Responsibility assignment among institutions of maternal health care system in Beijing and Shanghai: a literature study
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摘要:
目的 比较京沪两地妇女保健组织体系各方职责明确状况的差异,明确其意义,探索对其量化评估的可行性。 方法 穷尽的方法收集2000 — 2017年上海、北京公开发布的涉及妇女保健工作的政策文件,共收集上海417份、北京232份,从中提取并量化相关信息,评价各方职责明确状况,利用Spearman相关、线性回归,分析其与孕产妇死亡率的关系。 结果 京沪两地妇女保健各方职责明确状况分别由2000年的1.8 %、9.5 % 上升为2017年的23.7 %、28.0 %,总体偏低,上海略高于北京;两地各方职责明确状况与孕产妇死亡率呈负相关。 结论 京沪两地职责明确状况呈上升趋势,促使妇保健康结果的改善,但仍需切实明确除业务条线部门以外各相关部门的职责;适宜的妇保体系应各方权责明确;本研究所探索采用的量化评价方法具备可行性和可推广性。 Abstract:Objective To compare the disparity in responsibility assignment among various functional institutions of the maternal health care (MHC) system between Beijing and Shanghai and to explore the feasibility of quantitative evaluation on the degree of well-defined responsibility assignment. Methods We systematically and extensively collected documents and materials on MHC issued by administrative agencies of Beijing and Shanghai municipality published during 2000 – 2017. Then we extracted relevant information from 649 retrieved documents (232 relevant to Beijing and 417 to Shanghai) and analyzed the information quantitatively to assess the responsibility assignment among various functional institutions of MHC system in the two municipalities. Spearman correlation and linear regression analysis were used to analyze the relationship between the degree of well-defined responsibility assignment of MHC system and maternal mortality rate (MMR). Results The relevant information-derived index for the degree of well-defined responsibility assignment of MHC system increased from 1.8% in 2000 to 23.7% in 2017 in Beijing municipality; while, the index increased from 9.5% to 28.0% in Shanghai, indicating a relatively low level for the MHC system's well-defined responsibility assignment. There was an inverse correlation between the index for well-defined responsibility assignment of MHC system and MMR in the two municipalities. Conclusion The responsibility assignment among various functional institutions of the maternal health care system was improved and the improvement facilitated maternal health care practice in Beijing and Shanghai during 2000 – 2017; but the responsibility assignment for nonmedical institutions should be well defined. The study verified the feasibility of quantitative assessment on responsibility assignment among various functional institutions of the maternal health care system. -
Key words:
- maternal health care /
- organization system /
- well-defined responsibility assignment /
- Beijing /
- Shanghai
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表 1 京沪两地妇女保健体系各部门职责明确程度(%)与孕产妇死亡率(1/10万)
2000 2001 2002 2003 2004 2005 2006 2007 2008 孕产妇死亡率 北京 9.70 11.7 15.1 15.6 15.19 15.91 7.87 16.74 18.52 上海 9.61 8.95 9.99 11.99 10.79 1.4 8.31 6.68 6.91 总体职责明确程度 北京 1.8 3.2 3.2 4.4 5.0 5.0 5.0 6.7 6.7 上海 9.5 11.0 19.8 19.8 20.5 20.5 20.5 20.5 21.2 其中:覆盖部门程度 北京 45.7 54.7 54.7 55.5 55.9 55.9 55.9 60.9 60.9 上海 65.8 71.7 72.1 72.1 72.1 72.1 72.1 72.1 72.1 部门职责清晰程度 北京 36.4 37.2 37.7 38.1 38.5 38.5 38.5 38.9 38.9 上海 43.4 44.3 44.7 44.7 46.4 46.8 46.8 46.8 48.5 部门职责可考程度 北京 1.3 2.2 2.2 3.1 3.6 3.6 3.6 4.5 4.5 上海 5.7 6.7 12.1 12.1 12.5 12.5 12.5 12.5 12.9 2009 2010 2011 2012 2013 2014 2015 2016 2017 孕产妇死亡率 北京 14.55 12.14 9.09 6.05 9.45 7.19 8.69 10.83 8.17 上海 7.08 5.30 1.04 4.27 7.74 3.39 4.16 2.53 1.01 总体职责明确程度 北京 15.7 15.7 21.1 21.1 21.1 21.1 20.4 23.7 23.7 上海 20.9 20.9 28.0 28.0 28.0 28.0 28.0 28.0 28.0 其中:覆盖部门程度 北京 60.9 60.9 66.0 66.0 66.0 66.0 70.9 70.9 70.9 上海 80.4 80.4 80.4 80.4 80.4 80.4 80.4 80.4 80.4 部门职责清晰程度 北京 38.9 38.9 41.5 41.5 41.5 41.5 41.9 47.2 57.8 上海 48.9 48.9 52.5 52.5 52.5 52.5 52.5 52.5 62.7 部门职责可考程度 北京 10.3 10.3 13.9 13.9 13.9 13.9 13.9 16.2 16.2 上海 13.4 13.4 17.9 17.9 17.9 17.9 17.9 17.9 17.9 -
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