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目的:评估上海市结核病防治体系关键要素的现状,分析大城市加强结核病防治体系的可行政策和措施。方法:以上海市7个结核病防治示范区为调查对象,采用定量和定性研究相结合的方法,应用世界卫生组织卫生系统关键因素框架进行分析。结果:示范区建立了结防领导组织体系,加大了患者减免和补助力度,建立了多层次质量考评机制;实施了整合区域卫生资源、提供综合防治服务的改革;2009年区均配置专兼职结防人员约24名;各级财政专项经费投入96.8万元,其中区级占55.6%;各示范区进一步开发了结核病管理信息系统功能,均具备痰涂片和痰培养检测能力。结论:上海市结核病防治系统在政府治理、服务提供、人力资源、经费投入、信息系统和技术等关键要素方面都取得了一定的成果,但在人力配置、经费使用和监管、信息系统建设等方面应加强政策开发,使其更加合理化和具有可持续性。
OBJECTIVE: To assess the status quo of the key elements of the Shanghai TB control system and to analyze the feasible policies and measures for strengthening the TB prevention and control system in large cities. Methods: Seven TB prevention and treatment demonstration areas in Shanghai were selected as research objects. The methods of combining quantitative and qualitative research were applied to analyze the key factors of WHO’s health system. Results: The Guiding District established a leading organization system for prevention and treatment of incontinence, increased the relief and subsidy for patients, established a multi-level quality evaluation mechanism, implemented reforms to integrate regional health resources and provide comprehensive prevention and treatment services, Anti-personnel about 24; special funds for all levels of investment 968,000 yuan, of which district level accounted for 55.6%; the demonstration zone to further develop the tuberculosis management information system functions, are equipped with sputum smear and sputum culture detection capabilities. Conclusion: Shanghai tuberculosis prevention and control system has achieved some achievements in the key elements of government governance, service provision, human resources, financial input, information system and technology. However, in terms of manpower allocation, funding use and supervision, and information system construction, Policy development should be strengthened to make it more rational and sustainable.