青海省世界银行贷款基本卫生服务（卫生Ⅷ）项目评价研究
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摘要
研究背景及立题依据
为响应世界卫生组织通过初级卫生保健来实现“2000年人人享有卫生保健”的目标,我国卫生部从1984年开始,连续利用世界银行贷款进行卫生服务建设,到目前为止,我国已同世界银行合作进行了十个卫生项目,历次向世界银行贷款累计91060万美元。
我国政府利用世界银行贷款开展的第八个卫生项目---“加强中国农村贫困地区基本卫生服务项目”,简称“卫生Ⅷ项目”(H8P)。英国政府赠款设立了卫生Ⅷ支持性项目(H8SP),重点是加强国家级、省级专家能力建设,同时设立了600万元的创新基金资助乡镇级卫生创新项目。
卫生Ⅷ项目的总体目标是:改善农村贫困地区卫生服务提供能力和提高卫生服务利用水平,保证当地居民获得基本医疗卫生保健服务,在农村贫困县人口中实现可持续发展的健康改善。
该项目覆盖我国中西部10个省(市、自治区)的97个国家级和省级贫困县的3486万人口,是我国涉及贫困地区范围较大、受益人口较多的卫生扶贫项目。
项目分为两部分:A部分,又称“基本卫生服务子项目”,覆盖山西、安徽、河南、重庆、贵州、甘肃、青海等7省(市)的71个县;B部分又称“秦巴卫生子项目”,覆盖陕西、宁夏、四川等3省(自治区)的26个县。
本项目总投资为10.69亿元,基本卫生服务子项目8.87亿元,秦巴卫生子项目1.82亿元。
各项目省贷款数量安排为:青海省710.7万美元;河南省1219.8万美元;重庆市1020.9万美元;贵州省1109.8万美元;甘肃省1014.3万美元;安徽省1218.8万美元;山西省705.7万美元;宁夏自治区221.6万美元;陕西省530.3万美元;四川省748.1万美元。
青海省作为卫生Ⅷ项目基本卫生服务子项目中的一个省,自1998年开始实施卫生Ⅷ项目,青海省政府按照世界银行和卫生部国外贷款办的要求以及事先签订的协议,组成了由主管副省长为组长的青海省世行贷款“卫生Ⅷ项目”领导小组。
青海省人民政府按照世界银行和卫生部国外贷款办对卫生Ⅷ项目县选择的统一要求,最终选择如下12个项目县,乐都县、湟中县、互助、大通、循化、同仁、都兰、门源、兴海、达日、玉树、民和等。
青海省卫生Ⅷ项目总投资9075.21万元,其中世界银行贷款5898.81万元(约710.7万美元),占总投资额的65%;国内配套3176.4万元,占35%。国内配套中省级配套1597万元,占50.3%;州(地、市)县配套1579.4万元,占49.7%。
卫生Ⅷ项目于2007年6月在我国已结束,针对卫生Ⅷ项目的各项内容也已全面结束,其中卫生Ⅷ项目重点疾病的干预于2005年底已截止。2006年下半年开始,由卫生部国外贷款办组织各省卫生Ⅷ项目办参与的卫生Ⅷ项目终期评价考核工作在全国10个卫生Ⅷ项目省展开。2006年底到2007年6月,基本为卫生Ⅷ项目的评价、总结阶段,对于卫生Ⅷ项目具体干预工作已不再进行。
本研究作为卫生Ⅷ项目总体评价中的一个子项目,对青海省卫生Ⅷ项目实施情况及结果进行外部终期评价。
研究目的
本研究利用青海省卫生Ⅷ项目资料和通过现场抽样调查,系统地对青海省卫生Ⅷ项目实施情况进行综合评价,总结卫生Ⅷ项目所取得的经验,发现其中的不足,并为未来更好地在青海全省,尤其是在非项目地区推广卫生Ⅷ项目中取得经验提供依据和参考。
研究方法
1.描述性研究方法。对于青海省卫生Ⅷ项目县历年项目监督指标完成情况进行定量分析,以了解其发展变化情况。
2.焦点组访谈和个人深入访谈法。利用焦点组访谈和个人深入访谈的方式,深入了解卫生Ⅷ项目取得的经验和存在的问题,以期未来在青海省全省,尤其是在非项目县推广中提出合理的策略和建议。
3.卫生统计学分析方法。将青海省2006年卫生Ⅷ项目最终考核情况同全国其它卫生Ⅷ项目省进行比较分析;利用随机抽样的方法,选取青海省项目县和非项目县,将二者在乡镇卫生院、村卫生室建设以及居民对健康的认知、态度和行为(KAP)得分等情况进行对照比较分析。
4.综合评价方法。利用综合指数的综合评价方法,对青海省卫生Ⅷ项目实施情况同A部分7省平均实施情况,进行系统评价比较分析。
5.利益相关者、政策分析等方法。案例研究中,对于项目开展中遇到的困难,利用利益相关者分析或政策分析的方法,对于其可行性及实施的困难等进行系统分析。
研究结果
1.青海省各项目县1998-2006年卫生Ⅷ各业务开展结果分析表明:到2006年底,青海省12个卫生Ⅷ项目县均已完成了卫生Ⅷ项目在A领域中的各项指标;对于B1领域,青海省卫生Ⅷ项目各县在改善卫生服务提供系统的各个指标至2005年除符合国家X线防护要求的乡卫生院比例仍较低以外,为23.16%;其余指标均达到80%及以上,其中使用基本药物目录的卫生院和村卫生室的比例分别达到100%和93.81%;卫生Ⅷ项目C1领域,即合作医疗开展,到2006年青海省项目地区100.0%的乡镇均开展了合作医疗,覆盖人口达到1922066人,占项目地区总人口的比值为89.6%;对于卫生Ⅷ项目C2领域,即特困医疗救助,2006年青海省12个卫生Ⅷ项目县均已开展了特困医疗救助;对于B2领域,即重点疾病干预情况,青海省1998-2006年重点疾病干预,以结核病控制干预参与县数最多,占青海省卫生Ⅷ项目县总数的66.7%,其次为计划免疫,占所有卫生Ⅷ县数的58.3%;对于妇幼保健干预参与县数占所有卫生Ⅷ项目县总数的50%,另外,对于碘缺乏病防治、消除白内障和儿童肠道驱虫三类项目的干预,青海省均为1个县参与。对于2002年中期考核后新增加的疾病干预项目,青海省基本没有进行干预。
2.青海省卫生Ⅷ项目各指标完成情况同全国其他项目省比较结果表明:青海省1998-2006年省级累计综合督导为3102人次,分别为全国各省及A部分7省平均水平的3.6和5.0倍;青海省项目期间省级开展短期业务培训为1742人次,分别为全国各省及A部分7省平均水平的0.5和0.4倍;青海省2006年12个卫生Ⅷ项目县均已开展了合作医疗及特困医疗救助,二者开展率均高于全国及A部分7省平均水平;青海省项目期间重点疾病干预的活动中,以结核病控制干预参与县数最多,占青海省卫生Ⅷ项目县总数的66.7%,其次为计划免疫干预,占所有卫生Ⅷ县数的58.3%,以上两种项目干预参与县数比例均超过全国及A部分7省平均水平;妇幼保健干预参与县数占所有卫生Ⅷ项目县总数的50%,低于全国及A部分7省各项目县参与的比例;对于碘缺乏病防治、消除白内障和儿童肠道驱虫、性病/艾滋病预防、生殖道感染控制、意外损伤干预六类项目,青海省均为1个县参与干预,上述各类均低于全国及A部分7省各项目县参与的比例;对于室内污染氟中毒预防,青海省则没有一个卫生Ⅷ项目县进行过干预。
3.本研究利用综合指数对青海省卫生Ⅷ项目实施情况各指标同A部分7省平均水平进行了综合评价。结果显示:合作医疗与特困医疗救助,青海省实施情况好于A部分各省平均水平,其余7个类别均低于A部分各省平均水平。最终综合评价结果为:青海省综合指数得分6.613,小于卫生Ⅷ项目A部分7省各省平均水平综合指数11.679的得分,即青海省卫生Ⅷ项目实施最终评价结果为总体低于A部分7省平均水平。
4.青海省卫生Ⅷ项目县和非项目县在乡镇卫生院、村卫生室建设以及居民对健康的KAP得分对照比较结果显示:项目地区卫生院在卫生人员基本素质、业务用房面积、医疗设备的配置、卫生服务能力的提供及业务内容的开展各方面均优于非项目县;项目地区村卫生室在乡村医生素质、卫生室面积、现有医疗及预防保健设备、乡村医生收入以及村卫生室业务内容的开展各方面,均优于非项目县;项目地区居民对健康的KAP得分优于非项目地区。
本研究的创新
卫生Ⅷ项目于2007年6月正式结束。本研究利用青海省卫生Ⅷ项目资料和现场抽样调查资料对青海省卫生Ⅷ项目的终期评价,具有较强的时效性和现实意义。
本研究对青海省卫生Ⅷ项目的实施情况进行了终期评价,采用了同全国卫生Ⅷ项目各省以及A部分7省平均水平为外对照,同时利用青海省具有可比性的非项目县卫生资源配置以及居民对健康的KAP得分等为内对照,结合历年青海省卫生Ⅷ项目各指标的完成情况,对青海省卫生Ⅷ项目的实施情况进行了综合评价。本文对于综合评价中发现的问题,以案例介绍和评价的方式对项目开展中遇到的困难利用利益相关者分析等方法进行了分析。
Background
In response to "2000 Health for All" initiated by the World Health Organization, the Chinese Ministry of Health has been using World Bank loans for the construction of health services since 1984. So far, China has carried out 10 sanitation projects in cooperation with the World Bank, which provided US＄910.6 million loans in total.
The eighth health project carried out by the Chinese government by using World Bank loans is aimed to "strengthen basic health services in China's rural poverty-stricken areas", and it is hereafter referred to as the "HealthⅧProject" (H8P). The British Government also granted fund to support projectsⅧ(referred to as H8SP), the focus of which is to strengthen national, provincial expert capacity-building, and to establish a 6 million Innovation Fund for the township level health innovation projects.
The overall objective of the H8P is to improve supply capacity of health services in poverty-stricken areas and to improve health services utilization level. By ensuring that local residents have access to basic health care services in rural poverty-ridden areas, health improvement can be achieved among the poor county population. Covering China's 10 central and western provinces, municipalities and autonomous regions, this project is wide-ranging geographically and benefits a large population.
H8P was divided into two parts: Part A, also known as the "basic health services component", covering 71 counties in Shanxi, Anhui, Henan, Chongqing, Guizhou, Gansu, and Qinghai provinces (municipalities); part B, also known as the "Qinba health component ", covering 26 counties in. Shaanxi, Ningxia, Sichuan and other provinces and autonomous regions.
The total project investment is 1.069 billion yuan. Basic health services component is 887 million yuan, while the left belonged to Qinba health component. Project loan is allocated among the provinces as follows: US＄7.107 million for Qinghai Province; US＄12,198 million for Henan Province; US＄10,209 million for Chongqing Municipality; US＄11,098 million for Guizhou Province; US＄10,143 million for Gansu Province; US＄12,188 million for Anhui Province; US＄7.057 million for Shanxi Province; US＄2,216 million for Ningxia; US＄5,303 million for Shaanxi Province; US＄7,481 million for Sichuan Province.
As one of the basic health services component provinces in H8P, Qinghai Province has been implementating H8P since 1998.
Qinghai Provincial Government, as required by the World Bank and the Foreign Loans Office of the Ministry of Health and according to the requirements of the prior agreement, formed the World Bank loan "H8P" leading group, headed by the vice governor of Qinghai province.
According to the standard set by the World Bank and the Foreign Loans Office of the Ministry of Health, Qinghai Provincial People's Government selected the follwing 12 counties as the project counties: Ledu, Huangzhong, Huzhu, Datong, Xunhua, Tongren, Dulan, Menyuan, Xinghai, Dari, Yushu and Minhe.
The total project investment was 90.7521 million yuan, of which the World Bank loans amounted to 58.9881 million yuan (about US＄7,107 million), accounting for 65 % of the total investment, the domestic support accounted for the 35% of the investment. The provincial investment was 15.97 million yuan, accounting for 50.3% of the domestic support.
Major project investments were spent on the transformation of township hospitals, necessary equipment, allocation of medicines and materials, personnel training, technical assistance, project management and operation of the project activities, and so on.
H8P has been fully concluded in June 2007. Consequently, the components of the projects were also concluded. As a project component, the H8P disease intervention had ended by the end of 2005..
In 2006, under the leadership Foreign Loans Office of the Ministry of Health, the provincial H8P organizations started to carry out the final evaluation and examination on H8P in 10 project provinces. Therefore, from the end of 2006 to June 2007, the focus of H8P was to carry out project evaluation. The specific interventions were no longer carried out.
This study is a subset of H8P overall evaluation. Commissioned by the Office of the Qinghai Provincial Health, Fudan University would carry out the final evaluation study on the H8P implementation in Qinghai province.
Objective
The purpose of this study is to evaluate comprehensively the implementation of the H8P in Qinghai, making a summary of the experience gained in the project and the shortfalls found in it. It is expected that the lessons and reference will be useful for the non-project areas in Qinhai Province.
Methods
1. Descriptive research method. To understand the development of the H8P project counties, we have used quantitative method to make an analysis of the completion of the health monitoring indicators which were demanded by the H8P since 1998 in Qinghai province.
2. Qualitative research method. Using the focus group interview, as well as in-depth interviews, we have had an evaluation on the implementation of H8P in Qinghai, from which we want to understand the problems existing in the project and find the counter measures and suggestions for the non-project counties in the future.
3. Health statistics method. We have made a comparison between the final assessment in Qinghai and those of the other H8P provinces. Using random sampling method, we have selected the Qinghai project and non-project counties, both in township hospitals and village clinics, as well as residents of the building of the health situation KAP scores compared comparative analysis.
4. Comprehensive evaluation method. Using the composite Index method, we have made a comparison between the implementation of Qinghai and that of other H8P provinces.
5. Stakeholder analysis method and Policy Analysis Method. In the case studies, we have used stakeholder analysis and policy analysis method to conduct a systematic analysis of the feasibility and implementation difficulties
Results
1. We have made an analysis on the unified indicators of H8P from the World Bank. The results is shown as follows. By the end of 2006, all of the 12 H8P counties in Qinghai have completed every indicator in the fields of Part A of H8P. In the fields of Part B1-- improving health services delivery system—the completion rate of all indicators achieved 80% by the end of 2005. One exception is the X-ray protection rate as required by the state, only 23.16 percent rural hospitals met the standard. As for the use of the drug directory, hospitals and village clinics respectively reached the ratio of 100 percent and 93.81 percent. In the field of Part C1, that is, developing the cooperative medical system, all the 177 surveyed participated in the CMS, covering a population of 1,922,066, accounting for 89.6% of the total project area. It can be concluded that cooperative medical system has met the expectation. By 2006, health assistance for those extremely poor has been implemented in all the 12 counties which were included in H8P; Among the intervention projects from 1998 to 2006, 66.7% of the counties participated in tuberculosis intervention, 50% counties participated in the intervention against maternal and child diseases, and only one county participated in the intervention against cataract and insecticide. Qinghai Province did not participate in the disease intervention projects added to the list after the 2002 mid-term evaluation.
2. We have made a comparison between Qinghai province and other H8P provinces. The results are as follows. In the period of the H8P, Qinghai Province has consolidated provincial supervision for 3,102 persons, which was 3.6 and 5.0 times compared to the average of the H8P provinces and the average of 7 provinces in Part A among H8P respectively. Qinghai Province has conducted short-term professional training for 1,742 per person, which was 0.5 and 0.4 times compared to the average of the H8P provinces and the average of 7 provinces in Part A among H8P respectively. All of the H8P counties in Qinghai had established cooperative medical system and given medical assistance to those extremely poor, with both rates higher than the national rate in Part A of the seven provinces and the average level. By the end of 2006, the percentage which the county participated in either CMS or medical assistance occupied 100 percent in the H8P counties in Qinghai, both of them were higher than the average of the H8P provinces and the average of 7 provinces in Part A among H8P.
Among the H8P focus interventions in Qinghai Province, the percentage which the county participated in TB control interventions occupied 66.7 percent in the H8P counties in Qinghai, which was the highest in the H8P focus interventions, followed by the intervention immunization, which the ratio was 58.3 percent. In both of the two focus interventions, Qinghai Province had achieved a higher participation percentage than the average of the H8P provinces and the average of 7 provinces in Part A among H8P. For the maternal and child health intervention, its percentage was 50 percent, lower than the average of the H8P provinces and the average of 7 provinces in Part A among H8P respectively. By the end of 2006, there was only 1 county respectively which did iodine deficiency disease prevention and control, eliminate cataract, children intestinal insecticide, STD / AIDS prevention, reproductive tract infection control, pre-injury accident six projects intervention. The participation percentages of the above control interventions were lower than the average of the H8P provinces and the average of 7 provinces in Part A among H8P respectively. For the indoor pollution prevention fluorosis, no Qinghai county had carried out this project, while the other H8P provinces had done it.
3. In this study, we have used the composite index method to make the systematic evaluation of Qinghai and the average of 7 provinces in Part A among H8. The results is shown as follows. Except the CMS and medical assistance, the remaining seven categories of H8P in Qinghai were lower than the average level of 7 provinces in Part A among H8P. The final comprehensive evaluation results showed that the score of the composite index were 6.613, which was lower than the average level of 7 provinces in Part A among H8P whose score was 11.679.
4. Based on the comparison between the Qinghai H8P counties and the non-project ones as regards the point of township hospitals and village clinics, as well as residents of the building of the health control KAP scores, we can understand that the health service abilities either in the township hospitals or in the village clinics, were higher in H8P counties than non-project counties; as for the KAP on health, the scores of the citizens in H8P county were higher in the non-project counties.
Innovation
H8P was concluded in June 2007. This study as the final evaluation is of great practical significance and is carried out in a timely manner. The main findings of this study have been handed over to the Foreign Loans Office of the Ministry of Health in the form of a report titled "Completion of the H8 Project in Qinghai Province" in June 2007. Through verification, the accreditation experts agreed that the evaluation report on the H8P in Qinghai was accordant with the actual situation in Qinghai and meet the requirements set by the Foreign Loans Office of the Ministry of Health and the World Bank.
The study is the final evaluation on the H8P implementation in Qinghai. We have used the implementation data of the average of the H8P provinces and the average of 7 provinces in Part A among H8P as the external control. At the same time, we have chosen the comparative non-project counties as the internal control in terms of township hospital and village clinics construction, as well as the scores about the KAP in the residents. For the problems identified through the comprehensive evaluation, we have analyzed the reasons and the difficulties in the form of case study by employing various methods, such as stakeholders, policy analysis method, etc.
为响应世界卫生组织通过初级卫生保健来实现“2000年人人享有卫生保健”的目标,我国卫生部从1984年开始,连续利用世界银行贷款进行卫生服务建设,到目前为止,我国已同世界银行合作进行了十个卫生项目,历次向世界银行贷款累计91060万美元。
我国政府利用世界银行贷款开展的第八个卫生项目---“加强中国农村贫困地区基本卫生服务项目”,简称“卫生Ⅷ项目”(H8P)。英国政府赠款设立了卫生Ⅷ支持性项目(H8SP),重点是加强国家级、省级专家能力建设,同时设立了600万元的创新基金资助乡镇级卫生创新项目。
卫生Ⅷ项目的总体目标是:改善农村贫困地区卫生服务提供能力和提高卫生服务利用水平,保证当地居民获得基本医疗卫生保健服务,在农村贫困县人口中实现可持续发展的健康改善。
该项目覆盖我国中西部10个省(市、自治区)的97个国家级和省级贫困县的3486万人口,是我国涉及贫困地区范围较大、受益人口较多的卫生扶贫项目。
项目分为两部分:A部分,又称“基本卫生服务子项目”,覆盖山西、安徽、河南、重庆、贵州、甘肃、青海等7省(市)的71个县;B部分又称“秦巴卫生子项目”,覆盖陕西、宁夏、四川等3省(自治区)的26个县。
本项目总投资为10.69亿元,基本卫生服务子项目8.87亿元,秦巴卫生子项目1.82亿元。
各项目省贷款数量安排为:青海省710.7万美元;河南省1219.8万美元;重庆市1020.9万美元;贵州省1109.8万美元;甘肃省1014.3万美元;安徽省1218.8万美元;山西省705.7万美元;宁夏自治区221.6万美元;陕西省530.3万美元;四川省748.1万美元。
青海省作为卫生Ⅷ项目基本卫生服务子项目中的一个省,自1998年开始实施卫生Ⅷ项目,青海省政府按照世界银行和卫生部国外贷款办的要求以及事先签订的协议,组成了由主管副省长为组长的青海省世行贷款“卫生Ⅷ项目”领导小组。
青海省人民政府按照世界银行和卫生部国外贷款办对卫生Ⅷ项目县选择的统一要求,最终选择如下12个项目县,乐都县、湟中县、互助、大通、循化、同仁、都兰、门源、兴海、达日、玉树、民和等。
青海省卫生Ⅷ项目总投资9075.21万元,其中世界银行贷款5898.81万元(约710.7万美元),占总投资额的65%;国内配套3176.4万元,占35%。国内配套中省级配套1597万元,占50.3%;州(地、市)县配套1579.4万元,占49.7%。
卫生Ⅷ项目于2007年6月在我国已结束,针对卫生Ⅷ项目的各项内容也已全面结束,其中卫生Ⅷ项目重点疾病的干预于2005年底已截止。2006年下半年开始,由卫生部国外贷款办组织各省卫生Ⅷ项目办参与的卫生Ⅷ项目终期评价考核工作在全国10个卫生Ⅷ项目省展开。2006年底到2007年6月,基本为卫生Ⅷ项目的评价、总结阶段,对于卫生Ⅷ项目具体干预工作已不再进行。
本研究作为卫生Ⅷ项目总体评价中的一个子项目,对青海省卫生Ⅷ项目实施情况及结果进行外部终期评价。
研究目的
本研究利用青海省卫生Ⅷ项目资料和通过现场抽样调查,系统地对青海省卫生Ⅷ项目实施情况进行综合评价,总结卫生Ⅷ项目所取得的经验,发现其中的不足,并为未来更好地在青海全省,尤其是在非项目地区推广卫生Ⅷ项目中取得经验提供依据和参考。
研究方法
1.描述性研究方法。对于青海省卫生Ⅷ项目县历年项目监督指标完成情况进行定量分析,以了解其发展变化情况。
2.焦点组访谈和个人深入访谈法。利用焦点组访谈和个人深入访谈的方式,深入了解卫生Ⅷ项目取得的经验和存在的问题,以期未来在青海省全省,尤其是在非项目县推广中提出合理的策略和建议。
3.卫生统计学分析方法。将青海省2006年卫生Ⅷ项目最终考核情况同全国其它卫生Ⅷ项目省进行比较分析;利用随机抽样的方法,选取青海省项目县和非项目县,将二者在乡镇卫生院、村卫生室建设以及居民对健康的认知、态度和行为(KAP)得分等情况进行对照比较分析。
4.综合评价方法。利用综合指数的综合评价方法,对青海省卫生Ⅷ项目实施情况同A部分7省平均实施情况,进行系统评价比较分析。
5.利益相关者、政策分析等方法。案例研究中,对于项目开展中遇到的困难,利用利益相关者分析或政策分析的方法,对于其可行性及实施的困难等进行系统分析。
研究结果
1.青海省各项目县1998-2006年卫生Ⅷ各业务开展结果分析表明:到2006年底,青海省12个卫生Ⅷ项目县均已完成了卫生Ⅷ项目在A领域中的各项指标;对于B1领域,青海省卫生Ⅷ项目各县在改善卫生服务提供系统的各个指标至2005年除符合国家X线防护要求的乡卫生院比例仍较低以外,为23.16%;其余指标均达到80%及以上,其中使用基本药物目录的卫生院和村卫生室的比例分别达到100%和93.81%;卫生Ⅷ项目C1领域,即合作医疗开展,到2006年青海省项目地区100.0%的乡镇均开展了合作医疗,覆盖人口达到1922066人,占项目地区总人口的比值为89.6%;对于卫生Ⅷ项目C2领域,即特困医疗救助,2006年青海省12个卫生Ⅷ项目县均已开展了特困医疗救助;对于B2领域,即重点疾病干预情况,青海省1998-2006年重点疾病干预,以结核病控制干预参与县数最多,占青海省卫生Ⅷ项目县总数的66.7%,其次为计划免疫,占所有卫生Ⅷ县数的58.3%;对于妇幼保健干预参与县数占所有卫生Ⅷ项目县总数的50%,另外,对于碘缺乏病防治、消除白内障和儿童肠道驱虫三类项目的干预,青海省均为1个县参与。对于2002年中期考核后新增加的疾病干预项目,青海省基本没有进行干预。
2.青海省卫生Ⅷ项目各指标完成情况同全国其他项目省比较结果表明:青海省1998-2006年省级累计综合督导为3102人次,分别为全国各省及A部分7省平均水平的3.6和5.0倍;青海省项目期间省级开展短期业务培训为1742人次,分别为全国各省及A部分7省平均水平的0.5和0.4倍;青海省2006年12个卫生Ⅷ项目县均已开展了合作医疗及特困医疗救助,二者开展率均高于全国及A部分7省平均水平;青海省项目期间重点疾病干预的活动中,以结核病控制干预参与县数最多,占青海省卫生Ⅷ项目县总数的66.7%,其次为计划免疫干预,占所有卫生Ⅷ县数的58.3%,以上两种项目干预参与县数比例均超过全国及A部分7省平均水平;妇幼保健干预参与县数占所有卫生Ⅷ项目县总数的50%,低于全国及A部分7省各项目县参与的比例;对于碘缺乏病防治、消除白内障和儿童肠道驱虫、性病/艾滋病预防、生殖道感染控制、意外损伤干预六类项目,青海省均为1个县参与干预,上述各类均低于全国及A部分7省各项目县参与的比例;对于室内污染氟中毒预防,青海省则没有一个卫生Ⅷ项目县进行过干预。
3.本研究利用综合指数对青海省卫生Ⅷ项目实施情况各指标同A部分7省平均水平进行了综合评价。结果显示:合作医疗与特困医疗救助,青海省实施情况好于A部分各省平均水平,其余7个类别均低于A部分各省平均水平。最终综合评价结果为:青海省综合指数得分6.613,小于卫生Ⅷ项目A部分7省各省平均水平综合指数11.679的得分,即青海省卫生Ⅷ项目实施最终评价结果为总体低于A部分7省平均水平。
4.青海省卫生Ⅷ项目县和非项目县在乡镇卫生院、村卫生室建设以及居民对健康的KAP得分对照比较结果显示:项目地区卫生院在卫生人员基本素质、业务用房面积、医疗设备的配置、卫生服务能力的提供及业务内容的开展各方面均优于非项目县;项目地区村卫生室在乡村医生素质、卫生室面积、现有医疗及预防保健设备、乡村医生收入以及村卫生室业务内容的开展各方面,均优于非项目县;项目地区居民对健康的KAP得分优于非项目地区。
本研究的创新
卫生Ⅷ项目于2007年6月正式结束。本研究利用青海省卫生Ⅷ项目资料和现场抽样调查资料对青海省卫生Ⅷ项目的终期评价,具有较强的时效性和现实意义。
本研究对青海省卫生Ⅷ项目的实施情况进行了终期评价,采用了同全国卫生Ⅷ项目各省以及A部分7省平均水平为外对照,同时利用青海省具有可比性的非项目县卫生资源配置以及居民对健康的KAP得分等为内对照,结合历年青海省卫生Ⅷ项目各指标的完成情况,对青海省卫生Ⅷ项目的实施情况进行了综合评价。本文对于综合评价中发现的问题,以案例介绍和评价的方式对项目开展中遇到的困难利用利益相关者分析等方法进行了分析。
Background
In response to "2000 Health for All" initiated by the World Health Organization, the Chinese Ministry of Health has been using World Bank loans for the construction of health services since 1984. So far, China has carried out 10 sanitation projects in cooperation with the World Bank, which provided US＄910.6 million loans in total.
The eighth health project carried out by the Chinese government by using World Bank loans is aimed to "strengthen basic health services in China's rural poverty-stricken areas", and it is hereafter referred to as the "HealthⅧProject" (H8P). The British Government also granted fund to support projectsⅧ(referred to as H8SP), the focus of which is to strengthen national, provincial expert capacity-building, and to establish a 6 million Innovation Fund for the township level health innovation projects.
The overall objective of the H8P is to improve supply capacity of health services in poverty-stricken areas and to improve health services utilization level. By ensuring that local residents have access to basic health care services in rural poverty-ridden areas, health improvement can be achieved among the poor county population. Covering China's 10 central and western provinces, municipalities and autonomous regions, this project is wide-ranging geographically and benefits a large population.
H8P was divided into two parts: Part A, also known as the "basic health services component", covering 71 counties in Shanxi, Anhui, Henan, Chongqing, Guizhou, Gansu, and Qinghai provinces (municipalities); part B, also known as the "Qinba health component ", covering 26 counties in. Shaanxi, Ningxia, Sichuan and other provinces and autonomous regions.
The total project investment is 1.069 billion yuan. Basic health services component is 887 million yuan, while the left belonged to Qinba health component. Project loan is allocated among the provinces as follows: US＄7.107 million for Qinghai Province; US＄12,198 million for Henan Province; US＄10,209 million for Chongqing Municipality; US＄11,098 million for Guizhou Province; US＄10,143 million for Gansu Province; US＄12,188 million for Anhui Province; US＄7.057 million for Shanxi Province; US＄2,216 million for Ningxia; US＄5,303 million for Shaanxi Province; US＄7,481 million for Sichuan Province.
As one of the basic health services component provinces in H8P, Qinghai Province has been implementating H8P since 1998.
Qinghai Provincial Government, as required by the World Bank and the Foreign Loans Office of the Ministry of Health and according to the requirements of the prior agreement, formed the World Bank loan "H8P" leading group, headed by the vice governor of Qinghai province.
According to the standard set by the World Bank and the Foreign Loans Office of the Ministry of Health, Qinghai Provincial People's Government selected the follwing 12 counties as the project counties: Ledu, Huangzhong, Huzhu, Datong, Xunhua, Tongren, Dulan, Menyuan, Xinghai, Dari, Yushu and Minhe.
The total project investment was 90.7521 million yuan, of which the World Bank loans amounted to 58.9881 million yuan (about US＄7,107 million), accounting for 65 % of the total investment, the domestic support accounted for the 35% of the investment. The provincial investment was 15.97 million yuan, accounting for 50.3% of the domestic support.
Major project investments were spent on the transformation of township hospitals, necessary equipment, allocation of medicines and materials, personnel training, technical assistance, project management and operation of the project activities, and so on.
H8P has been fully concluded in June 2007. Consequently, the components of the projects were also concluded. As a project component, the H8P disease intervention had ended by the end of 2005..
In 2006, under the leadership Foreign Loans Office of the Ministry of Health, the provincial H8P organizations started to carry out the final evaluation and examination on H8P in 10 project provinces. Therefore, from the end of 2006 to June 2007, the focus of H8P was to carry out project evaluation. The specific interventions were no longer carried out.
This study is a subset of H8P overall evaluation. Commissioned by the Office of the Qinghai Provincial Health, Fudan University would carry out the final evaluation study on the H8P implementation in Qinghai province.
Objective
The purpose of this study is to evaluate comprehensively the implementation of the H8P in Qinghai, making a summary of the experience gained in the project and the shortfalls found in it. It is expected that the lessons and reference will be useful for the non-project areas in Qinhai Province.
Methods
1. Descriptive research method. To understand the development of the H8P project counties, we have used quantitative method to make an analysis of the completion of the health monitoring indicators which were demanded by the H8P since 1998 in Qinghai province.
2. Qualitative research method. Using the focus group interview, as well as in-depth interviews, we have had an evaluation on the implementation of H8P in Qinghai, from which we want to understand the problems existing in the project and find the counter measures and suggestions for the non-project counties in the future.
3. Health statistics method. We have made a comparison between the final assessment in Qinghai and those of the other H8P provinces. Using random sampling method, we have selected the Qinghai project and non-project counties, both in township hospitals and village clinics, as well as residents of the building of the health situation KAP scores compared comparative analysis.
4. Comprehensive evaluation method. Using the composite Index method, we have made a comparison between the implementation of Qinghai and that of other H8P provinces.
5. Stakeholder analysis method and Policy Analysis Method. In the case studies, we have used stakeholder analysis and policy analysis method to conduct a systematic analysis of the feasibility and implementation difficulties
Results
1. We have made an analysis on the unified indicators of H8P from the World Bank. The results is shown as follows. By the end of 2006, all of the 12 H8P counties in Qinghai have completed every indicator in the fields of Part A of H8P. In the fields of Part B1-- improving health services delivery system—the completion rate of all indicators achieved 80% by the end of 2005. One exception is the X-ray protection rate as required by the state, only 23.16 percent rural hospitals met the standard. As for the use of the drug directory, hospitals and village clinics respectively reached the ratio of 100 percent and 93.81 percent. In the field of Part C1, that is, developing the cooperative medical system, all the 177 surveyed participated in the CMS, covering a population of 1,922,066, accounting for 89.6% of the total project area. It can be concluded that cooperative medical system has met the expectation. By 2006, health assistance for those extremely poor has been implemented in all the 12 counties which were included in H8P; Among the intervention projects from 1998 to 2006, 66.7% of the counties participated in tuberculosis intervention, 50% counties participated in the intervention against maternal and child diseases, and only one county participated in the intervention against cataract and insecticide. Qinghai Province did not participate in the disease intervention projects added to the list after the 2002 mid-term evaluation.
2. We have made a comparison between Qinghai province and other H8P provinces. The results are as follows. In the period of the H8P, Qinghai Province has consolidated provincial supervision for 3,102 persons, which was 3.6 and 5.0 times compared to the average of the H8P provinces and the average of 7 provinces in Part A among H8P respectively. Qinghai Province has conducted short-term professional training for 1,742 per person, which was 0.5 and 0.4 times compared to the average of the H8P provinces and the average of 7 provinces in Part A among H8P respectively. All of the H8P counties in Qinghai had established cooperative medical system and given medical assistance to those extremely poor, with both rates higher than the national rate in Part A of the seven provinces and the average level. By the end of 2006, the percentage which the county participated in either CMS or medical assistance occupied 100 percent in the H8P counties in Qinghai, both of them were higher than the average of the H8P provinces and the average of 7 provinces in Part A among H8P.
Among the H8P focus interventions in Qinghai Province, the percentage which the county participated in TB control interventions occupied 66.7 percent in the H8P counties in Qinghai, which was the highest in the H8P focus interventions, followed by the intervention immunization, which the ratio was 58.3 percent. In both of the two focus interventions, Qinghai Province had achieved a higher participation percentage than the average of the H8P provinces and the average of 7 provinces in Part A among H8P. For the maternal and child health intervention, its percentage was 50 percent, lower than the average of the H8P provinces and the average of 7 provinces in Part A among H8P respectively. By the end of 2006, there was only 1 county respectively which did iodine deficiency disease prevention and control, eliminate cataract, children intestinal insecticide, STD / AIDS prevention, reproductive tract infection control, pre-injury accident six projects intervention. The participation percentages of the above control interventions were lower than the average of the H8P provinces and the average of 7 provinces in Part A among H8P respectively. For the indoor pollution prevention fluorosis, no Qinghai county had carried out this project, while the other H8P provinces had done it.
3. In this study, we have used the composite index method to make the systematic evaluation of Qinghai and the average of 7 provinces in Part A among H8. The results is shown as follows. Except the CMS and medical assistance, the remaining seven categories of H8P in Qinghai were lower than the average level of 7 provinces in Part A among H8P. The final comprehensive evaluation results showed that the score of the composite index were 6.613, which was lower than the average level of 7 provinces in Part A among H8P whose score was 11.679.
4. Based on the comparison between the Qinghai H8P counties and the non-project ones as regards the point of township hospitals and village clinics, as well as residents of the building of the health control KAP scores, we can understand that the health service abilities either in the township hospitals or in the village clinics, were higher in H8P counties than non-project counties; as for the KAP on health, the scores of the citizens in H8P county were higher in the non-project counties.
Innovation
H8P was concluded in June 2007. This study as the final evaluation is of great practical significance and is carried out in a timely manner. The main findings of this study have been handed over to the Foreign Loans Office of the Ministry of Health in the form of a report titled "Completion of the H8 Project in Qinghai Province" in June 2007. Through verification, the accreditation experts agreed that the evaluation report on the H8P in Qinghai was accordant with the actual situation in Qinghai and meet the requirements set by the Foreign Loans Office of the Ministry of Health and the World Bank.
The study is the final evaluation on the H8P implementation in Qinghai. We have used the implementation data of the average of the H8P provinces and the average of 7 provinces in Part A among H8P as the external control. At the same time, we have chosen the comparative non-project counties as the internal control in terms of township hospital and village clinics construction, as well as the scores about the KAP in the residents. For the problems identified through the comprehensive evaluation, we have analyzed the reasons and the difficulties in the form of case study by employing various methods, such as stakeholders, policy analysis method, etc.
引文
[1]世界卫生组织.阿拉木图宣言.1978.
[2]卫生部国外贷款办公室.贷款办大事记.http://flomoh.moh.gov.cn.
[3]段明月.世行贷款卫生项目对我国卫生发展的作用.中国农村卫生事业管理,2004,24(1):16-18.
[4]中华人民共和国卫生部国外贷款办公室.中国基本卫生服务项目研究前言.中国初级卫生保健,2005,19(5):1.
[5]刘方.世界银行贷款卫生项目简介.中国医疗器械信息,2005,11(4):9.
[6]卫生部规财司,国家计委社会发展司,财政部国际司.世界银行贷款《基本卫生服务项目》管理办法.1999.
[7]卫生部国外贷款办公室.世界银行贷款《基本卫生服务项目》财务管理办法.1999.
[8]青海省世界银行贷款卫生Ⅷ项目领导小组.青海省世界银行贷款卫生Ⅷ项目管理工作手册.2000.
[9]卫生部规财司.关于中国农村基本卫生服务项目被世界银行评为1998年十大优秀设计项目的通知.1997.
[10]段明月.世行贷款卫生项目对我国卫生发展的作用.中国农村卫生事业管理,2004,24(1):16-18.
[11]刘谷琮.建立县级卫生规划体制的探索和创新.北京:中国财政经济出版社.2007.
[12]刘谷琮.项目县制定与实施县卫生资源规划的实践与思考.中国初级卫生保健,2005,19(5):33-34.
[13]方华洲,杨春燕.实施卫生现项目县级卫生资源规划的实践与效果评价[J].中国卫生资源.2008,11(1):45-47.
[14]苏维,王禄生,马存锁,等.对卫生Ⅷ项目乡镇卫生院设施建设效果的满意度调查.中国初级卫生保健,2005,19(5):39-42.
[15]李红星,吴建.河南省世行贷款卫生Ⅷ项目地区乡镇卫生院建设的基本要求.中国卫生资源,2006,9(1):20-23.
[16]张亮,刘运国.改善卫生服务提供.北京:中国财政经济出版社.2007.
[17]王燕,王海俊,康楚云,等.卫生Ⅷ项目外部评估报告.卫生部国外贷款办.2007.
[18]高军,张耀光.卫生Ⅷ项目/卫生Ⅷ支持性项目妇幼卫生干预效果分析.中国初级卫生保健,2005,19(5):29-31.
[19]青海省政府办公厅.青海省人民政府办公厅关于成立省世行贷款“卫八”项目领导小组的通知.1997.
[20]青海省政府办公厅.青海省人民政府办公厅关于对开展世行贷款卫八项目有关要求承诺的函.1999.
[21]青海省人民政府办公厅.青海省政府办公厅关于同意乐都等12个县为我省实施世行贷款卫八项目县的批复.1998.
[22]青海省财政厅.青海省财政厅州(地市)人民政府关于利用世界银行贷款基本卫生服务项目的转贷协议.1998.
[23]青海省统计局.2007年青海统计年鉴.北京:中国统计出版社.2007,1-6.
[24]中华人民共和国卫生部.2007年中国卫生统计年鉴.北京:中国协和医科大学出版社.2007,356.
[25]青海省统计局.1999年青海统计年鉴.北京:中国统计出版社.1999,441-487.
[26]青海省统计局.2000年青海统计年鉴.北京:中国统计出版社.2000,452-496.
[27]青海省统计局.2001年青海统计年鉴.北京:中国统计出版社.2001,471-515.
[28]青海省统计局.2002年青海统计年鉴.北京:中国统计出版社.2002,473-499.
[29]青海省统计局.2003年青海统计年鉴.北京:中国统计出版社.2003,473-499.
[30]青海省统计局.2004年青海统计年鉴.北京:中国统计出版社.2004,489-515.
[31]青海省统计局.2005年青海统计年鉴.北京:中国统计出版社.2005,477-512.
[32]青海省统计局.2006年青海统计年鉴.北京:中国统计出版社.2006,487-522.
[33]青海省卫生厅卫生Ⅷ项目办.1998-2006年青海省卫生Ⅷ项目年报表.
[34]青海省卫生厅.全国卫生Ⅷ项目2006年实施情况汇总.
[35]李立明.流行病学(第四版).北京:人民卫生出版社.2000,91.
[36]倪宗瓒.卫生统计学.北京:人民卫生出版社.2000,233-236.
[37]焦建军.医院医疗综合指数应用分析.中国医院统计,2001,8(3):165.
[38]蒋辉权,王咪咪,杨海飞.综合指数法在疚控机构综合效益评价中的应用.浙江预防医学,2008,20(1):76-77.
[39]刘争,刘惠英,李蔓.综合指数法在评价医院中医医疗质量中的应用.中医药管理杂志,2007,15(3):170-172.
[40]李云霞.利用综合指数法评价我院五年医疗上作.中国卫生统计,2007,24(3):322-323.
[41]刘莉.应用综合指数法对病房医疗质量的综合评价.中国医院统计,2007,14(3):267-268.
[42]戴石元,钱津,卢大丽,等.用综合指数法分析我院2006年业务收入.中国医院统计,2007,14(4):347-348.
[43]王德峰,张卉,朱海燕,等.应用综合指数分析某精神病医院5年效益.中国医院统计,2006,13(1):62-63.
[44]张秀红.综合指数法在医疗工作评价中的应用.中国卫生统计,2006,23(5):477.
[45]汪耘,何亚晶,孙宏,等.试用综合指数评价分析医院效益.中国医院统计,2000,7(1):33.
[46]孟乐弟,杨丽琴,张伟.综合指数法在医疗工作评价中的应用.中国医院统计,2000,7(3):151-152.
[47]卫生部.医疗机构基本标准(试行).1994.
[48]曹承建,朱培华,金慧娟.农村居民健康知识和行为及影响因素分析.中国农村卫生事业管理,2005,25(11):53-54.
[49]龚幼龙.卫生服务研究.上海:复旦大学出版社,2002,305-306.
[50]中华人民共和国卫生部.2006年中国卫生统计年鉴.北京:中国协和医科大学出版社.2006,251.
[51]Mitchell A,Wood D.Toward a Theory of Stakeholder Identification and Salience:Defining the Principle of Who and What really Counts? Academy of Management Review,1997,22(4):853-886.
[52]万建华.利益相关者管理.深圳:海天出版社,1998.5-8.
[53]李心合.面向可持续发展的利益相关者管理.当代财经,2001,(1):66-70.
[54]卫生部,农业部,财政部,等.农村合作医疗章程(试行草案).1979.
[55]国务院.关于建立新型农村合作医疗制度意见的通知.2003.
[56]卫生部.关于加快推进新型农村合作医疗试点工作.2006.
[57]卫生部,财政部.关于做好2007年新型农村合作医疗工作.2007.
[58]宋绮霞.计划生育生殖保健启动三大工程.中国计划生育学杂志,2000,(7):45.
[59]http://www.xinyq.com/html/200603/20/095201722.htm
[60]孙俊华,马娟,吴焕玲.农村妇女生殖道感染普查结果分析.中国生育健康杂志,2004,15(5):307.
[61]程晓明,赵大海,洪哲芳,等.山西省和顺县合同购买卫生服务试点项目成本效果分析.卫生部国外贷款办.
[62]生殖道感染干预工程拉开序幕.http://www.69123.com/Article/72/100802.htm
[1]世界卫生组织.阿拉木图宣言.1978.
[2]卫生部国外贷款办公室.贷款办大事记.http://flomoh.moh.gov.cn.
[3]梁万年,周纪安,段明月,等.综合性区域卫生发展项目的(卫生Ⅲ项目)的效果评价[J].中国卫生经济.1999,18(6):19-21.
[4]葛正义,王亚东.实施安徽省卫生Ⅳ项目的对策与思考[J].安徽卫生职业技术学院学报.2003,2(1):8-10.
[5]段明月.世行贷款卫生项目对我国卫生发展的作用.中国农村卫生事业管理,2004,24(1):16-18.
[6]罗文丽,郭岩.世界银行货款卫生Ⅵ项目县特困孕产妇医疗救助费用分析.中国初级卫生保健,2002,16(4):33-34.
[7]卫生部疾病控制司,卫生部国外贷款办公室,中国预防医学科学院.世界银行贷款中国疾病预防(卫生Ⅶ)项目省免疫接种率基线调查报告.中国计划免疫,1998,4(1):1-9.
[8]中华人民共和国卫生部国外贷款办公室.中国基本卫生服务项目研究前言.中国初级卫生保健,2005,19(5):1.
[9]卫生部国外贷款办公室.卫生九项目妇幼卫生部分.中国健康教育,2008,(2):1-3.
[10]生部国外贷款办公室.卫生九项目艾滋病性病部分.中国健康教育,2008,(1):1-3.
[11]刘方.世界银行贷款卫生项目简介.中国医疗器械信息,2005,11(4):9.
[12]翁秀山.认真实施卫生Ⅳ项目加强农村卫生事业建设.中国农村卫生事业管理.[J].1997,17(11):36-37.
[13]陈娟,郭岩.世界银行贷款卫生Ⅵ项目特困医疗救助资金筹集的问题与建议.中国初级卫生保健,2002,16(7):34-35.
[14]陈辉,方鹏骞,熊光练,等.卫Ⅵ项目地区贫困居民卫生服务利用分析.中国初级卫生保健,2002,17(5):279-281.
[15]任正洪,周小平.世界银行贷款中国卫生九项目妇幼卫生子项目外部中期评估圆满完成.北京大学学报(医学版),2004,36(1):98.
[16]刘英,胡代玉,刘利,等.重庆市世行贷款/英国赠款中国结核病控制项目中期评估.中国防痨杂志,2007,29(3):212-215.
[17]玛依夏提·马合木提,李月华,吴刚.2002-2005年新疆实施世行贷款/英国赠款中国结核病控制项目效果分析.地方病通报,2006,21(5):25-27.
[18]中华人民共和国与国家开发协会.基本卫生服务项目开发信贷协定.1998.
[19]青海省世界银行贷款卫生八项目领导小组.青海省世界银行贷款卫生八项目管理工作手册.2000.
[20]刘谷琮.建立县级卫生规划体制的探索和创新.北京:中国财政经济出版社.2007.
[21]刘谷琮.项目县制定与实施县卫生资源规划的实践与思考.中国初级卫生保健,2005,19(5):33-34.
[22]方华洲,杨春燕.实施卫生现项目县级卫生资源规划的实践与效果评价[J].中国卫生资源.2008,11(1):45-47.
[23]苏维,王禄生,马存锁,等.对卫生八项目乡镇卫生院设施建设效果的满意度调查.中国初级卫生保健,2005,19(5):39-42.
[24]李红星,吴建.河南省世行贷款卫生Ⅷ项目地区乡镇卫生院建设的基本要求.中国卫生资源,2006,9(1):20-23.
[25]张亮,刘运国.改善卫生服务提供.北京:中国财政经济出版社.2007.
[26]王燕,王海俊,康楚云,等.卫生八项目外部评估报告.卫生部国外贷款办.2007.
[27]高军,张耀光.卫生Ⅷ项目/卫生Ⅷ支持性项目妇幼卫生干预效果分析.中国初级卫生保健,2005,19(5):29-31.
[2]卫生部国外贷款办公室.贷款办大事记.http://flomoh.moh.gov.cn.
[3]段明月.世行贷款卫生项目对我国卫生发展的作用.中国农村卫生事业管理,2004,24(1):16-18.
[4]中华人民共和国卫生部国外贷款办公室.中国基本卫生服务项目研究前言.中国初级卫生保健,2005,19(5):1.
[5]刘方.世界银行贷款卫生项目简介.中国医疗器械信息,2005,11(4):9.
[6]卫生部规财司,国家计委社会发展司,财政部国际司.世界银行贷款《基本卫生服务项目》管理办法.1999.
[7]卫生部国外贷款办公室.世界银行贷款《基本卫生服务项目》财务管理办法.1999.
[8]青海省世界银行贷款卫生Ⅷ项目领导小组.青海省世界银行贷款卫生Ⅷ项目管理工作手册.2000.
[9]卫生部规财司.关于中国农村基本卫生服务项目被世界银行评为1998年十大优秀设计项目的通知.1997.
[10]段明月.世行贷款卫生项目对我国卫生发展的作用.中国农村卫生事业管理,2004,24(1):16-18.
[11]刘谷琮.建立县级卫生规划体制的探索和创新.北京:中国财政经济出版社.2007.
[12]刘谷琮.项目县制定与实施县卫生资源规划的实践与思考.中国初级卫生保健,2005,19(5):33-34.
[13]方华洲,杨春燕.实施卫生现项目县级卫生资源规划的实践与效果评价[J].中国卫生资源.2008,11(1):45-47.
[14]苏维,王禄生,马存锁,等.对卫生Ⅷ项目乡镇卫生院设施建设效果的满意度调查.中国初级卫生保健,2005,19(5):39-42.
[15]李红星,吴建.河南省世行贷款卫生Ⅷ项目地区乡镇卫生院建设的基本要求.中国卫生资源,2006,9(1):20-23.
[16]张亮,刘运国.改善卫生服务提供.北京:中国财政经济出版社.2007.
[17]王燕,王海俊,康楚云,等.卫生Ⅷ项目外部评估报告.卫生部国外贷款办.2007.
[18]高军,张耀光.卫生Ⅷ项目/卫生Ⅷ支持性项目妇幼卫生干预效果分析.中国初级卫生保健,2005,19(5):29-31.
[19]青海省政府办公厅.青海省人民政府办公厅关于成立省世行贷款“卫八”项目领导小组的通知.1997.
[20]青海省政府办公厅.青海省人民政府办公厅关于对开展世行贷款卫八项目有关要求承诺的函.1999.
[21]青海省人民政府办公厅.青海省政府办公厅关于同意乐都等12个县为我省实施世行贷款卫八项目县的批复.1998.
[22]青海省财政厅.青海省财政厅州(地市)人民政府关于利用世界银行贷款基本卫生服务项目的转贷协议.1998.
[23]青海省统计局.2007年青海统计年鉴.北京:中国统计出版社.2007,1-6.
[24]中华人民共和国卫生部.2007年中国卫生统计年鉴.北京:中国协和医科大学出版社.2007,356.
[25]青海省统计局.1999年青海统计年鉴.北京:中国统计出版社.1999,441-487.
[26]青海省统计局.2000年青海统计年鉴.北京:中国统计出版社.2000,452-496.
[27]青海省统计局.2001年青海统计年鉴.北京:中国统计出版社.2001,471-515.
[28]青海省统计局.2002年青海统计年鉴.北京:中国统计出版社.2002,473-499.
[29]青海省统计局.2003年青海统计年鉴.北京:中国统计出版社.2003,473-499.
[30]青海省统计局.2004年青海统计年鉴.北京:中国统计出版社.2004,489-515.
[31]青海省统计局.2005年青海统计年鉴.北京:中国统计出版社.2005,477-512.
[32]青海省统计局.2006年青海统计年鉴.北京:中国统计出版社.2006,487-522.
[33]青海省卫生厅卫生Ⅷ项目办.1998-2006年青海省卫生Ⅷ项目年报表.
[34]青海省卫生厅.全国卫生Ⅷ项目2006年实施情况汇总.
[35]李立明.流行病学(第四版).北京:人民卫生出版社.2000,91.
[36]倪宗瓒.卫生统计学.北京:人民卫生出版社.2000,233-236.
[37]焦建军.医院医疗综合指数应用分析.中国医院统计,2001,8(3):165.
[38]蒋辉权,王咪咪,杨海飞.综合指数法在疚控机构综合效益评价中的应用.浙江预防医学,2008,20(1):76-77.
[39]刘争,刘惠英,李蔓.综合指数法在评价医院中医医疗质量中的应用.中医药管理杂志,2007,15(3):170-172.
[40]李云霞.利用综合指数法评价我院五年医疗上作.中国卫生统计,2007,24(3):322-323.
[41]刘莉.应用综合指数法对病房医疗质量的综合评价.中国医院统计,2007,14(3):267-268.
[42]戴石元,钱津,卢大丽,等.用综合指数法分析我院2006年业务收入.中国医院统计,2007,14(4):347-348.
[43]王德峰,张卉,朱海燕,等.应用综合指数分析某精神病医院5年效益.中国医院统计,2006,13(1):62-63.
[44]张秀红.综合指数法在医疗工作评价中的应用.中国卫生统计,2006,23(5):477.
[45]汪耘,何亚晶,孙宏,等.试用综合指数评价分析医院效益.中国医院统计,2000,7(1):33.
[46]孟乐弟,杨丽琴,张伟.综合指数法在医疗工作评价中的应用.中国医院统计,2000,7(3):151-152.
[47]卫生部.医疗机构基本标准(试行).1994.
[48]曹承建,朱培华,金慧娟.农村居民健康知识和行为及影响因素分析.中国农村卫生事业管理,2005,25(11):53-54.
[49]龚幼龙.卫生服务研究.上海:复旦大学出版社,2002,305-306.
[50]中华人民共和国卫生部.2006年中国卫生统计年鉴.北京:中国协和医科大学出版社.2006,251.
[51]Mitchell A,Wood D.Toward a Theory of Stakeholder Identification and Salience:Defining the Principle of Who and What really Counts? Academy of Management Review,1997,22(4):853-886.
[52]万建华.利益相关者管理.深圳:海天出版社,1998.5-8.
[53]李心合.面向可持续发展的利益相关者管理.当代财经,2001,(1):66-70.
[54]卫生部,农业部,财政部,等.农村合作医疗章程(试行草案).1979.
[55]国务院.关于建立新型农村合作医疗制度意见的通知.2003.
[56]卫生部.关于加快推进新型农村合作医疗试点工作.2006.
[57]卫生部,财政部.关于做好2007年新型农村合作医疗工作.2007.
[58]宋绮霞.计划生育生殖保健启动三大工程.中国计划生育学杂志,2000,(7):45.
[59]http://www.xinyq.com/html/200603/20/095201722.htm
[60]孙俊华,马娟,吴焕玲.农村妇女生殖道感染普查结果分析.中国生育健康杂志,2004,15(5):307.
[61]程晓明,赵大海,洪哲芳,等.山西省和顺县合同购买卫生服务试点项目成本效果分析.卫生部国外贷款办.
[62]生殖道感染干预工程拉开序幕.http://www.69123.com/Article/72/100802.htm
[1]世界卫生组织.阿拉木图宣言.1978.
[2]卫生部国外贷款办公室.贷款办大事记.http://flomoh.moh.gov.cn.
[3]梁万年,周纪安,段明月,等.综合性区域卫生发展项目的(卫生Ⅲ项目)的效果评价[J].中国卫生经济.1999,18(6):19-21.
[4]葛正义,王亚东.实施安徽省卫生Ⅳ项目的对策与思考[J].安徽卫生职业技术学院学报.2003,2(1):8-10.
[5]段明月.世行贷款卫生项目对我国卫生发展的作用.中国农村卫生事业管理,2004,24(1):16-18.
[6]罗文丽,郭岩.世界银行货款卫生Ⅵ项目县特困孕产妇医疗救助费用分析.中国初级卫生保健,2002,16(4):33-34.
[7]卫生部疾病控制司,卫生部国外贷款办公室,中国预防医学科学院.世界银行贷款中国疾病预防(卫生Ⅶ)项目省免疫接种率基线调查报告.中国计划免疫,1998,4(1):1-9.
[8]中华人民共和国卫生部国外贷款办公室.中国基本卫生服务项目研究前言.中国初级卫生保健,2005,19(5):1.
[9]卫生部国外贷款办公室.卫生九项目妇幼卫生部分.中国健康教育,2008,(2):1-3.
[10]生部国外贷款办公室.卫生九项目艾滋病性病部分.中国健康教育,2008,(1):1-3.
[11]刘方.世界银行贷款卫生项目简介.中国医疗器械信息,2005,11(4):9.
[12]翁秀山.认真实施卫生Ⅳ项目加强农村卫生事业建设.中国农村卫生事业管理.[J].1997,17(11):36-37.
[13]陈娟,郭岩.世界银行贷款卫生Ⅵ项目特困医疗救助资金筹集的问题与建议.中国初级卫生保健,2002,16(7):34-35.
[14]陈辉,方鹏骞,熊光练,等.卫Ⅵ项目地区贫困居民卫生服务利用分析.中国初级卫生保健,2002,17(5):279-281.
[15]任正洪,周小平.世界银行贷款中国卫生九项目妇幼卫生子项目外部中期评估圆满完成.北京大学学报(医学版),2004,36(1):98.
[16]刘英,胡代玉,刘利,等.重庆市世行贷款/英国赠款中国结核病控制项目中期评估.中国防痨杂志,2007,29(3):212-215.
[17]玛依夏提·马合木提,李月华,吴刚.2002-2005年新疆实施世行贷款/英国赠款中国结核病控制项目效果分析.地方病通报,2006,21(5):25-27.
[18]中华人民共和国与国家开发协会.基本卫生服务项目开发信贷协定.1998.
[19]青海省世界银行贷款卫生八项目领导小组.青海省世界银行贷款卫生八项目管理工作手册.2000.
[20]刘谷琮.建立县级卫生规划体制的探索和创新.北京:中国财政经济出版社.2007.
[21]刘谷琮.项目县制定与实施县卫生资源规划的实践与思考.中国初级卫生保健,2005,19(5):33-34.
[22]方华洲,杨春燕.实施卫生现项目县级卫生资源规划的实践与效果评价[J].中国卫生资源.2008,11(1):45-47.
[23]苏维,王禄生,马存锁,等.对卫生八项目乡镇卫生院设施建设效果的满意度调查.中国初级卫生保健,2005,19(5):39-42.
[24]李红星,吴建.河南省世行贷款卫生Ⅷ项目地区乡镇卫生院建设的基本要求.中国卫生资源,2006,9(1):20-23.
[25]张亮,刘运国.改善卫生服务提供.北京:中国财政经济出版社.2007.
[26]王燕,王海俊,康楚云,等.卫生八项目外部评估报告.卫生部国外贷款办.2007.
[27]高军,张耀光.卫生Ⅷ项目/卫生Ⅷ支持性项目妇幼卫生干预效果分析.中国初级卫生保健,2005,19(5):29-31.
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