中英医疗救助项目实施以来银川市社区卫生作发展

【Abstract】wWw.shuoshilunwen.com China/UK Urban Health and Poverty Project(UHPP) was a Sino-British cooperation project signed in 2000.It was the United Kingdom Department for International Development that provided financial support and technical assistance needed to support the Chinese government’s ongoing urban health reform.The project had two objectives:First,to explore establishing the urban poor medical aid mechani;second,to improve the service capacity of community health service. Yinchuan,one of the four pilot cities,started the project in 2005,planning to use three years to provide medical assistance services for urban poor population.The project aimed to promote the establishment of health insurance system for urban poor population relying on the platform of local community health services,and to explore establishing economic,appropriate and sustainable model of urban community health service.Fuethermore,the experience will be extended.Community health service is an important part of UHPP.This study analysed the achievements of Yinchuan community health services in policy development,system construction and function improvement since the implementation of UHPP,which provides a useful reference to improve the function of urban community health services,and to enhance the level of health services.The major findings of this study are as follows:1) On policy,Yinchuan insisted the leadship of government and public institutions dominated.Community health agencies were distributed scientificly.A series of policies of personnel training and standard management had been formulated.The charity status of community health services were fully implemented.Furthermore, some policies of community health service had been broken through:Non-profit sales policy of drugs in community health agencies was carried out.Public community health agencies were fully budgeted.The compensation to community health agencies was based on the performance assesent.Community health services were purchased by government mainly based on public health services.Brand management of community health services was implemented through the"six reunification".2)Government input was constantly increased.Financial special investments in 2007 were 2.1 times higher than those in 2004.The number of community health agencies and practitioners grew steadily.Staff and basic medical equipment met the national standards on the whole.The financial situation of public community health service agencies were furtherly improved.And the propotion of income from drugs accounting for the whole income had declined.On community staff training,training bases was established.Management and general medical teacher training and follow-up erpanded training were carriede out.Through training,The concept of community service of the staff had changed,and their theoretical knowledge and operational level were increased.Community poor medical assistance for the poor was deeply developed.Some medical assistance services for exmaple family health records, chronic disease management were actively expanded to community residents.The standard management of community health service was realized:strict access management;improving operative and technical standards;putting first community consultation and two-way referral into effet.First community consultation was mostly chosen by the poor.Referral to the hospital oothed,while referral to the community was further explored.The information system of community health service was improved.Community health service had been electronically managed.3) Recognition in community health agencies had been constantly enhanced. Outpatient amount per month of community health agencies raised.Outpatient prescription had been effectively controlled.Propotion of antibiotics and hormones has declined obviously prior to the project.Utilization of community health service of the poor continuously increased,as well as satiaction with health services.Recognition in all aspects of community health service of community residents and the poor also constantly increased.But some problems also existed:community health agencies still lacked general practical staff,staff mobility was frequent.Most of public community health agencies had no their own fixed workplace,therefore service costs increased owe to rental housing.Two-track system restricted the overall development of community health service.The number of patients Referried to the community was less in two-way referral.Recommendations:1) to strengthen the training of community health staff and make general medical training institutionalized,and to further implement reform of personnel and distribution of community health agencies in order to improve salaries and welfare and working conditions of community staff.2) to break limits of the two-track system,to make public health agencies and enterprises hospitals managed unifiedly,and to bring enterprises hospitals into government budget gradually.3)to incorporate solving the shortage of operational space into development planning of community health service,to enhance housing rental subsidies,and to solve this problem gradually through purchase and raising ailability.4)on two-way referral,to coordinate properly economic interests between medical institutions and strengthen the supervision of two-way referral.