落发生率的影响。方法随机抽选2021年1月至2023年6月期间出生符合研究要求的新生儿85例为研究对象,经盲选抽签法分为两组(对照组42例、实验组43例)。对照组采取常规新生儿护理,实验组采取新生儿早期基本保健脐带护理法。比较新生儿脐带脱落时间占比、脐带残端脱落时间均值、脐部愈合质量,脐带感染发生率的差异。结果实验组新生儿脐带脱落时间、脐部甲级愈合占比均高于对照组(P<0.05)。实验组新生儿脐轮红肿及脐部渗血渗液、肉芽肿增生发生率均低于对照组(P<0.05)。结论新生儿早期基本保健脐带护理法的临床开展,可积极促进新生儿脐带残端脱落,降低脐带感染风险,并优化脐带脱落后创面愈合质量。

中央政策试验的差异化模式及其选择逻辑——基于两项社会政策的案例研究

政策试验是中国社会政策建立及发展的重要机制。政策试验具有多种类型,但中央政府准备开展政策试验时,如何对此前地方自主试验的政策进行评估并考量以何种方式在全国范围内进行试点推广,已有研究对此讨论不足。论文依据政策试验及政策学习理论建立分析框架,通过对城镇职工基本医疗保险和长期护理保险这两项社会政策试点过程的回顾,从“创制紧迫性”和“政策工具确定性”两个维度,分析中央政府在开展试点过程中如何进行政策试验的模式选择。在“创制紧迫性”和“政策工具确定性”都较高的情况下,政策试验项目会采用政策目标和政策工具均比较明确的“由点至面验证型”的“金字塔模式”,而在上述两者都较低的情况下,政策试验项目会采用政策工具比较模糊的“多点试验探索型”的“木桶模式”。论文阐释了中央政府进行试点方案的选择机制,细化了社会政策试验策略选择中的评议标准,展示了政府在社会政策学习中的多元学习源及学习渠道。论文通过论证梳理了中国政策试验中纵向政府间的复杂互动关系,进一步深化了对于中央政府在政策试验中行动逻辑的理解。

医防协同的国际经验与启示

目的:创新医防协同机制,为建设中国特色医防融合体系提供部分借鉴。方法:采用文献研究、政策对比、国际比较等方法分析典型国家医防融合模式与经验,并进行具体分析。结果:与部分发达国家相比,我国医防协同机制不完善,医防脱节问题突出,缺乏有效的信息共享与交流机制,人才和科学技术短缺,资源配置不平衡,难以完成连续、综合的健康服务。结论:推进医防协同机制,要统筹医保基金和公卫资金使用、创新医防融合服务、完善以价值为导向的医保支付政策、发挥医保在推动分级诊疗中的促进作用等。

病有所医、病无所恐:我国农村合作医疗制度发展历程、运行逻辑与未来进路

新中国成立70多年来,国家一直在探索如何更好地为农村人口供给可负担、高质量的医疗保障,在经历了从传统农村合作医疗到新型农村合作医疗的不间断探索后,形成了中国特色社会主义制度下的农民医疗保障全覆盖模式,这种连续性、从未间断的合作医疗形成了新中国治理变迁的独特经验,是形成国家发展的“中国奇迹”的一种基础保障力量。以历史变迁的长镜头观之,我国合作医疗历经了从“集体福利”“个体消费”“民生服务”走向基本公共服务均等化的实践轨迹,各个阶段都努力在现实需求与资源约束的矛盾运动下最大限度保证农民群众“人人看得起病”。为了在更高水平上保障农民“病有所医、病无所恐”,未来需要继续大力推动城乡居民基本医疗保障制度的一体化改革,扩展农民群众医保报销范围、降低个人承担份额,最终实现城乡居民人人享有健康权利的国家战略规划,迈向以人民为中心的社会主义“共同健康”之路。

基础型社区养老服务供给对老年人生活满意度的影响——自评健康变化的中介作用

基于2018年中国老年健康影响因素跟踪调查(CLHLS 2018)数据,运用多元线性回归、逐步回归、Bootstrap等研究方法分析基础型社区养老服务供给对老年人生活满意度的影响,并引入自评健康变化作为中介变量,探讨了其影响机制。研究发现:基础型社区养老服务供给对老年人生活满意度具有正向影响,且通过老年人自评健康变化对其生活满意度可以产生间接影响效应。在社区养老服务体系建设过程中,应重视基础型社区养老服务的作用,充分发挥政府购买公共服务的优势。

新生儿早期基本保健在新生儿早期预后及产妇康复中的干预价值探讨

目的观察新生儿早期基本保健在新生儿早期预后及产妇康复中的干预价值。方法选取正常阴道分娩的新生儿及其母亲各60例,采用随机数字表法分为对照组和研究组,每组30例新生儿及其母亲。对照组行常规干预,研究组行早期基本保健干预。比较两组新生儿早期预后,产妇产后康复指标,家属康复满意率。结果两组新生儿出生后即刻、出生后12 h的体温比较差异无统计学意义(P>0.05);研究组新生儿出生后1、2 h的体温(36.43±0.42)、(36.51±0.29)℃均高于对照组的(35.82±0.37)、(35.87±0.35)℃,新生儿出生后2 h内啼哭次数(6.97±1.23)次少于对照组的(11.42±1.81)次,新生儿出生后2 h内平均啼哭持续时间(32.05±8.73)min短于对照组的(49.44±13.91)min,新生儿觅乳开始时间(17.12±4.82)min、脐带脱落时间(3.16±1.43)d均早于对照组的(21.61±5.96)min、(5.48±1.67)d,而首次母乳喂养持续时间(31.96±6.42)min长于对照组的(24.97±4.34)min,差异具有统计学意义(P<0.05)。研究组产妇的产后排尿时间(4.37±0.96)h、产后恶露持续时间(14.28±2.78)d、宫缩疼痛明显缓解时间(3.73±0.99)d、宫底降入脐耻间时间(8.42±2.05)d、子宫降入盆腔内时间(6.86±1.02)d均短于对照组的(5.28±1.15)h、(18.19±4.09)d、(4.41±1.12)d、(11.08±3.24)d、(9.15±2.33)d,超声检测子宫底高度(11.76±2.18)cm低于对照组的(15.53±4.15)cm,差异具有统计学意义(P<0.05)。研究组家属康复总满意率100.00%显著高于对照组的80.00%,差异有统计学意义(P<0.05)。结论新生儿早期基本保健用于新生儿早期预后及产妇康复中,可显著改善新生儿在出生后短期内的体温恢复,减少啼哭次数,并缩短啼哭持续时间、新生儿觅乳开始时间、新生儿脐带脱落时间,延长首次母乳喂养持续时间,显著缩短产妇的产后排尿时间、产后恶露持续时间,宫缩疼痛明显缓解,宫底降入脐耻间时间、子宫降入盆腔内时间均缩短,帮助加速子宫恢复,并提高了产妇及其家属的满意度,效果理想。

Evaluation of the Maternal Health Indicators: An Ecological Study from 2000 to 2014

The aiming of this worksheet is to evaluate and to compare the quantity of prenatal appointment indicators;childbirth by kind of delivery;maternal mortality coefficient and maternal deaths number. It is about an ecological, descriptive and analytical study, made through the appreciation of secondary data related to the maternal mortality in Rio Grande do Norte, from 2000 to 2014. To that, it was used information from SISPACTO to compare real data to the estimated goals. The results show that there was an increase on the number of women who performed seven or more prenatal queries, in turn, there was an increase of alive newborns through cesarean, moreover, it is observed an oscillation on the maternal deaths number by residence during the studied period, achieving superior values to the agreed goals during the last two analyzed years. It is concluded that the maternal health, in Rio Grande do Norte, negative indicators are being presented concerning the maternal mortality, in spite of presenting an improvement on the prenatal access.

Characteristics of Geriatric Health Service Facilities Designated as Sites of Death

There are many deaths occurring among the aged population in Japan. Geriatric Health Service Facilities (GHSFs) are highlighted as some of the chosen facilities designated as sites of death. The aim of our study was to clarify the characteristics and related factors, including physical signs first noticed by staff at the end-of-life period, in GHSFs designated as sites of death, using a nationwide survey in Japan. We administered a questionnaire to 3971 GHSFs in Japan. Eligible responses for the study were obtained from 854 GHSFs. We found that GHSFs designated as sites of death were more likely to have basic policies and documented preferences regarding end-of-life care. We also found that staff members in GHSFs designated as sites of death were less likely to first notice physical signs of pain. We found that GHSFs designated as sites of death tended to identify earlier symptoms, such as reduced oral intake and less vigor. Our results would enable elderly persons, their families, and staff in GHSFs to prepare for the elderly’s death more efficiently though earlier identification of the end-of-life period. We hope that GHSFs have an important role to play in end-of-life care provision to elderly persons in Japan, through the strengthening of these intermediate facilities.

政策因素对精神分裂症患者就医行为的影响研究

背景我国精神分裂症患者的基础就医需求较高,但不合理的就医行为可能会造成卫生资源的浪费,相关政策的出台旨在增进就医保障、合理引导患者就医。当前学界对于政策因素与就医行为的研究鲜少涉及精神卫生政策与精神分裂症患者就医行为的关联。目的分析政策因素对精神分裂症患者就医行为的影响,了解在基本医疗保险政策和精神卫生政策引导下精神分裂症群体的卫生服务利用情况和利用效果,为政策完善提供实证参考。方法于2019年11月以重庆市某区2018年三级精神病防治网络体系数据为基础,结合重庆市人力资源与社会保障局医疗保险信息平台匹配该区患者医疗卫生服务利用数据,最终获得关键数据有效的精神分裂症样本2314例。以患者是否发生就医行为及就医时选择的医疗机构为被解释变量,以患者的基本医疗保险参保情况(包括城乡居民/城镇职工基本医疗保险参保情况、门诊特殊病种报销办理情况)和精神卫生政策覆盖情况(包括社区康复服务、监护人补助、残联补助、“686”项目、“免费二代药”项目、精神残疾证)为关键解释变量,以患者的人口学特征为控制变量,进行多因素Logistic回归分析。结果纳入的2314例精神分裂症患者中,1915例(82.76%)发生就医行为。1482例发生门诊就医行为的患者中,选择到一级医疗机构就诊者252例(17.01%),二级医疗机构就诊者1080例(72.87%),三级医疗机构就诊者150例(10.12%);795例发生住院就医行为的患者中,选择到一级医疗机构就诊者38例(4.78%),二级医疗机构就诊者518例(65.16%),三级医疗机构就诊者239例(30.06%)。Logistic回归分析结果显示,基本医疗保险类型、门诊特殊病种报销办理情况、社区康复服务参与情况、“686”项目办理情况、“免费二代药”项目办理情况是精神分裂症患者是否就医的影响因素(P<0.05);基本医疗保险类型、门诊特殊病种报销办理情况、社区康复服务参与情况、“免费二代药”项目参与情况、精神残疾证办理情况是精神分裂症患者选择门诊医疗机构的影响因素(P<0.05),基本医疗保险类型、精神残疾证办理情况是精神分裂症患者选择住院医疗机构的影响因素(P<0.05)。结论政策因素对于引导精神分裂症患者就医发挥了积极作用,但存在参与度低、覆盖路径不够全面等问题。应尽快优化精神卫生政策,完善帮扶救助体系,加大宣传力度以提高政策参与度,积极引导家庭康复活动,进一步推动精神卫生服务社区化,持续健全精神卫生保障体系。

《基本医疗卫生与健康促进法》对公立医院导向作用浅析

文章阐释了《基本医疗卫生与健康促进法》的出台背景,浅析该法对医院管理的导向意义,并从加强公立医院人才储备、发展社区联动、管理体制优化和加强党的领导等方面提出完善医院管理的对策建议,以期提升促进公立医院高质量发展,更好地保持党委引领下的公立医院建设的公益性,更好地促进公立医院的人民主体性。

新医改下发挥基层中医服务优势促进分级诊疗制度构建

构建分级诊疗制度的关键在于促进基层卫生服务能力的发展。在短期内难以培养出高质量、大批量的全科医生队伍的情况下,发挥中医在基层的特色与优势有利于分级诊疗的实现。甘肃省与广东省已在基层开展发挥中医服务优势的实践,通过文献分析法和对甘肃省、广东省的典型调查法,探讨新医改下发展基层中医服务以促进分级诊疗制度构建的优势和实现策略。

赤脚医生制度对当前农村基本医疗卫生工作坚持公益性的启示

目的回顾性研究赤脚医生时期首都农村卫生工作公益性状况,为当前农村基本医疗卫生工作坚持公益性提供借鉴。方法通过抽样于2009年7月对北京市5个区县22个乡镇的三部分人群(赤脚医生、管理者和受益人群)进行问卷调查,主要调查赤脚医生时期的医患关系、管理政策等。结果赤脚医生时期首都农村基本医疗卫生工作公益性的人员、机构、经费等保障比较健全,符合当时的实际需求。结论应尽快建立和完善适应我国农村实际需求的公益性基本医疗卫生服务体系。

流动人口基本公共卫生服务可及性及影响因素分析

目的:了解流动人口基本公共卫生服务可及性及其影响因素。方法:以安德森卫生服务利用模型为理论基础,使用"流动人口卫生计生服务流出地监测调查(2014)"数据,采用多水平Logistic回归模型从宏观和微观两个层面,对流动人口基本公共卫生服务可及性及影响因素进行分析。结果:流动人口基本公共卫生服务利用率偏低,其在流出地和流入地均有卫生服务需求;对于全人群适用的健康档案、健康教育和健康体检服务项目的利用,流动人口群体内部存在差异;在同一调查点,流动人口卫生服务利用存在组内聚集性,多水平logistic回归分析发现经济社会发展水平、流出地卫生资源配置水平这两个宏观因素和流动人口的性别、年龄、受教育程度、医疗保险参保情况、流动范围及就业单位性质等个体微观因素,是影响流动人口基本公共卫生服务可及性的主要因素;不同服务项目的影响因素既有共性又有差异。结论:流动人口基本公共卫生服务可及性较差,应强化健康教育和引导干预;不同服务项目利用水平存在差异,应重点关注全人群适用项目和慢性非传染病管理;宏观环境因素和微观个体因素对服务可及性均存在影响,因此在增加服务供给的同时还应从流动人口特征着手,提高其主动性和参与意愿;不同性质就业单位中的流动人口卫生服务利用情况不同,应考虑单位及职业特征对服务利用的影响。

复杂适应系统理论视角下国家基本药物制度的实施分析

近年来,愈来愈多的学者将复杂适应系统(CAS)理论应用于理解卫生系统和卫生服务提供过程。以CAS理论为框架,通过对3个西部贫困区县医疗机构案例进行分析,为理解现阶段基层医疗机构实施国家基本药物制度所面临的挑战提供新的思路。