国家慢性病综合防控示范区政府及多部门合作现状与机制研究
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摘要
目的了解示范区政府及多部门在组织保障、经费保障、政策保障、多部门职责和参与方面的情况,以及面临的困难和建议,为推动示范区长效机制的建设提供建议。方法于2016年11月至2017年1月,采用定量研究与定性研究相结合的方法在全国265个国家慢性病综合防控示范区开展调查。采用政府及多部门合作过程评估问卷进行调查,问卷由政府主管示范区工作的负责人填写。对265个国家级示范区按照地区分布和示范区批次进行抽样,共抽取10个国家级示范区,对其领导小组组长或副组长进行定性访谈,了解在政府及多部门合作中,各部门职责及面临的问题和建议。用SPSS 21.0软件进行确切概率法统计分析,用Nvivo 8.0软件对访谈的定性资料进行整理分析。结果共256个国家级示范区上报了信息收集表,整体应答率为97.7%。在组织保障方面,67.2%的示范区每年由示范区办公室组织召开4次及以上的联络员会议,除此之外,其他各项工作开展率均在96.0%以上,东部、中部、西部示范区差异无统计学意义(P>0.05)。经费保障方面,84.0%的示范区所在地政府按照中央投入提供了配套的项目经费;43.0%的示范区疾控机构慢性病防控工作经费占业务总经费比例小于10%。政策保障方面,97.0%以上的示范区的政府将慢性病预防控制工作列入了当地社会经济发展规划和政府重要议事日程,制定并出台了慢性病防控规划,东部、中部、西部示范区差异无统计学意义(P>0.05)。访谈结果显示,"加强顶层设计"、"加强多部门合作协调"、"提升示范区荣誉感"、"提供技术及人才支持"这四类建议被提出的频率最高。结论在示范区政府及多部门保障措施工作开展方面,政府重视程度较高,大部分示范区已建立起由政府主导,多部门共同协作的工作机制;应持续发挥政府在慢性病防控中的主导作用,同时进一步提高非卫生部门的参与积极性,重视慢性病防控长效机制的建设,落实经费、政策及人才队伍等保障,促进示范区慢性病防控工作长期有效地开展。
Objective To understand the organizational guarantee, fund guarantee and policy guarantee in the National Demonstration Areas for Comprehensive Prevention and Control of Non-Communicable Diseases(NCD demonstration areas),difficulty or suggestion, and to provide the suggestion for long term mechanism and construction of NCD demonstration areas.Methods The quantitative study combined with qualitative study was used to investigate 265 NCD demonstration areas in China from November of 2016 to January of 2017. The investigation was performed with the questionnaire assessed by multi-sectoral cooperation. The questionnaires were written by government chiefs in charge of NCD demonstration areas. According to regional distribution and the accreditation time of the NCD demonstration areas, 10 NCD demonstration areas were selected form 265 NCD demonstration areas in China. The interviews with heads of the 10 NCD demonstration areas were conducted for multi-sectoral cooperation, responsibility, problems and suggestion. SPSS 21.0 software was used for the statistical analysis of exact probability method, and Nvivo 8.0 software was utilized to analyze the qualitative data. Results The information forms of 256 NCD demonstration areas were reported. In organizational guarantee, the meetings were held by NCD demonstration area offices for 4 times every year in 67.2% of NCD demonstration areas, the development rates of other works were ≥96.0%, there were no significant differences among NCD demonstration areas from eastern part, middle part and western part(P >0.05). In fund guarantee, 84.0% of the local governments financed the NCD demonstration areas projects with the compensation from central government; but the proportion of chronic diseases control work fee in disease control budget was <10% in 43.0% of NCD demonstration areas; in policy guarantee, the chronic disease control work was listed in the important schedule and the local social and economic development plan, and the prevention and control planning for chronic diseases was formulated in 97.0% of NCD demonstration areas; there were no significant differences among NCD demonstration areas from eastern part, middle part and western part(P>0.05). The results of interviews showed that four suggestions(strengthening the top floor design, strengthening the coordination of multi-sectoral cooperation, enhancing the sense of honor in the demonstration area, providing technical and talent support) were submitted most frequently. Conclusion In most of the NCD demonstration areas, the mechanism of multi-sectoral cooperation leaded by government has been built; the government should play the important role in chronic diseases control and prevention work, and pay attention to the long term mechanism, fund, policy and talent support of chronic diseases control and prevention, improving the long term and effective development of chronic diseases control and prevention in NCD demonstration areas.
Objective To understand the organizational guarantee, fund guarantee and policy guarantee in the National Demonstration Areas for Comprehensive Prevention and Control of Non-Communicable Diseases(NCD demonstration areas),difficulty or suggestion, and to provide the suggestion for long term mechanism and construction of NCD demonstration areas.Methods The quantitative study combined with qualitative study was used to investigate 265 NCD demonstration areas in China from November of 2016 to January of 2017. The investigation was performed with the questionnaire assessed by multi-sectoral cooperation. The questionnaires were written by government chiefs in charge of NCD demonstration areas. According to regional distribution and the accreditation time of the NCD demonstration areas, 10 NCD demonstration areas were selected form 265 NCD demonstration areas in China. The interviews with heads of the 10 NCD demonstration areas were conducted for multi-sectoral cooperation, responsibility, problems and suggestion. SPSS 21.0 software was used for the statistical analysis of exact probability method, and Nvivo 8.0 software was utilized to analyze the qualitative data. Results The information forms of 256 NCD demonstration areas were reported. In organizational guarantee, the meetings were held by NCD demonstration area offices for 4 times every year in 67.2% of NCD demonstration areas, the development rates of other works were ≥96.0%, there were no significant differences among NCD demonstration areas from eastern part, middle part and western part(P >0.05). In fund guarantee, 84.0% of the local governments financed the NCD demonstration areas projects with the compensation from central government; but the proportion of chronic diseases control work fee in disease control budget was <10% in 43.0% of NCD demonstration areas; in policy guarantee, the chronic disease control work was listed in the important schedule and the local social and economic development plan, and the prevention and control planning for chronic diseases was formulated in 97.0% of NCD demonstration areas; there were no significant differences among NCD demonstration areas from eastern part, middle part and western part(P>0.05). The results of interviews showed that four suggestions(strengthening the top floor design, strengthening the coordination of multi-sectoral cooperation, enhancing the sense of honor in the demonstration area, providing technical and talent support) were submitted most frequently. Conclusion In most of the NCD demonstration areas, the mechanism of multi-sectoral cooperation leaded by government has been built; the government should play the important role in chronic diseases control and prevention work, and pay attention to the long term mechanism, fund, policy and talent support of chronic diseases control and prevention, improving the long term and effective development of chronic diseases control and prevention in NCD demonstration areas.
引文
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[11]乔良,邓颖,胥馨尹,等.四川省疾病预防控制系统慢性病防控机构基础配置现状及公平性研究[J].预防医学情报杂志,2012,28(1):26-30.
[2]任学锋,姜亚伟,邵安娜,等.社会多部门参与艾滋病防治信息需求与供应现状的评估[J].现代预防医学,2005,32(9):1224-1227.
[3]周静,罗英.建立机制多部门多渠道合力控烟[J].中国初级卫生保健,2012,26(6):51-52.
[4]张艳春,秦江梅.将健康融入所有政策视角下慢性病防控的挑战与对策——基于我国健康城市的典型调查[J].中国卫生政策研究,2014,7(1):65-69.
[5]Alcorn T.Redefining public health in New York City[J].Lancet,2012,379(9831):2037-2038.
[6]刘蒲,徐望红,付朝伟,等.纽约市慢性病防控成功经验的剖析与借鉴[J].中华预防医学杂志,2013,47(1):78-81.
[7]张春华,丁贤彬,王豫林,等.重庆市慢性病综合防控示范区建设的做法、成效与体会[J].中国慢性病预防与控制,2015,23(5):398-399.
[8]中华人民共和国中央人民政府.中共中央国务院印发《“健康中国2030”规划纲要》[EB/OL].[2017-04-07].http://www.gov.cn/zhengce/2016-10/25/content_5124174.htm.
[9]孔灵芝.关于当前我国慢性病防治工作的思考[J].中国卫生政策研究,2012,5(1):2-5.
[10]司向,尹香君,施小明.全国疾控系统慢性病预防控制人力资源现状分析[J].中华疾病控制杂志,2010,14(09):892-895.
[11]乔良,邓颖,胥馨尹,等.四川省疾病预防控制系统慢性病防控机构基础配置现状及公平性研究[J].预防医学情报杂志,2012,28(1):26-30.