New Attempt for Building Rural Water Environment Management System Based on the Investigation and Analysis of Water Environment in Xianxia Town, Yudu County

Water environment is a part of ecological environment, and conservation of water environment has always been a focus of public attention in China, but water environment management in the vast countryside has been stuck in bottleneck. Based on the fi eld investigation in Xianxia Town, Yudu County, Ganzhou City, Jiangxi Province, this paper explored the current situation of local water environment and the management diffi culties, then introduced the holistic view to integrate the linkage of government, market and society, proposed the universality of the individual case, and the new attempt centering on urban-rural integrated water environment management system with public participation mechanism, management subjects' benefit balance and coordination system, marketing operation mechanism and economic incentive mechanism as the extension.

Effectiveness of Hospital Management Committees in Busia County, Kenya

The Kenya Ministry of Health restructured the health sector in 2009 with the goal of promoting and improving the health status of all citizens. It established the Hospital Management Services Fund to be managed at the facility level by the Hospital Management Committees (HMCs). Since the establishment of the HMCs at the county level following the devolution of health services in 2016, no evaluation has been done to assess their performance in Busia County. We assessed the criteria, selection process, orientation, induction, and the performance of the HMCs in Busia and considered their implications for Kenya and similar contexts in Africa. Data were collected by purposive sampling of all HMC members in six level 4 and one level 5 hospitals through Focus Group Discussions and key informant interviews. Documents collected both at the facility and county levels were analysed and used appropriately. All seven hospitals evaluated did not fully comply with the National Guidelines. Three (43%) of the hospitals nominated persons with educational levels below the required O-level certification. Another 3 (43%) contravened the Constitution of Kenya (2010) by excluding persons with disabilities and minorities. The study identified systemic commissions and omissions in the recruitment process, leading to anxiety and frustrations by members of HMCs, staff and the catchment population of the respective hospitals. In conclusion, the nominated HMC members have no legitimacy to assume their roles and responsibilities as they have not been gazetted, appointed, oriented, and facilitated.

Indigenous Knowledge Used in Breeding and Management of Capra hircus Populations in Kajiado and Makueni Counties, Kenya

The aim of this project was to study indigenous breeding practices used in management of Capra hircus (Galla and Small East African goats) populations in Kajiado County in Rift valley province and Makueni County in Eastern province. Data were obtained through a field survey using questionnaires (Appendix I) and personal observations between 1st September, 2013 and 2nd December, 2013. This study covered key characteristics of goats production and areas of goat breeding, such as general farm details, number of goats, main activities of the farmers, farming types, breeds, flock structure, feeding, housing, catastrophes, selection, mating systems, breeding systems, average age at parturition, breeding problems, and the importance of goats. Results showed that the average number of goats in Kajiado was 100.65 ± std 49.88 while in Makueni it was 12.28 ± std 6.46. The main activity of the people interviewed was farming as 58 people (96.67%) in Kajiado and 42 people (61.60%) chose farming as their main activity because this was their main source of livelihood. Flocks were dominated by breeding females at a mean of 39.06 ± std 16.75 in Kajiado and a mean of 5.62 ± std 3.50 in Makueni because females were kept to reproduce to increase the size of the flock and the males were kept majorly for cash and only one or two were left to reproduce with the females. Drought was the major catastrophe as it killed an average number of goats of 6.33 ± std 4.36. Pneumonia and diarrhoea were the major diseases according to 28 farmers (46.66%) in Kajiado and 31 farmers (51.66%) in Makueni. Ticks and fleas were the major parasites according to 42 farmers (70%) in Kajiado and 4 farmers (63.34%) in Makueni. Treatment was mostly done by the farmers individually as 54 farmers (90%) in Kajiado and 46 farmers (76.67%) in Makueni treated the animals by themselves. This was so because it was either not easy to get a veterinarian or expensive for them to hire veterinarian doctors. Some farmers used traditional medicine like mavuavui;Steganotaenia araliacea was used to treat pneumonia. Farmers also devised feeding methods during drought as 48 farmers (80.00%) in Kajiado and 23 farmers (38.33%) in Makueni cut leaves from up trees to feed the goats. When doing selection of breed, 58 farmers (96.67%) and 57 farmers (95%) considered large body size and drought resistance respectively in Kajiado. The farmers in Makueni considered age and drought resistance at equal chances of 59 farmers (98.33%). The main mating system was naturally uncontrolled as 113 farmers (95.17%) of the overall 120 farmers interviewed in Kajiado and Makueni chose this as the main mating method. The major breeding system was pure breeding at 85 farmers (70.83%). The average age at parturition of the goats was 1.435 ± 0.125 years in Kajiado and 1.44 ± 0.121 years in Makueni. Abortion was the major breeding problem because it was caused by environmental stressors like drought and diseases as 54 farmers (93.92%) in Kajiado and 55 farmers (95.66%) claimed that it was a problem. Goats were majorly kept for cash (100%) and meat (100%) in Kajiado and for cash (100%) and dowry (100%) in Makueni. In conclusion, the study showed that crossbreeding was encouraged by mating that occurred at the markets, water points, free ranging feeding method, pastoralism due to drought, selection methods and translocation of female goats from Makueni County to be mated with the males in Kajiado County. Environmental problems like drought and diseases caused several deaths and reduced the level of existing gene pool of the goats.

Typical Experience and Legal Problems of Urban-rural Integration Development in Counties of Chongqing

With"people as the core",Chongqing vigorously explores the reform of integration of urban and rural elements in counties,gradually breaks down the institutional barriers that hinder the free flow and equal exchange of urban and rural elements,and promotes the balanced development of land,talent,medical care,pension,education and service towards"equalization"and"integration".Some typical experience practices and outstanding results have been formed.At the same time,restricted by system,capital,technology and other factors,there are still many"pain points"and"difficulties"in the integration of urban and rural development in counties of Chongqing.Based on the reform practice,some countermeasures and suggestions for the integrated development of urban and rural elements in counties of Chongqing were put forward.

广东省县区级医院感染管理质量控制中心的现状调查

目的调研广东省县区级医院感染管理质量控制中心现实情况,为本省院感质控中心对县区级院感质量控制中心质控管理方案的制定提供参考依据,并探讨相应的管理对策。方法通过问卷星问卷调查平台对广东省2023年12月31日前成立的县区级质控中心进行调研,内容包括医院感染管理专业质控中心的成立时间、人员架构、信息化水平、管理、质控及培训工作情况等。结果广东省有68家县区级院感质控中心,覆盖率达50.37%,近五年成立的占95.59%。专家以临床和护理为主(分别占23.75%、62.97%),学历以本科为主(占71.06%)。仅13%有运行经费。39家已建医院感染信息化监测,23家未配备,6家在建。20家进行质控督导出具质控报告,占29.41%;41家举办培训,占60.29%。结论广东省医院感染管理质量控制组织体系县区级覆盖率正在稳步提升,但是未完全覆盖所有县区,缺乏政策、经费支持,人员配备、人员专业覆盖面不足。卫生健康行政部门及县区级院感质控中心需统一监测标准、质控规范及考核评价方案,提升院感质控能力,完善“四级”管理与培训体系,以有效推动提升基层医疗机构的质量安全管理水平。

集体林权制度下的安吉竹林经营认证模式探索与实践

分析了安吉县林业生产与社会经济条件、竹林认证历程和认证模式,阐述了集体林权制度下安吉县毛竹股份合作社的组织形式、经营管理与“协会+合作社”模式开展竹林经营认证的运行机制,总结了“协会+合作社”模式开展竹林经营认证对提高竹林经济效益、促进竹林生态效益、加快农村城镇建设进程中的作用。提出在当前我国南方集体林权制度下引入新型竹林经营主体、推进竹林专业化经营、健全竹林经营管理体系,对开展竹林经营认证有积极作用。安吉县以“协会+合作社”开展竹林经营认证,对促进我国南方集体林权制度下的林业可持续发展具有示范作用。

制度压力如何影响预算绩效管理改革成效?——基于西北G省县级政府的实证分析

县级政府是全面实施预算绩效管理的“最后一公里”。然而,实际上相比其他层级政府,县级政府的预算绩效管理改革进展较慢,改革效果不尽人意。论文基于新制度主义和资源基础理论,选取西北G省县级层面相关工作人员收集的一手数据,实证检验制度压力影响预算绩效管理改革成效的作用机制。研究发现,制度压力、领导行为、规则导向型文化、资源禀赋对改革成效均产生了直接正向影响;制度压力可分别通过规则导向型文化、领导行为间接提升改革成效;规则导向型文化和领导行为在制度压力和改革成效之间起到了链式中介作用。此外,资源禀赋强化了制度压力对改革成效的正向影响,但抑制了领导行为对改革成效的积极效应。研究明晰了制度压力影响改革成效的作用机制,为进一步促进县级政府预算绩效管理改革提质增效提供了实践参考。

基层财政治理、医疗竞争与居民健康

推动优质医疗资源下沉农村是巩固脱贫成果、推动乡村振兴的重要落脚点。财政运行紧平衡是各级财政当下及未来一段时期需要面对的现状,科学合理的基层财政治理模式是提高财政对医疗卫生投入效益的制度性保障。本文以“乡财县管”改革为准自然实验,探讨了财政运行紧平衡背景下的医疗卫生市场与居民健康水平。研究发现:(1)“乡财县管”改革显著改善了改革县居民的健康状况;(2)改革后,随着财政压力的增加以及财政对医疗机构补贴力度的下降,医疗市场的准入门槛以及医疗服务的平均价格显著降低,医疗可及性以及医疗服务供需匹配程度得到改善,最终改革地区居民健康状况得到显著改善;(3)异质性研究发现,“乡财县管”改革的健康改善作用,主要体现在农村居民群体中。本文为我国如何在财政紧平衡下推动优质医疗资源下沉、提升基层医疗服务能力提供了参考与借鉴。

省直管县改革能够促进共同富裕吗?——基于双重差分模型的实证分析

省直管县改革被视为发展县域经济、缩小城乡差距的重要举措,但已有研究对其能否实现缩小“三大”差距和推进公共服务均等化等共同富裕的主要政策目标仍存在争议。对此,以浙江省“省直管县”改革1997-2017年的面板数据为样本,运用双重差分法重新审视省直管县改革对实现共同富裕主要政策目标的整体效果。研究发现:省直管县试点和全面实施两个阶段对共同富裕均具有正向效应,且随着时间的推进呈现出逐年上升趋势。进一步分析发现,试点和全面实施阶段对共同富裕的正向效应存在区域差异,“省直管县试点”对共同富裕的影响具有“弱者变强、强者愈强”特征,而“省直管县全面实施”对共同富裕的影响则呈现出“抑强扶弱、协同发展”的特性。这些研究发现对优化省管县制度、探讨实现共同富裕的政策创新路径具有重要意义。

区域行政整合、市场扩张与企业高质量发展

打破地方保护和降低市场分割是加快统一大市场建设、推动高质量发展的内在要求。基于中国1998—2013年撤县设区改革,采用多时点双重差分法考察区域行政整合是否有利于企业发展质量提升及其作用机制。研究结果表明,区域行政整合对企业全要素生产率具有正向促进作用,有效提升了企业发展质量;机制检验表明,区域行政整合通过扩大企业市场规模和改善企业管理效率进而促进了企业发展质量提升;并且这种促进作用主要通过民营企业、非出口企业和小规模企业来实现;相较于县,县级市的整合效果更为明显;进一步研究证明,区域行政整合也有助于区域整体发展质量的改善。

基于应急管理全过程均衡理论的县级公立医院应对突发公共卫生事件应急管理研究——以资阳市安岳县为例

在面对突发公共卫生事件时,县级公立医院主导的救治体系是应对突发公共卫生事件、保障人民生命安全和身体健康的重要基础,是应对突发公共卫生事件实施医疗救援的主阵地。本文基于应急管理全过程均衡理论的“6+1”框架模型,以四川省安岳县县级公立医院为研究对象,对该县县级公立医院应对突发公共卫生事件应急管理流程进行分析,梳理县级公立医院应对突发公共卫生事件的特点,针对不足和短板提出优化安岳县县级公立医院应对突发公共卫生事件应急管理的路径,以期提升县级公立医院应对突发公共卫生事件应急管理的能力与水平。

专业功能县流动人口管理服务机制研究——以东南某商贸特色县级市为例

大流动社会和新型城镇化背景下,专业功能县在集聚人口、推进共同富裕方面作用更加突出,构建高水平流动人口管理服务机制意义重大。以东南某商贸特色县级市为例,流动人口管理服务认识不到位、管理和服务多头,统筹机制缺失,管理边界模糊、数据欠准确,智慧治理广度和深度不够、信息化效能不高,流而不留等矛盾仍然突出。需要加强调研、提高认识,快速建成流动人口智慧治理系统,积极探索流动社会治理的有效抓手,不断提升人口承载能力和水平。

县级医院预算管理中HERP运用案例分析--以A医院为例

近年来,以信息技术为依托的HERP系统受到社会各界的广泛关注.文章以县级医院的预算管理为研究对象,通过对A医院实施HERP系统案例的分析,揭示其在数据集成与共享、实时数据监控、自动化流程、数据分析与决策支持、预算控制与合规性等方面的应用效果,并对县级医院信息化建设未来的发展趋势进行了梳理.

新时期基础测绘规划省市县联动协同编研刍议

基础测绘是基础性、公益性事业,国家对基础测绘实行分级管理。立足于机构改革后基础测绘在自然资源管理格局中的职责定位、工作重点,以及如何更好地履行新《测绘法》赋予的法定职责,分析了新形势下基础测绘的发展现状和面临的形势,提出了基础测绘“十四五”规划省市县一体化协同编研的主要遵循和具体思路,据此明确了工作重点和任务举措,相关观点已在广东省、惠州市及其各县区基础测绘“十四五”规划编制中得到了应用。

山东省郓城县整县域高标准农田建设SWOT分析

为更加科学、高效地推进高标准农田建设与管护提供改进建议和科学支撑,利用SWOT分析法对山东省郓城县整县域高标准农田建设情况进行研究。分析了郓城县整县域高标准农田建设优劣势、机遇与威胁,判明其存在的主要问题及原因。研究发现,整县域高标准农田建设存在投资标准低、缺乏管护资金、农田用电同质不同价及耕地进出平衡对接困难等劣势和威胁。针对上述劣势和威胁,提出提高单位土地面积财政资金投资密度、拓宽资金筹措渠道、合理优化布局结构、推进农业灌溉用电价格改革、统筹耕地进出平衡指标、建立健全高标准农田资产管理和基础设施管护制度等对策建议。

紧密型县域医共体药物协同政策研究

为提升基层医疗服务能力,促进患者有序就医,国家明确规定紧密型县域医共体实行药物协同政策,但目前大部分紧密型县域医共体存在药物不协同现象,主要归因于基本药物目录、财政投入、医保目录、集采药品使用和药事管理相关规定限制基层用药品种。对此,应从药物管理角度出发,以患者为中心、重大慢性病管理为主导,将紧密型县域医共体视为一个服务整体来管理、监督和考核用药情况,从而更好地落实药物协同政策。

生态脆弱区县域生态系统服务综合管控分区模拟与优化——以陕西陇县为例

[目的]明晰生态脆弱区县域单元内多元生态系统服务时空分异特征与综合管控路径,对维护区域生态安全,践行生态文明战略有重要意义。[方法]以陕西陇县为例,评估县域空间2000年、2010年、2020年5项关键生态系统服务物质量值,识别服务供给高值区及权衡关系、权衡协同变化趋势;结合OWA方法,筛选出综合最优的管控情景并给出优化建议。[结果](1) 2000—2020年,县域多项服务整体呈现出上升趋势;(2)生境质量的高值聚集区分布与自然保护地位置一致;土壤保持和水源涵养热点区主要分布于南北部林草高覆盖区域;食物供给的热点区沿千河主河道分布。(3)生态休闲与食物供给服务在东南镇、温水镇、天成镇权衡空间扩张较为明显。水源涵养和生境质量的协同空间在西南部呈扩大趋势。(4)选取能够响应“供给高值区、权衡协同变化区”管控需求的模拟情景9作为最优管控模式,其中管控优先级最高的“关键保护与修复区”占县域面积的13.9%。[结论]生态脆弱区县域生态系统服务管控不仅应注重对服务供给高值地区的保护,还应关注局部服务权衡加剧、协同减弱的现象,适时调控地域发展导向,探索综合可持续管控模式。

县域高血压合理用药与综合管理指南

《县域高血压合理用药与综合管理指南》(以下简称本指南)是主要针对我国县域医疗机构管理高血压患者的医生们如何合理管理患者血压的指导性文件。本指南遵循了循证医学的新证据,在维持原有的5类降压药物的基础上又添加了一些新的降压药物,提出了更适合县域基层应用的降压药物,明确了降压治疗原则,注重药物治疗中的准确性、安全性和县域应用的适应性。本指南主要包括高血压的流行病学及基层用药现状,降压药物的分类、用药原则与相互作用,降压药物中的单药和单片复方制剂的合理用药,以及基层高血压综合因素管理5部分核心内容。本指南适用于县域各类医疗机构的医务工作者学习,也适用于合并其他疾病的高血压患者阅读。

“链”动嘉善:基于区块链的慢性病管理模式研究

目的/意义以嘉善县基于区块链的慢性病管理模式为例,探讨紧密型县域医共体模式下慢性病管理新策略。方法/过程采用PEST-SWOT分析法,从政治、经济、社会和技术4方面分析嘉善县基于区块链的慢性病管理模式的优势、劣势、机遇和挑战。结果/结论基于区块链的慢性病管理模式可确保数据间无缝连接与共享,保障患者个人信息和健康资料的安全可追溯性,促进嘉善县区块链技术和慢性病管理共同发展。

老年慢性病患者中医药健康管理服务获得感调查研究

目的:了解五寨县老年慢性病患者中医药健康管理服务获得感现状及影响因素,为政府部门制订相关政策、提升中医药健康管理服务质量提供借鉴和参考。方法:采用文献研究法,编制老年慢性病患者中医药健康管理服务获得感调查问卷;运用典型抽样法、简单随机抽样法,对在五寨县孙家坪卫生院、三岔镇卫生院接受过中医药健康管理服务的480名65岁及以上老年慢性病患者进行问卷调查;使用SPSS 26.0软件对调查数据进行统计分析。结果:老年慢性病患者中医药健康管理服务获得感得分为(3.88±0.62)分,其中五个维度的得分从高到低依次是满意度(4.08±0.60)分、公平度(4.07±0.65)分、可及度(3.96±0.63)分、有效度(3.87±0.66)分、回应度(3.48±0.97)分;老年慢性病患者中医药健康管理服务获得感的显著影响因素是年龄,65~69岁老年慢性病患者中医药健康管理服务获得感明显高于70~74岁、75~79岁老年慢性病患者(P<0.05)。结论:优化有效度、回应度相关内容,促进满意度、有效度、可及度、公平度、回应度协调发展,进一步提升老年慢性病患者中医药健康管理服务获得感。