First of all, you have to determine the object of your investigation.
I. Basic situation
II. Main problems
1. Poor infrastructure and medical equipment.
2, townships and villages health institutions are not reasonably configured, the development is not balanced.
3, the lack of health technical personnel.
4, farmers due to disease, the problem of poverty, poverty is more prominent.
5, townships, villages, prevention and protection network system is not sound.
6, health centers are struggling to operate.
7, the lack of investment, the staff's ideological difficulties in stabilizing.
8, health supervision system is not smooth, the pharmaceutical market confusion.
Three, to solve the problem of countermeasures
1, grasp the leadership, strengthen the ideological understanding.
2, grasp the carrier, deepen institutional reform.
3, grasp the prevention and protection, improve network construction.
4, grasp measures to strengthen support.
5, grasp the team, improve the quality of talent.
6, grasp the supervision, increase law enforcement.
7, grasp the investment, improve the overall level.
Four, summary report
Attached is my report, you can refer to:
In mid- to late-October 2008, in-depth to the townships of Maoba, around the creek, Shuangqiao, Artemisia ping, Shuang'an and Jinchuan carried out a survey. In the survey, access to townships, health centers (centers), village health clinics, individual medical points and pharmacies of relevant information, were held in the townships, villages and groups of cadres and the public, the health of the medical staff to participate in the symposium, and visited more than 160 households in 18 administrative villages. The leaders and medical staff of the townships and health centers visited gave active support, and the surveyed farmers were able to reflect the actual situation objectively and put forward their opinions sincerely. The survey is now reported as follows:
I, the basic situation
My county jurisdiction over 25 townships, 269 administrative villages, **** there are 86,751 households, 338,000 people. At present, the county *** there are 369 medical institutions, including 25 township health centers (including central health centers), 65 branch outlets, 234 village health clinics, 36 individual medical outlets, 44 individual pharmacies. There are currently 552 active practitioners, 379 of whom graduated from formal medical and health institutions, including 103 from junior colleges, 276 from secondary schools, and 173 who only have high school education or below, and who are self-taught in medicine; there are 466 professional and technical personnel (including 50 epidemic prevention personnel and 16 maternal and child health care personnel), of whom 12 are of senior titles, 103 are of intermediate titles, and 324 are of junior titles. There are 86 laborers without titles. There are 550 people who have obtained the license to practice medicine, of which 168 are licensed as physician assistants, 231 are licensed as medical practitioners, and 151 are licensed as nurses. The city has 3.1 health personnel per 1,000 people, 1,000 people have 1.77 beds, bed utilization rate of 57.33%, an average annual outpatient 3,973,995, hospitalized patients reached 66,878, discharged an average hospitalization costs of 2,361.79 yuan, while the county has 1.6 health personnel per 1,000 people, 1,000 people have 0.44 beds, beds, beds, beds, utilization rate of 30.03%, an average of 15,933 outpatient visits a year. 15,933 outpatient visits, hospitalized patients amounted to 303, discharged from the hospital average hospitalization costs of 534 yuan.
Two, the main problems
In recent years, the county party committee, the county government and health administrative departments to conscientiously implement the Chinese, provincial and municipal guidelines on rural health care, the implementation of the "health project" and the health of poverty alleviation, to take a series of effective measures, and to mobilize funds, the county main Infrastructure construction of medical institutions has made initial improvements, rural health system reform has achieved certain results, the county health care work has been a great development, the people's medical environment and health level has improved. However, on the whole, the current development of rural medical and health work is still very unbalanced, and there is still a big gap with the people's growing health needs. The survey shows that the main reason for the development of health care in our county:
1, infrastructure and medical equipment is simple. The county still has 32% of the township health center infrastructure backward, there are eight township health center office building or dangerous, has not really solved the problem of "nothing three supporting", there is an urgent need to build (renovation) housing 4500 square meters. Serious shortage of medical equipment, the existing basic medical equipment accounted for an average of only 45% of the basic requirements of the national regulations, even if the existing equipment is also configured in the 1960s and 1970s, aging, lagging behind in functionality, part of the equipment has been more than the stipulated period of use for many years. The diagnosis of medical personnel in some medical institutions is still the "old three" (stethoscope, thermometer, blood pressure meter), medical equipment is slow to update, and the equipment of the village health office is even more impossible to talk about. Basic office equipment, each township health center in addition to several sets of desks and chairs and a telephone, other office facilities are almost non-existent. Lack of necessary diagnostic and examination equipment and the necessary office conditions, many diagnostic tests can only be used in traditional Chinese medicine, "four diagnostic method", resulting in hospitals can not expand the scope of services for the people, can not improve the quality of diagnosis and treatment.
2, townships, villages, health organizations are not reasonable configuration, uneven development. The survey shows that in the mountain people rare places, there is a serious lack of medical phenomenon, remote mountainous areas of the village health room coverage is very low, the overall layout is unreasonable. Sixteen per cent of administrative villages do not have a village health office, and even where there is a village health office, the service area is too large, with an average service radius of more than 15 kilometers, and the furthest service radius of a village health office is 35 kilometers; 9 per cent of the village health offices, 7 per cent of the individual clinics, and 11 per cent of the individual pharmacies are located in market towns. Medical units in market towns are too densely populated and do not really play their respective functional roles. To artemisia ping township, for example, in addition to the central health center and under the clinic, there are another 5 individual clinics, village health room 4, individual pharmacy 5, veterinary station 2, family planning service station 1, in a township with 19 medical units, the limited health resources are concentrated in the township. Veterinary stations, family planning service stations, individual clinics and pharmacies are unauthorized expansion of the scope of practice, they coexist with the main medical units, business is not enough to compete for limited sources of disease, not conducive to the healthy development of rural health.
3, the lack of health technical personnel. First, the educational level of the staff is low, according to the national minimum requirements for health personnel education, undergraduate and above should reach more than 10%, college education should account for more than 30%, secondary education should reach more than 60%. The survey shows that none of the doctors in our county has the first degree of bachelor's degree, only 18.6% of them have obtained college degree, 50% of them have secondary school degree, and 31.3% of them have no medical degree and only high school or lower education level. Secondly, the age structure of professional and technical personnel is aging, and the reserve force is not only insufficient, but also out of joint. From the age of the surveyed township health personnel, personnel under 30 years old accounted for 21%, between 30 and 40 years old accounted for 33%, and personnel over 40 years old accounted for 43%. Like Shuangqiao Center Health Hospital in the county township health hospitals, belongs to the more effective hospitals, mainly rely on the higher level of medical technology to attract patients from the surrounding townships, while at present there are 15% of the main backbone of the main business doctors are close to retirement. The first echelon of young and middle-aged professionals and technicians have uneven levels of medical skills, resulting in a lack of successors in rural medical and health work. Thirdly, there is a lack of highly skilled and specialized professional and technical discipline leaders. In terms of the technical titles of professionals, those with senior titles account for only 2.5%, which is still a big gap from the requirement of meeting or exceeding 10%, while junior titles account for 69.5%, and there are too many laborers, accounting for 15.6% of the total number of people, exceeding the requirement of 10% as stipulated by the state. The structure of practitioners is disproportionate, and the technical level of professionals does not correspond to their titles, with high titles and low levels. Fourthly, the technical force at the village level is even worse. The county has 274 rural doctors, with secondary education 39 people, accounting for only 14.2%, no education up to 85.6%, with the qualification of practicing physician assistant only 7 people, accounting for only 2.5%. In some places, the barefoot doctors of the 1960s are still serving the villagers with extremely simple medical facilities, and there is a great hidden danger of medical safety. Fifth, the mechanism for training talents is not in place. As a result of the reform of medical institutions, health personnel rely on self-propelled self-feeding, better-run hospitals can only maintain the status quo, poor subsistence is a problem. The health system has no talent training program, but also no economic investment, want to go out to study for further education of personnel, not pay wages, no economic income, unable to maintain a normal life, resulting in the medical and technical team of education and technical level overall is not high. In recent years, the county went out to study and training of only 2%, further study only 3% of the people, the vast majority of health personnel is still the original level of education when graduating from school. Very few hospitals spend blood money to train the talent can not be retained, some technical backbone has also jumped into the conditions of good hospitals and townships birth control service station. Regular medical school graduates of universities and junior colleges can not be sent in, and the students can not stay in.
4, farmers due to disease, poverty, the problem of poverty is more prominent. Through the six townships survey shows that in the total population of 86,944 people, there are 5,255 poor households, 17,472 people, of which 2,622 households due to poverty, return to poverty due to disease, accounting for 49.8% of the total number of poor households; due to poverty, return to poverty due to disease, the number of 8,725 people, accounting for 49.9% of the total number of poor, accounting for 10% of the total population. The causes of poverty due to illness and the return to poverty are: firstly, the transportation is inconvenient, there is a lack of medicine, and farmers have to travel too far to seek medical treatment. Secondly, the hospitals are poorly equipped, the level of medical care and the quality of service are low, and some common minor illnesses cannot be completely diagnosed and cured locally, which invariably increases the cost of treatment for the patients. Thirdly, the cost of treatment is too high, which is now 65% higher than before the reform of medical institutions. Through the survey, some medical points of treatment costs are too high, the average price of each prescription is higher than the actual price of more than 2 yuan, and there is the behavior of prescribing a large number of prescriptions, in order to pursue the benefits of the doctor is to look at the money to cure the patient, the patient to take as much money as the amount of money on the prescription of the drug. Fourth, due to the disability and injury caused by migrant workers, the loss of labor capacity and the wife's separation of the family due to the treatment of poverty accounted for 16% and 6%, an average of about 2 - 3 people per village per year due to migrant workers disability (death) caused by the poverty of the farming households to poverty, return to poverty. Fifth, because of economic weakness, no money in time for medical treatment, resulting in a number of places, "small illnesses endure, big illnesses suffer, serious illnesses only to the hospital to carry the phenomenon of".
5, townships, villages, prevention and protection network system is not sound. First, the prevention of insufficient staffing. According to national standards, the prevention and protection personnel shall not be less than 20% of the total number of health professionals and technicians. And my county, townships and townships at the level of prevention and protection personnel accounted for only 14.1% of the total number of professional and technical personnel. The village level only epidemic prevention personnel, and generally no maternal and child health care workers, prevention and protection team is not only unsound, and the bottom of the net is very large loopholes; Secondly, the cadres and masses do not have enough knowledge. Many people and even cadres, the ideological awareness of the existence of heavy epidemic prevention, light maternal and child, heavy treatment, light prevention of the concept, so that the village level of the new law of delivery, women's disease census and universal treatment, children and maternal system management is difficult to get due to the implementation. Although the village level is equipped with epidemic prevention personnel, but these personnel are older, aging knowledge, to the new immunization program, vaccination methods to accept slower, the knowledge needs to be updated, the business needs to be rotated training; Third, the implementation of the remuneration is not in place. The salary of township-level preventive and protective personnel is too low, regardless of the size of the township, how many years they have worked, and how effective their work has been, they can only receive a fixed salary of 300 yuan per month, and there are no office funds. It is even more difficult to implement the remuneration of village-level preventive and protective staff. In the six townships surveyed, only one township implemented remuneration for village-level preventive and epidemiological staff, accounting for only 16% of the total, and the work of maternal and child health care is characterized by a lack of personnel, funding, remuneration, and business income. Children and maternal systematic management can not be implemented, epidemic prevention work only stays in the six times a year on the vaccine cold chain operation.
6, health centers are struggling to operate. Township health centers have a weak foundation, poor equipment, low technical force, poor quality of service, business income shrinks year by year, running hard. Investigated six township health centers, before 2002, operating losses, indebtedness running township health centers have 4, accounting for 67%, coupled with this year's SARS inputs, basically are indebted to operate, running unsustainable, seriously weakening the public **** health services. Due to the lack of operating funds, so that health education, health personnel training, health knowledge propaganda and popularization of a large number of public **** health work can not be completed.
7, insufficient investment, the staff thought difficult to stabilize. My county from 97 years after the implementation of financial funding for health services budget of 2.3 million yuan per year, allocated to the subsidy in addition to pay for health administrative organs, women and children epidemic prevention unit headcount funding, the rest can only pay for epidemic prevention, women and children cadres salary of 52.1%, 80% of the salary of retirees. Prevention and protection of women and children specialists have a large workload, specific tasks, but do not receive due labor compensation. Retirees from time to time to petition, always think that health workers retired different from other industries, the treatment of 20% lower. Coupled with the on-the-job workers involved in the distribution of factors of production, some due to different positions, limited technical staff, monthly income of only a few dozen dollars, the heart of the gap is very large. The county's health workers pension co-ordination, medical insurance has not participated in the old age is not guaranteed, sick and no medical insurance. Employee ideological mood, want to resign, want to jump ship phenomenon is common. According to incomplete statistics, the existing 47 people without pay, apply for the opening of a pharmacy, veterinary station of 10 people, transferred to the birth control service station of 18 people, the health workforce is difficult to stabilize.
8, health supervision system is not smooth, the pharmaceutical market confusion. With the reform of the market economic system, our county to the main medical mainly, individual as a supplement to the pattern of the basic formation of the people's access to health care to buy medicines has been convenient, but there are many problems, urgently need to be standardized. From our survey of the townships: First, over the scope of practice is more common, the veterinary station to sell human medicine, family planning service station to collect the hospitalized patients outside the service station, individual pharmacies please hall doctor, to carry out diagnostic and therapeutic activities, individual clinics are engaged in the diagnosis and treatment of difficult and miscellaneous diseases; Second, the prescription is a large, billing commission, drug inflated pricing, aggravate the burden on the patient; Third, the phenomenon of unlicensed operation of food, public **** place is more prominent, expired The problem of spoilage, poor sterilization is particularly obvious; Fourth, infectious diseases, endemic diseases, occupational diseases, serious hazards, poor monitoring.
Three, to strengthen the rural health work of the main ideas and suggestions
In order to further strengthen the county's rural health work, improve rural health care backwardness, and strive to improve the quality and level of health work, in view of the above problems, we recommend:
1, grasp the leadership, and strengthen the ideological understanding. To build Ziyang into a selenium-rich ecological and economic powerhouse, we must put the health work for the people's life safety and health, for the sustained and stable economic and social development of the basic security role in the birth control policy, education, the foundation of the same status to. Party committees and governments at all levels should realize the goal of a moderately prosperous society, improve the quality of life of the height of the rural health work effectively.
2, grasp the carrier, deepen institutional reform. Township health center is the hub of the rural health service network, is organized by the government social welfare units. It is necessary to strengthen infrastructure construction and deepen institutional reform. First, to develop the county township health center construction overall planning, clear functions, classification guidance, scientific positioning, construction scale should be in line with the regional township. Second, in accordance with the actual allocation of regional health resources, what is missing to make up for the principle of purchasing and updating the necessary diagnostic, testing equipment. Such as X-ray machines, electrocardiograms, ultrasound, gastric lavage machine, etc., to create conditions for clinical diagnosis of diseases. Third, to deepen the personnel system reform. The president of the implementation of the term of office target system, professional and technical personnel regardless of administrative boundaries of the appointment system, logistics personnel to implement the contract system, the county institutions to implement the post system; key professions and shortage of technical personnel to formulate preferential policies, in accordance with the requirements of the market system, so that the talent to come in, stay.
3, grasp the prevention and protection, improve network construction. The village health office is responsible for the health administrative department given the task of preventive health care, provide primary diagnosis and treatment of common injuries and illnesses, is the first level of health services for the masses, is to carry out the work of prevention and protection of the position and rely on. Reasonable standards for the construction of village health offices and access conditions should be formulated as soon as possible. Practical and feasible preferential policies should be formulated to attract and encourage students from universities and colleges specializing in health to work in rural health institutions. Existing village doctors should be trained and managed on a rotational basis; village health offices built in market towns should be immediately abolished or transferred to villages without village health offices. The management system of village doctors in townships should be implemented, and the construction of the three-tiered prevention and protection network team should be strengthened, and the remuneration of prevention and protection officers should be realized.
4, grasp measures to strengthen support. To the health of poverty alleviation as an important part of the county's poverty alleviation work, and effectively strengthen the health of agricultural support. First, county-level medical institutions to support the work of a township health center every year. The second is to continue to implement the "city doctors in the promotion of higher titles before the rural areas to serve a cumulative one-year system. Third, the county village departments to make the health of poverty alleviation as an important part of the work of the village, the rural health construction and civilization of the new village construction organically combined.
5, grasp the team, improve the quality of talent. First, we must rectify the rural health talent team, the implementation of talent policy. Health system professional and technical personnel, the existing on-the-job collective workers more than 110 people, they are distributed in the grass-roots health system units, most of which are the backbone of the business, from the overall situation of stabilizing the health team, the implementation of the spirit of the purple hair (1997) No. 10 document, the township health system for more than 15 years of work, through the Unified Examination to achieve the level of physician or above the status of the collective of the professional and technical personnel, meet the conditions can be Recruitment as official medical personnel, the implementation of relevant treatment. Secondly, a sound system of continuing education should be established. Increase the rural medical and health personnel further training, training efforts, to combine academic education and job rank and title promotion, so that they gradually achieve what title has a corresponding level of medical care.
6, grasp the supervision, increase law enforcement. Streamline the supervision system, increase health law enforcement. According to the State Council "on accelerating the work of rural health guidance," the spirit of the requirements of government departments at all levels to establish and improve the health supervision system. Suggested in our county to set up health supervision, according to the five hundred thousandths of a full complement of supervisory personnel.
7, grasp the investment, improve the overall level. First, the health administration to seize the opportunity to seize the opportunity to fight for China and the province of the poor county policy tilt and financial support for projects to further improve infrastructure, diagnostic and treatment equipment, office conditions, and strive to improve the quality of service. Second, in accordance with the "Provincial Party Committee, the provincial government to implement the implementation of the views of the health sector to strive to increase investment year by year. Third, the competent health administrative department to arrange certain funds for medical and health units for personnel training, and constantly improve the overall medical level of professional and technical personnel.
8, grasp the reform, to solve the difficulties of farmers in access to health care. First, optimize the layout of rural health resources, the establishment of a public sector-led, multiple forms of ownership **** with the development of rural health service network. Second, vigorously promote the "health project". Counties, townships (towns) and villages are responsible for the implementation of the target responsibility system of management, from the source to give attention and support. Third, to start as soon as possible to establish a new type of rural cooperative medical system based on the coordination of major diseases, and effectively solve the problem of farmers due to disease, poverty, poverty. Fourth, vigorously carry out patriotic health campaigns. Grasp a number of typical, drive a side of farmers to grasp the water and toilet and stove as the focus of the comprehensive improvement of rural environmental health. Strengthen publicity efforts, regularly organize medical and health activities to the countryside, to poor medical conditions, endemic and infectious diseases are more prominent in the local publicity and popularization of health knowledge, to strengthen health education, so that farmers form good hygiene habits, and improve the public's health awareness.
In short, rural health care is directly related to the health of farmers and the development of the countryside, and the strengthening of rural health care is not only a social and economic issue, but also a major political issue, and the solution to this problem is very urgent. Please the government can be on the rural disease co-ordination and "health project" and the reform of rural medical institutions first pilot, and gradually pushed out, so as to promote the county's rural health work and farmers' health level has a big improvement, in order to accelerate the selenium-rich ecological and economic construction of strong county to make a contribution
.