(County-based)
1. General Goals
(1) Maternal mortality rate: decrease by 1/4 from 2001 (below 80/100,000)
(2) Neonatal tetanus incidence rate: control below 1 per thousand
(3) Hospitalized delivery rate for pregnant and lactating mothers: more than 50%
(4) High-risk maternal hospital delivery rate: more than 95%
(5) Monitoring of maternal deaths, children under 5 and birth defects Maternal hospitalization and delivery rate: over 95%
(5) Monitoring of maternal deaths, monitoring of children under the age of 5, and monitoring of birth defects.
2, supportive goals
(1) maternal prenatal checkup coverage: ≥90%
(2) high-risk maternal screening and management rate: more than 70%
(3) sterilized delivery rate: ≥98%
(4) county-level health care institutions, townships (districts) health centers, the obstetrics department "three basic" examination pass rate: more than 95%
(5) to monitor maternal mortality monitoring and monitoring of children under 5 years old and birth defects. (4) county-level health care institutions, townships (districts) health centers obstetrics "three basic" examination pass rate: ≥ 98%
(5) health education for women of childbearing age knowledge rate: >85%
The second, the scope of the project and the time to implement
(a) the project covers the entire county all the townships (districts), villages.
(ii) Maternal deaths are monitored throughout the county, and the monitoring points for the deaths of children under the age of five are: Sangmu Township, Wenshui Township and Minhua Township. Birth defects monitoring points are: the county people's hospital, the county hospital of traditional Chinese medicine, the county birth control maternal and child health center.
(C) project implementation time: December 2005 - December 2006
Three, project tasks
The overall task of the project: personnel training; rural maternal hospital delivery assistance; establish and improve maternal emergency "green channels
The overall tasks of the project are: personnel training; rural maternal hospital delivery assistance; establish and improve the maternal emergency "green channel" and "emergency rescue center", health education, supervision and guidance; township-level health centers obstetrics department equipped with basic equipment to consolidate and create the results of the baby-friendly hospitals, and actively create a baby-friendly county.
Four, project measures
This phase of the project work in the last cycle of work on the basis of further intensification of efforts.
(A) project management
1, adjusted and enriched the "reduction and elimination" project coordination leading group, give full play to the coordination, organization and management functions, responsible for the project implementation of the whole process of leadership.
2, the County Health Bureau to adjust and enrich the project technical steering group and supervisory group to strengthen project management and business guidance.
3, the implementation of the target management responsibility system. The county people's government and the county to reduce and eliminate the project coordination leading group members, township (district) people's government signed a target responsibility, the township (district) according to the county "to reduce and eliminate" project implementation program, combined with the actual township (district), to formulate a specific implementation plan, signing a letter of responsibility at each level, will be the project work tasks are effectively implemented to the grass-roots level.
(2) personnel training
1, management training: (each training to have notice, training records, sign-in book and other information)
(1) Responsible departments: the county health bureau is the main, the county women's and children's working committee with.
(2) training object and content
①Administrative staff training: training object for the county, township (district) administrative leadership cadres, the organization and implementation of the project related to the work of the department in charge. Training content for the purpose and significance of the project, the responsibilities of the relevant departments, project implementation and funding management, project supervision and coordination.
② health care institutions training: training for county health care institutions and staff. Training content for the purpose and significance of the project, project implementation and implementation of unit responsibilities and management, maternal emergency system set up and operation.
③Village cadres training: the training target for village branch secretary, director, women's director. The content of the training is the purpose and significance of the project, the duties of village cadres, health education methods, the establishment and operation of the village maternal operation emergency "green life channel" support system.
2, business training: the county health bureau organization, each training has training content and curriculum, scripts and participants in the training roster and examination results.
(1) county-level teacher training. The training content includes: the purpose of the project training requirements, training methods, the development of training programs; maternal health care, obstetrics critical care and referral; relevant health technology service standards, obstetrics commonly used technical operating procedures and emergency equipment operating specifications, the management and use of equipment and so on.
(2) county-level health care institutions, townships (districts) health hospitals midwifery training: county-level health care institutions and the center of townships (districts) health hospitals midwifery personnel focus on training obstetric first aid basic knowledge, skills and technical specifications, in order to improve the ability of first aid obstetrics; general townships (districts) health hospitals midwifery personnel focus on the training of normal birth processing, the basic skills of common obstetric first aid in the process of referral to basic First aid skills. The training materials are based on the county, township and village level teaching materials and question banks of the "Reduction and Elimination" program.
(3) village doctors, village midwives, health workers training: focus on training maternal system health management, maternal risk identification and management, postpartum visits, breastfeeding and infant nutrition guidance, health education methods. The midwives' functions have been transformed so that they can do a better job of publicizing and mobilizing pregnant women (especially high-risk pregnant women) to give birth in hospitals.
3. Time schedule
The various types of training at the county and township levels will be completed in two phases, with operational training completed in early April 2006 and administrative training completed by June 30, 2006, respectively. During the implementation of the project, intensive training will be conducted in due course to address problems and deficiencies in management and obstetrics clinical and maternal and child health services.
(C) project supervision
1, sent experts squatting supervision
Expert candidate: by the county health bureau to coordinate the provincial and municipal health departments (bureaus) to send with middle and senior titles and certain clinical and management experience in maternal and child health care, obstetrics and clinical backbone of the business as a special sent to the county experts.
2, hierarchical supervision
(1) the county of the project leading group office is responsible for project management and business supervision, according to the principle of hierarchical supervision, in the implementation of the project period, county supervision from time to time, the county maternal and child health care station to implement the project piece of the responsibility system, covering all the townships (towns, districts) and administrative villages; townships (districts) health hospitals should also be divided into pieces of the package to guide the work of the village guidance, guidance to cover all the administrative villages, and the work of the county health department. The work should cover all administrative villages.
(2) Supervision content
①Project organization and management. Township (district) government (management committee) and the relevant departments of the organization and leadership, coordination and project planning, implementation of matching funds, project data collection and collation;
② personnel training, health education and publicity;
③ county-level maternal emergency center operation, township health centers midwifery technical services and high-risk pregnancy and childbirth referral system operation, all levels of health care institutions, obstetrics standardized management;
4) Management and use of funds for maternal hospitalization and delivery assistance, and price-limiting charges for flat birth hospitalization and delivery at county and township levels.
(3) Supervision requirements
①Supervision and guidance throughout the implementation of the project, to grasp the operation of the project implementation unit;
②Help grass-roots units to improve the implementation of the project's capacity and quality of work;
③Help grass-roots to solve the difficulties and problems encountered in the process of implementation of the project;
④Deep into the countryside and farming households to understand the situation.
⑤Supervision records, each supervision fill out the project supervision records, in duplicate, signed by the supervised unit head, a copy of the supervised unit, a copy of the supervised unit to stay, a copy of the report to the Office of Consumer Protection Programs (Department of Health) for inspection.
(D) baby-friendly hospitals (health centers)
Based on the work of the "Reduce and Eliminate" project (continuation of the period), continue to consolidate the results of the baby-friendly hospitals (health centers) to carry out the creation of "baby-friendly county" activities. County People's Hospital, the county hospital to grasp the lot of perinatal health care, Tucheng, Liangcun, Wenshui, Sangmu, Erlang, Ma Lin, Dapo, Chengzhai, Tongmin, Yong'an Hospital to strengthen the construction of obstetrics and quality of service at the same time, and actively promote the development of maternal and child health care in rural areas, Xi wine, Guandian, Zhaiba three townships of the center of the township health centers and other townships with conditions of the township hospitals to actively create a baby-friendly health centers.
(V) Maternal hospital delivery
Promoting maternal hospital delivery is the top priority of this phase of the project.
1, the implementation of hospital delivery price limit
In order to make rural pregnant women can receive hospital delivery, county-level health care institutions and townships (districts) health centers to implement hospital delivery price limit, flat delivery costs. The price limit object is: the county rural household pregnant women (urban laid-off workers, special hardship households with the relevant departments issued by the relevant certificates, documents can enter the project management).
(1) the county-level medical institutions hospital delivery flat birth limit of 300 yuan, township, township health centers 200 yuan;
(2) county-level medical institutions cesarean section limit of 1,500 yuan, township health centers 1,000 yuan;
(3) the implementation of the project units to be the limit of the price of the price of the situation is announced on a public list or through the media publicized limit of the charges.
2, to carry out inpatient delivery assistance
(1) maternal inpatient delivery assistance object: all in the city and county health bureau issued by the "maternal and child health care technical services license" and "medical institutions license" county Mothers with family planning documents who are hospitalized in healthcare institutions at the county, township and township levels and who have given birth to women with rural household registration, urban special hardship cases, or laid-off workers in the county. For those who give birth to a baby in a healthcare facility without a family planning certificate, the healthcare facility must give timely feedback to the local family planning department and deal with them according to the law.
(2) the standard of aid: hospital delivery aid funds according to each pregnant woman flat delivery aid 150 yuan, 250 yuan per case of difficult labor aid, cesarean section (with medical indications need special rescue) and obstetrics serious complications per case of aid 500 yuan (here the so-called difficult labor for: ① forceps delivery; ② transverse breech delivery; ③ prolonged labor needs to be dealt with; ④ haemorrhage; ⑤ intrauterine distress of fetus; ⑥ obstetric injury needs to be dealt with; ⑦ placental damage), the birth canal, and the delivery of the baby. (6) birth canal injury to be treated; (7) placental adhesions; (8) lack of uterine contractions, etc.).
(3) the poverty relief and remission procedures in accordance with the "Ministry of Health, Department of Basic Women's on the "Reduction and Elimination" project of poor pregnant women in hospital delivery relief fund operation program" requirements, combined with the actual development of the county's "Xishui County, reduction and elimination of the project of maternal inpatient delivery relief fund operation program The program was developed in accordance with the requirements of the county's actual "Xishui County maternal hospitalization assistance fund operation program".
(4) townships (districts) should be audited poor maternal aid objects, and after 7 days of no reaction to the list, do a good job of publicity and mobilization of hospital delivery, quarterly to the county elimination of the project office (Health Bureau) to submit a "poor maternal hospital delivery relief funds application form", after the validation of the implementation of the maternal hospital delivery of poverty relief measures.
3, the implementation of high-risk maternal hospital delivery transfer subsidies
Village doctors, health workers, midwives escorting a high-risk pregnant women to the health center and county-level health care institutions to give birth to a lost time subsidies, the subsidy of 30 yuan, the delivery unit advances to the County Office of the Cancer Reduction and Elimination Project (Health Bureau) to the quarterly accounts.
4, county-level health care institutions, townships (districts) health centers to strengthen the quality of obstetrics management, rational use of medication, to avoid the abuse of antibiotics, and do everything possible to reduce medical costs, improve the quality of medical services, reduce the economic burden of maternity hospital delivery.
(F) Green Channel of Life
1. Strengthen the construction of county-level maternal emergency centers. Improve the rules and regulations, improve first aid facilities, strengthen skills training, improve the level of treatment, and seriously do a good job of critical maternal and neonatal emergency work and maternal transportation and treatment. Township (district) health centers should also strengthen the construction of obstetrics departments, standardize operational skills, and strictly implement the referral indications for high-risk pregnant women. Rural doctors and midwives should do a good job of maternal health services, improve the ability to identify high-risk pregnant women, timely transfer and escort high-risk pregnant women, the formation of up and down through the maternal emergency "green life channel".
2, the establishment and improvement of maternal transportation support system. Township (district) government (management committee) and village committees should attach great importance to maternal transport work, give full play to the skills of the township and village maternal transport team, organization and coordination of the relevant departments (personnel), the establishment of townships and villages at the two levels of the "maternal hospital delivery transport" organization, timely transport of pregnant women to hospitals or health centers for delivery and treatment.
3. Improving conditions for hospital delivery, 80% of township health centers have reached the "Guizhou Province Township Health Center Obstetrics Review Standards," health care institutions and health centers should standardize the setting of mother and baby rooms and delivery areas, and provide convenience for pregnant women and their families to eat, and maternity wards and mother and baby rooms have warming facilities, so as to create a safe, hygienic, warm, and comfortable environment for pregnant women to have their babies in hospitals.
(VII) Health Education
The county's Women and Children's Working Committee and the health sector work closely together to carry out comprehensive and in-depth health education and publicity, and vigorously create a social atmosphere of "caring for the health of mothers and children".
1, in the county cable TV, townships (districts) relay station, radio station free broadcast of maternal and child health science and knowledge.
2. Women's cadres and medical personnel are organized to go into villages and households to carry out health education campaigns "with women as the core and the family as the best place", and to promote and educate pregnant women and mothers on health care during pregnancy and childbirth, safe delivery and other health care knowledge.
3, the county health care institutions, townships (districts) health centers and village health clinics to run a good health education health columns, with the Women and Children's Working Committee to carry out a variety of forms of maternal and child health care publicity and consultation activities.
4, the timely distribution and posting of provincial and municipal production and dissemination of the "drop elimination" program and eugenics posters, folders to be distributed to pregnant women at home. The townships should also make leaflets and slogans according to local conditions, and medical institutions should issue open letters to pregnant women, use the inpatient health education guidance form, and vigorously publicize the "hospital delivery, maternal and child safety" maternal and child health science and knowledge, and publicize the implementation of the county's "reduction and elimination" project, the implementation of the "reduction and elimination" program. The county's implementation of the "reduction of consumption" project, the implementation of hospital delivery charges and medical assistance policies.
(H) information management
County elimination project office (Health Bureau), township project working group (health hospitals) and county-level project implementation units, we must pay attention to the jurisdiction of this unit, the project-related information management, a clear person is responsible for reflecting the project work of the information, such as the project responsibility statement, implementation plan, meeting (regular meeting) records, supervision form, training files and rosters, Health education, publicity and consulting activities, typical examples, vouchers and documents of financial expenditure and other original materials should be carefully collected, organized, archived management and reported in accordance with the regulations.
Fifth, the use of project funds and arrangements
(a) the use of funds
1, the central funds
2006 elimination of the project central financial transfer funds *** counted 1,006,850,000 yuan, mainly used for maternal hospitalization assistance, personnel training, equipment, and health education, supervision, and maternal and child health monitoring.
(1) health education: 10,000 yuan, managed by the county women and children working committee.
(2) Personnel training: 10,000 yuan, managed by the REDD Project Office. County-level training: 2,928, township-level training: 32 yuan per village subsidized township health centers according to the number of administrative villages, 24 townships **** counted 7,072 yuan.
(3) equipped with equipment: 30,000 yuan, by the County Decline and Eliminate Project Office according to the higher level of the designated equipment name to report the equipment plan, by the Provincial Finance, the Provincial Department of Health unified bidding and procurement.
(4) Hospital delivery assistance: 956,850 yuan, managed by the Reduction and Elimination Project Office. According to the number of live births per case (the number at the end of 04) x 150 yuan budget for each township aid.
2. Project matching funds
Mainly for project information management and project supervision.
(2) Funding and equipment management
1, in strict accordance with the national and provincial health department, the financial department of the implementation of the provisions of the management of special funds to strengthen the management of project funds, improve the efficiency of the use of funds.
2, the project funds for the implementation of closed operation (running on the books), poverty relief relief costs and the cost of lost wages subsidies by the health care institutions to bring together to obtain poverty relief relief for hospital delivery of maternal or escort handprints and signature of the relevant basis for reporting to the project office.
3, the implementation of the project funds management reporting system, every two months to report a financial statement, the end of the year to report the annual financial statements. Specifically in accordance with the "Guizhou Province to reduce maternal mortality and elimination of neonatal tetanus project funds financial management methods".
4, the township health centers to establish a project maintenance registration system, the project funds must be earmarked, the county health bureau and the Finance Bureau in accordance with the relevant provisions of the use of project funds, equipment maintenance and use of verification, serious misappropriation.
5, the project is equipped with equipment from the county health bureau according to the actual needs of township health centers, health centers have a person in charge, and keep in good condition.
6, project supervision and evaluation
(a) supervision and guidance
1, accept the higher supervision and guidance 2-3 times a year. County to carry out daily work supervision, supervision 4 times a year, covering the townships (districts) and county-level project units.
2. The content of supervision and guidance mainly includes: the use of project plans and project funds; the situation of hospital delivery assistance, focusing on the benefits to the public; the effectiveness of personnel training and health education; the purchase and use of equipment; the completion of project indicators; on-site guidance and special lectures as well as the public's evaluation of the project.
(ii) Evaluation
During the project period, the county*** conducted 2 evaluations, divided into half-period and final (July and December) evaluations, which took the form of self-inspection and evaluation by townships and project units and reassessment by the evaluation team organized by the Department of Health, and the evaluations covered all townships and county-level project units.
Seven, the project organization and implementation and departmental responsibilities
(a) County
1, the county "down elimination" project leading group office responsibilities
(1) the development of the county's project implementation plan and organize the implementation of the project into the government's work agenda, the implementation of the target responsibility system management
(2) manage the entire project work, organize supervision, training, and report the progress of the project to the county government;
(3) sign a letter of responsibility with the project implementation unit, and implement the project work tasks;
(4) be responsible for the arrangement and use of project funds.
The county Women and Children's Working Committee Office is responsible for coordinating project-related departments and organizing health education and publicity as well as mobilization, escorting pregnant women to hospital delivery, etc. The county Finance Bureau is responsible for the allocation of funds and strengthening the supervision and management of the use of funds with the cooperation of the Health Bureau.
2, county-level health care institutions
(1) county health center
① comprehensive and timely grasp of the townships (districts) the progress of the project activities, collection, statistics, analysis and reporting of data on project work;
② organization of maternal deaths and neonatal tetanus case investigation and evaluation;
③ responsible for the township level personnel training, to assist in guiding the township (district) health centers to carry out village-level training;
④ sub-package responsible for the township, village maternal and child health management and service technical guidance, in the lower elimination of the Office of the project (Department of Health) arrangements to assist the project technical steering group to carry out grass-roots project supervision;
Monthly written to the county health bureau to report on the progress of the work of the project.
(2) County Emergency Center (County People's Hospital)
①According to the arrangements of the Health Bureau, improve the organization of maternal emergency care, and do a good job in the maternal emergency center;
②Assisting the REDD Project Office (Health Bureau) to do a good job of training township personnel;
③In the arrangements of the REDD Project Office (Health Bureau) to assist the project technical steering group to carry out grass-roots level Project supervision;
④ Responsible for guiding the construction of obstetrics departments and midwifery technical services in townships (districts) health centers, guiding the county's analysis of the causes of maternal and infant deaths, reviewing and improving interventions, and assisting the Family Planning Maternal and Child Health Center in guiding the grass-roots level of maternal and child health technical services.
(2) township level: township (district) project working group (health hospitals) responsibilities
1, the development of the project work plan, included in the government's work agenda, and organize the implementation of the project;
2, responsible for the training of village health personnel;
3, a sound regular work system, the township convened a meeting of the village doctors once a month, through the monthly meeting to collect the previous month's work data information
4, the county maternal and child health care stations and township health centers, in-depth guidance in the townships and villages;
5, to strengthen the hospital obstetrics construction and quality management, improve the capacity of midwifery technical services, to promote hospital births, and timely organization of emergency treatment and transfer of critically ill pregnant women;
6, strengthen maternal and child health information management, grasp the number of women of childbearing age in each village, the number of pregnant women, the number of high-risk pregnant women, the number of live births, the number of hospital deliveries and disinfection of births, maternal deaths and deaths of children under the age of five, the incidence of tetanus in newborns and the basic data of health care services in the pregnancy and childbirth, and on time collection of statistics and report to the county family planning, maternal and child health care centers.
(3) Village level
1, "village maternal hospital delivery transfer team" consists of village chief, women's director, village doctor, village chief assistant and village influential people, responsible for mobilizing the village maternal hospital delivery and high-risk maternal transfer;
2, the village health office is responsible for the village maternal and child health care work and related data. The village health office is responsible for the work of maternal and child health care in the village and the recording, collection, statistics and reporting of relevant data;
3. The village doctor should do a good job in establishing the card of the mother, maternity examination, maternity visit, high-risk identification screening and health education and mobilization of the mother to give birth in the hospital, and to find out that high-risk mothers should be reported to the village committee in time and assist in the referral;
4. For the mothers who really need to be delivered in the home, they should be carried out in strict accordance with the operation standard of sterilizing the delivery;
5, timely grasp of maternal and children under 5 years of age, death, neonatal tetanus cases, register, immediately report the township (district) health center prevention and protection team.
Eight, the relevant work requirements
(a) to further strengthen the management of the "birth medical certificate", and actively promote the increase in the rate of hospital delivery. The issuance of "birth medical certificates" for babies born outside of healthcare institutions must be supported by a certificate of delivery issued by the family midwife, who must hold a "Certificate of Competence in Midwifery Technology Examination" and must be certified by the village committee. The county health bureau and the people's governments (management committees) of each township (district) must do a good job of supervising and managing the Birth Medical Certificate. County Public Security Bureau to further strengthen the household registration management, newborn babies must be issued "birth medical certificate" before the household registration.
(ii) the continuation of the implementation of the project until the date of this program. The continuation of the project implementation unit to do a good job of project implementation work summary, develop project work plan and effective measures to ensure the normal operation of the project work.