【作者】 吴宇；

【导师】 杜玉开；

【作者基本信息】 华中科技大学 ， 儿少卫生与妇幼保健学， 2011， 博士

【摘要】 研究目的旨在客观全面了解海南农村卫生现状,评估海南农村卫生建设扶贫项目的执行情况及总体成果成效,探讨项目在海南农村卫生建设中的作用和影响,总结项目的经验和不足,为制定海南农村卫生事业发展政策及改革措施提供理论依据。研究方法本研究借鉴360°反馈评价思想,采用经典项目评估模型,对项目进行基线调查、中期评估和终期评估研究。研究的方法采取定性、定量和文献检索相结合的综合研究方法,收集来自项目各相关利益人(管理者、执行者、受益者)的资料和数据,利用多种统计分析方法和评价方法,如KirkPatrick四层次评估法、模糊矩阵评价法、玛叶指数、数据包络分析等,对资料进行汇总和分析,对项目做最全面和客观的评价。研究结果①海南农村卫生现况：2007年海南农村居民两周患病率为20.76%,就诊率为73.41％,慢性病患病率为27.48%,治疗率为70.46%；海南农村居民健康水平存在民族和地区差异,汉族要优于少数民族,东部和西部要优于中部地区；缺乏人才是制约海南农村卫生机构发展的首要原因,现有人力资源年龄偏老化,学历偏低,多为高中以下；卫生机构环境较差,危房多,卫生院建筑得分73.9分,布局得分80.2分；卫生机构必须设备配置率低,床位数大于19张的卫生院设备评价达标率85.1%,而床位数小于19张的普通卫生院评价达标率仅52.4%,卫生室设备达标率为60.0%,而村民对于卫生院满意度最低的就是医疗设备,仅79.5%的人表示满意；卫生院医生最不满意的就是待遇低；影响海南农村地区卫生服务需求、提供与利用的因素前六位是医疗卫生人员的匮乏、医疗卫生设备缺乏、政府的资金投入、村民自身卫生保健意识不足、卫生政策的落实和农村经济和交通条件；农村居民看病贵看病难的问题受制于交通条件、经济条件、卫生机构服务能力以及新农合政策的落实等因素。②项目的执行情况：项目管理链条健全、项目整体进展顺利,工作有序进行,进度基本符合预期安排,有部分土建项目因地形和资金影响,工期有延迟；项目执行中存在资金拨付慢的现象,问题主要在于繁琐的资金审核。③项目效果：项目直接受益村民100个卫生院、1000多所村卫生室、近3万村民,1000多卫生人员,短期间接受益村民20-30万,长期受益达数百万；项目提高了村民健康水平和对卫生服务的利用,慢性病患病率下降,两周患病就诊率和慢性病治疗率上升,卫生机构的医护人员技能水平明显提升,考试得分和村民评价提升,卫生机构环境改善,危房数减少、建筑和布局平均增加,设备配置率提高,评估得分增加；卫生院生产效率得到提高；市县的卫生状况改善。研究结论项目在海南农村卫生机构建设及卫生人员培训中发挥了重要作用,提高了卫生机构服务能力和村民的健康水平,成果成效得到肯定。农村卫生事业发展的关键在于加强机构科室建设,解决好人才问题,加大资金投入,同时重视吸取项目经验,促进和发挥项目的激励效应,以实现农村卫生机构服务能力及服务机制可持续性发展。更多还原

【Abstract】 ObjectivesThis study aimed to describe the situation of rural health in Hainan Province, to assess execution of Li Kashing Foundation donate rural health developing project in Hainan Province (RHDP), to summarize experience and shortage of the project, to discuss effectiveness of RHDP on developing rural health in Hainan Province, and finally, to provide certain suggestion on rural health policy.MethodsThis study, which was under the classic evaluation model and based on 360°feedback evaluation, carried out baseline investigation, mid-term evaluation, and final evaluation on RHDP. The methods of the study mixed quality and quantity research plus information index, collected all the data from stakeholders (manager, executor, beneficiary) of RHDP, analyzed the data using many statistic ways and evaluating methods, for example KirkPatrick’s Four-Level Model of Evaluation, Fuzzy Matrix Assessment, Maye Index, Data Envelopment Analysis.ResultsRural health situation of Hainan Provence. Two weeks prevalence of residents was 20.76% in 2007. The attendance rate was 73.41%. Chronic disease prevalence was 27.48% and heal rate was 70.46%. Health level was different in different nation and region. Han ethnicity was better than other ethnicities. East and West region were better than the middle region. Talents were the first reason which restricts the development of rural health institutions. Resent human resource was old and most of them had low education level even blow middle school. Environment health department was bad and had many dilapidated building. The health center building score was 73.9 and geographical layout score was 80.2. The necessary equipment configuration rate was low. Equipment evaluation of compliance rate was 85.1% in those health agencies which bad capacity was more than 19. Village health clinic’s compliance of equipment was 60.0% while the lowest degree of satisfaction was medical equipment to villagers, only 79.5% was satisfied. Low income was the most discontent thing to the doctors working in the health center. The top six factors that influenced rural health service demand, provide, and utilize were lack of doctors, lack of medical equipment, government founding, rural inhabitants’ health care consciousness of self-protection, carry out of health policies and economic-transportation condition. The factors leading to high fees and hard attendance were transportation condition, economic condition, capacity of health departments and NCMS policy. Accomplishment of the project. This project had a good management chain and had successfully progress. Everything was done in time except part of building project was late because of founding and geography condition. There were some problems about found because of the complicated financial audit. Project effectiveness. There were 100 public health centers,1000 village health clinics, more than 1000 health personals and nearly 30,000 people benefit from the project directly, while about 200,000 to 300,000 people would get benefits in short term and millions people would profit from it in long term. After the project, Chronic disease prevalence declined, the ratio of visiting doctor after getting sick in two weeks and the ratio of curing chronic disease rise, skills of doctors levels up, environment improved, the assessing scores of buildings and distribution rise, equipment dispose rate was higher, and health center became more efficiency.ConclusionsThe project played an important role in Hainan rural health developing and health personnel training, it enhanced health services ability of sanitary institutions and lift up the levels of people’s health. The key to develop rural health is making more investment to base sanitary institution, restoring human resource, changing the environment situation, while using the project experience and enlarge the effectiveness of the project.更多还原