Objective To understand the current situation of medical service and management in Luxi township health center (LxC) in Yongxin county of Jiangxi province, so as to provide baseline data about drug allocation, logistic key techniques research and products development for township health centers. Methods By means of questionnaire and focus interview, the LxC was investigated from the following aspects: general information, human resources, medicine list, basic device configuration, medical service and management, as well as service efficiency. Results a) Yongxin county including 13 village committees covers an area of 86 km2, with the population of 22 300 in 2009, and it pertains to a backward area with the annual per capita income of RMB 4 100 yuan; b) Among the total 28 staffs in LxC, 78.6% were health workers; the general practitioner (GP)/nurse ratio was about 1?0.58; the proportion of GP, nurses, medical technicians, other staffs was 54.55%, 31.82%, 9.09% and 4.54%, respectively; the proportion of bachelor degree, junior college graduation and secondary technical school graduation was 9.1%, 13.6%, and 77.3%, respectively; and the ratio of elementary, middle, and high professional title of health workers was 15?5?1; c) There were 625 species of drugs in LxC in 2009, and the hospital beds approved by government were 0.69 per thousand agricultural persons, which, however, were 1.15 in fact. The rate of 51 basic equipments shown in national regulation was actually 76.5%, and the readiness and utilization rate of existing 40 equipments was 92.5%; and d) In 2009, the outpatients were 12 150 person-time, with the average cost of RMB 29.39 yuan; the hospital discharge was 1 589 person-time, with the average stay of 12 days and the average cost of RMB 490.05 yuan; the vaccine inoculations were 5 053 person-time; among the total income, the medical service income accounted for 73.2%, while the drug income accounted for 53.7%; the personnel expenditure was 31.0% of the total, and the balance of income and expenditure was RMB –263 500 yuan. Conclusion The hardware condition of LxC is not so good owing to the financial difficulties of Yongxin county and Jiangxi provincial government. In comparison with the whole country, although the professional title structure is ok, health workers are still not enough, with unreasonable specialty structure and low educational background. The rate of basic equipments and the approved hospital beds per thousand agricultural persons are low. There are 625 species of drugs, containing 218 species shown in 2009 national essential medicine list. And the other conditions are as follows: no information system, lack of public health service, short of financial input, high ratio of “running hospital by selling drugs”, and low efficiency of medical service. So the top priority of LxC construction should be figuring out all of the above issues, and better serving the people.
Objective To investigate current situation of medical service and management in Gaozha Central Township Health Center (GzC), so as to provide baseline data for township health centers in both key techniques research and product development of drugs allocation and delivery. Methods A questionnaire combined with a special interview was carried out, which included the general information, human resources, medical service and management, and the practice of essential medicine list. Results a) The hardware condition of GzC was not good enough, and the economic status of the service recipients was lower than the average level of both Wuzhong City and China mainland; b) The constituent ratio of general practitioner (GP) and nurse, and GP and laboratorian were all lower than those of national level, while, the constituent ratio of GP and technician was a little bit higher. GzC was in short of medical technical personnel and, especially, the professional pharmacists. The logistics technical workers were as the same proportion as the nurses. The medical technical personnel without professional education background accounted for 3.4%, and about 38% of the staff members had no college degree, about 86.2% had at most primary profession titles. There was no personnel turnover of GzC in recently years; c) The bed utilization ratio was lower than national level (46.4% vs. 60.7%), while the average duration of stay and the in-patient and out-patient service workload of GP were longer or heavier than national level (8 vs. 4.8, 9 vs. 8.3, 4 vs. 1.3); d) The out-patient service in 2010 decreased 26.9% compared to 2009; and the in-patient service in 2010 decreased 42.4%; e) The average medical expense per outpatient and per inpatient increased 127.3% and 56.2%, respectively in 2010 compared to 2009; and f) Essential medicine list was put into practice in April 1st of 2010 and there was only 195 species available in GzC, which has not met the requirements of the national essential medicine list. Conclusion In order to meet the standards of general rural township health center in western China, GzC needs to cope with challenges of insufficient hardware conditions, short of staff, unreasonable personnel structure, low educational background and professional title of the staff, none human resources flow and low technical level of medical service. GzC dose well in drug expenses control, and the hospitalization costs are lower than those of the national level. However, it increases rapidly in 2010. The management of GzC may be influenced by zero-profit sale of the essential drugs, and appropriate subsidy and policy support are necessary to maintain its service quality. And it is required to complement the medicine based on the evidences, to carry out staff training and usage guidance of essential medicine, and to finally guarantee the safe and reasonable use of medicines.
Objective To understand current situation of medical service and management in Yong’an Central Township Health Center (YaC) through on-the-spot investigation, in order to provide references for personal employment and essential medicines list implement in township health centers. Methods Questionnaire and focus interview were carried out, which included the general information, human resources, medical service and management, and the practice of essential medicines list. Results The hardware equipments of YaC were fine, and the target population had fairly good health and economy status. The ratio of General Practitioner (GP)/ nurse and GP/ pharmacist were all above the national average level. The members with college degree and above accounted for 61.6%, and about 88% staffs were with or below primary profession titles. There was a balance between personnel flow out and in. The drug income accounted for 53.6% of the whole in 2009 and the medical expenses increased compared to 2008. Essential medicines list was put into practice in April 1st of 2010 with no relevant technical documents as correspondence. Conclusion YaC, as a good representative of fairly well-off rural Township Health Center in western China, needs to cope with challenges of irrational personnel structure, low educational background and professional title of the staff and human resources flow, and requires developing policy and adopting measures step by step. The management of YaC may be influenced by zero-profit price of the essential medicine, and appropriate subsidy and policy support are necessary to maintain current service quality.
Objective To understand the current situation of medical service and management in Xintian Central Township Health Center (XtC) through on-the-spot investigation, and to provide references for development of key techniques and products for township health centers in medicine allocation and delivery. Methods The questionnaire and the focus interview were carried out, which included the general information, human resources, medical service and management, as well as the practice of essential medicine list. Results a) The hardware conditions of XtC were not good enough, and the income of Lintao county and Gansu provincial government fell short of their needs; b) The General Practitioner (GP)/nurse ratio was higher than that of the national level, the GP/pharmacist ratio was a little bit lower, and the GP/laboratorian ratio reached the national level. There was only one medical technician. There was about 27.5% staff members having no college degree, and about 81% having at most primary profession titles. There were 26 medical workers allocated to XtC in recent two years and only one GP left; c) In 2009, the bed utilization ratio was a little bit higher than the national level (109% vs. 60.7%), while the average length of stay was longer than the national level (6 vs. 4.8); d) The outpatient service in 2010 increased by 17.6% compared to 2009 and the inpatient service in 2010 decreased by 17%; e) The average medical expense per outpatient and per inpatient increased by 23.5% and 14.9%, respectively, in 2010 compared to 2009; f) The essential medicine list (EML) was put into practice in June, 2010. The current count of medicine in hospital was 767, far beyond the EML demand. Conclusion XtC, as a basic rural Township Health Center in Western China, overtakes the burden of healthcare service for local population. The policy of “selecting graduates to work in Township Health Center” made by Gansu government ensures sufficient personnel reserve for rural Township Health Center. XtC needs to cope with challenges of insufficient hardware conditions, unreasonable personnel structure, low educational background and profession title of the staff, and low technical level of medical service. XtC has a big ratio of medicine income and the expense of outpatient is lower than that of the national level. The management of XtC may be influenced by zero-profit price of the essential medicine, and appropriate subsidy and policy support are needed to maintain its service quality. And it is necessary to carry out evidence-based selection of the essential medicine account and develop staff training and essential medicine usage guidance, so as to support the medicine used safely and rationally.
Objectives To describe background, measures and impacts of building essential healthcare system in the developed and developing countries aboard. Methods Search words were chosen by both health policy experts and search coordinators after discussion and pilot. The resources we searched included electronic databases, websites of health institutions and governments and search engine Google. Any reports of implemented strategy to develop an essential healthcare package were included. Pre-designed data extraction form was used for collecting strategies and study method of included studies. Then the extracted information was analyzed and described. Result 166 studies covering 72 countries were included, most of which were studies in the middle and low Countries. In terms of study objectives, many studies (160 articles) aimed to describe strategies, while few studies(6 articles) were to evaluate effectiveness of strategies. Most of studies evaluating effectiveness were cross-sectionnary data, Except one time cohort study with intervention. Conclusions Strategies to implement essential healthcare system varies in the different country because of diversity of political, culture and economic background and different goals. The experience in transition countries gives us more high lights.
Objective To evaluate the effect of maternal and child health care training at the primary levelin Chongqing, and to detect and solve the existing problems so as to provide evidence for the further training andmonitoring. Methods The rural maternal and children health staff of Rongchang County, Chongqing were trained. A test and, in-depth interviews and field observation wereused to evaluate the training process and results. Results Seventynine members of the Clinical Skill Group (CS) and 73 members of Health Education Group (HE) have taken the test. The median score of CS before training was 11 while it was 23 after training (Plt;0.01); the median score of HE was 18 before training while it was 25 after training (Plt;0.01). The scores change of thetest before and after training showed that the training had a good result. Conclusion Primary level health staff members had poor knowledge of maternal and children health care. This training enhanced their knowledge of maternal and child health care improved their skill. Organizers should ensure that the training contents are rich,novel, and varied. Maternal and child health staff should be willing to join the training.
Objective To describe the criteria and procedure for defining an essential healthcare package in the developed and developing countries. Method Search words were chosen by both health policy experts and search coordinators after discussion and pilot. We searched electronic databases, websites of health institutions and governments and search engine Google. Any reports of implemented strategy to develope an essential healthcare package were included. Pre-designed data extraction form was used for collecting strategies and study method of included studies. Then the extracted information was analyzed and described. Result One hundred and sixty-six studies covering 72 countries were included, most of which were studies in the middle and low Countries. In terms of study objective,160 articles aimed to describe strategies, 6 articles aimed to evaluate effectiveness of strategies.Five studies evaluating effectiveness were cross-sectionnary data, and one study was time series. Conclusion An appropriate package should be defined according to both technique criteria and social welfare criteria, considering each country’s healthcare system and market structure, characteristics of the demander and provider, capacity of government’s regulation. The experience in transition countries gives us more high lights.
Objective To provide evidence for establ ishing a health care system for pregnant women after disasters by evidence-based evaluation on the comparison of programs in different countries of the world. Methods We electronically searched The Cochrane Library (Issue 2, 2008), MEDLINE (1966 to June 2008), EMbase (1984 to June 2008), VIP ( 1989 to June 2008), CBM ( 1978 to June 2008), Wangfang database (1997 to June 2008), CNKI (1994 to June 2008) and handsearched Journals such as Chinese Journal of Obstetrics and Gynecology to identify l iteratures and guidel ines on pregnant women healthy care system after calamity. The qual ity of l iteratures and guidel ines was assessed. Results A total of 293 studies were searched, of which 25 studies were identified with the focuses on the consequence of pregnancy, development of fetus and first-aid of injuries of pregnant women. We found the studies on pregnant women’s health care were l imited, and most of them were retrospective and cohort studies, which was related to the paroxysmal ity, rarity and complexity of the disaster.? Conclusions The high proportion of pregnant women among displaced persons underscores the importance of examining how behavioral changes and difficulties in access to health care influencing the maternal and infant health, which needs comprehensive planning and arrangement.
Chris Silagy is the Chair of The Cochrane Collaboration between 1996 and 1998, and the founder as well as the first Director of the Australasian Cochrane Centre. He helped to establish the Chinese Cochrane Centre. He has made great contributions to the establishment and development of The Cochrane Collaboration to which he devoted his whole life. Though he died at the early age of 41, his optimism, great energy and b responsibility have left deep impression and inspiration to every one around him.
Objective To critically appraise and systematically reviewe the economic evaluations of all alternative interventions for hepatitis B in China. Methods We searched MEDLINE and the four largest Chinese electronic databases. The references of eligible studies were also screened. Economic evaluations of any type, which studied interventions for hepatitis B, were eligible for inclusion. A 25-item quality checklist modified from a BMJ checklist was used to appraise the quality of studies. The overall quality score was calculated against 100 points to indicate the risk of bias. Quality appraisal and data extraction were conducted by two independent reviewers. Results Nineteen full economic evaluations and two cost studies were included of which fourteen studies were scored 25-44 points, and seven scored 45-61 points. Most studies adequately documented effectiveness of interventions. However, the costs of interventions were not well reported in over 50% of studies. Many studies inadequately conducted data analysis, particular in sensitivity analysis and discounting. Ten studies compared lamivudine with interferon or conventional therapy for 1-year (or 6-month) effects, which indicated that lamivudine was generally cost-effective. Three evaluations studied 30-year outcomes of interferon compared with conventional therapy, which suggested that interferon usually saved additional costs and years of life. Another three studies compared interferon with less frequently used antiviral agents, however the comparative cost-effectiveness varied. Two cost studies showed the total costs and the percentage of medical costs increased rapidly in proportion to disease severity.Conclusions Of alternative interventions, lamivudine is cost effective for short-term effects. Interferon is superior to conventional therapy for long-term outcomes. However, the long-term economic outcomes cannot be justified by the current evidence. Quality of methods, particularly, that of costing and analytical methods, is a major limitation. There remains a b need to improve the quality of reporting. Careful considerations should be paid before applying the results to decision making.