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目的:探讨处于两套三级妇幼保健网交接点的县区级妇幼保健机构建设与规范化管理问题。方法:对海南省全部21所县区级妇幼保健机构2005年度资源与运营情况调查结果进行回顾性定量、定性比较分析。结果:基层群体妇幼保健工作大部分由县区级妇幼保健机构承担,县区级妇幼保健机构在妇幼保健工作领域具有不可替代的举足轻重作用。同时县区级妇幼保健机构面临困境:人手不足,编制达标率仅为28.57%,低于全国54.8%的水平;人员素质偏底,中专学历人员占67.13%,副高级职称人员占卫生技术人员比例的2.00%;基础建设不足,有2所保健机构未购建用房,全部租房开展业务及办公,占9.52%;基本设备欠缺,床位数达标率低,占14.29%,低于全国县级妇幼保健机构48.0%的达标率;财政补助不足,73.53%的收入来源于业务收入。由于客观条件限制及主观努力欠缺,导致基层妇幼保健工作存在诸多问题:人才培养投入不足,保健与临床结合松散,妇幼保健机构之间发展不平衡,群体保健工作力度不够,群体保健资金投入不足。结论:县区级妇幼保健机构要在困境中求生存,在逆境中求发展,就要学会夹缝生存本领。放眼全国现状,展望未来前景,研究市场经济,拓展业务范畴等是县区级妇幼保健机构的任务;立足本职工作,兼顾发展资本,扎实、稳妥、坚韧、全面、深入地发展基层妇幼保健工作,是县区级妇幼保健机构建设的前景所在。
Objective: To discuss the construction and standardized management of county-level maternity and childcare institutions at the junction of two sets of three-level maternity and child care networks. Methods: A retrospective quantitative and qualitative comparative analysis was conducted on the results of 2005 surveys of resources and operations of all maternal and child health organizations in 21 counties in Hainan Province. Results: Most of the grass-roots group maternal and child health care work is undertaken by the county-level maternity and child care agencies, and the county-level maternity and child care agencies have an irreplaceable role in the field of maternal and child health care. At the same time, county-level maternity and childcare institutions are facing difficulties: Insufficient manpower, the establishment of compliance rate is only 28.57%, which is lower than the national level of 54.8%; the quality of personnel is low, and 67.13% of the personnel with secondary qualifications account for the qualifications. 2.00% of the proportion; lack of infrastructure, 2 health care institutions did not purchase built-in housing, all rental housing to carry out business and office, accounting for 9.52%; lack of basic equipment, bed rate compliance rate is low, accounting for 14.29%, lower than the national county level Maternal and child health institutions reached the rate of 48.0%; financial subsidies were insufficient; 73.53% of the income was derived from business income. Due to the limitation of objective conditions and lack of subjective efforts, there are many problems in grass-roots MCH work: lack of investment in personnel training, loose integration of health care and clinics, unbalanced development between maternity and child care institutions, insufficient community health work, and insufficient investment in group health care. Conclusion: The county-level maternity and childcare institutions must survive in dilemma, and seek development in adversity, we must learn to seize the survival skills. Looking at the status quo in the country, looking into the future, studying the market economy, and expanding business scope are the tasks of the county-level maternity and child care organizations; based on their own work and giving full consideration to the development of capital, they will develop a solid, secure, tough, comprehensive and in-depth development of grassroots-level maternal and child health care. It is the prospect of the construction of county-level maternity and child care institutions.