湖南省卫生监督体系建设现况研究
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摘要
目的:通过对2007年湖南省各级卫生监督机构体系建设现状进行调查研究,探讨影响卫生监督体系发展的重要原因,提出政策建议,既为制订卫生监督体系建设政策提供理论依据,又为深化湖南省卫生监督体制改革、加快湖南省卫生监督体系建设提供决策参考。
方法:于2008年4～7月份,采取文献查阅、现况调查、实地调研、召开座谈会等方式,调查了湖南省省级、14个市(州)级、122个县(市、区)级卫生监督机构,以客观描述和主要因素绝对数、均数及其构成比等进行描述性统计分析,并与全国总体水平或与国家标准进行比较。
结果:截止2007年底,全省共有省、市、县三级卫生监督机构138个(含洪江区)。属公务员管理16个,全额事业单位122个,人员管理主要为事业单位编制,市级占58%,县级占91%。我省总人口约为6797万人(截至2007年底),有卫生监督员3345人,平均每万人配置卫生监督员为0.49。省级卫生监督人员中以本科学历为主,占61.25%;在市级和县级中均以专科学历构成比为最高,分别为40.79%和55.31%。省级卫生监督机构高级职称者占的比例最高,占52.5%,市级机构中以中级职称为主,占44.29%,县级机构以初级职称为主,占43.15%。年龄主要集中在26-45岁之间,其中36-45岁者最多,占总数的41-21%,25岁以下和56岁以上年龄的构成比最低,均为3.50%。省级、市级和县级医学相关专业人员所占比例分别为75%、34.25%和68.97%。2007年省、市、县拨款总额为8629.87万元,其中省级卫生监督所为381.5万元,市级卫生监督机构为2889.46万元,县级卫生监督机构为5358.91万元。省卫生监督机构无建设用地,无房屋产权;14个市州卫生监督机构目前仅郴州市和永州市拥有自主产权的办公用房,娄底市已取得了建设用地面积,其余11个市州均是借用或租用的场地进行办公,均未取得政府批复的建设用地。已批复成立的县、区卫生监督机构123家,加上新成立的屈原区、大通湖区卫生监督所共125家,目前仅5家单位具有自主产权的办公用房。2007年食品专项整治中其监督率、检测频次、食物中毒下降率比2006年分别增长18.2%和21.3%和下降了37.8%。
结论:湖南省卫生监督体系已经初步建立,但仍存在一些问题:政府投入不足,部分卫生监督机构面临困境;卫生监督机构运行的保障机制缺乏;卫生监督员队伍有待提高;卫生监督体制不顺畅,职责不明确,权与责不统一;房屋基础设施建设滞后,仪器设备落后,难以承担繁重的卫生监督任务。要解决这些问题,实现卫生监督事业的可持续发展,首先必须坚持科学发展观,从体制上解决组织体制、内部管理体制、人员体制的问题;各级政府要转变观念,强化公共卫生服务的政府职能;落实财政保障措施,加大经费投入;加强卫生监督机构基础设施建设,统一全省卫生监督机构名称;加强与其他执法部门的协调。
Objective: By the cross-sectional study on all levels of the Health Inspection and Supervision system in Hunan in 2007 and discuss the important reasons which impact it, put forward policy proposals. Both for provide a theoretical basis to the formulation of policy, and a decision-making reference to deepening structural reforms and speed up development for the system.
Methods: From April to July in 2008, take some approach such as literature search, status survey, field research, holding forums,etc, to investigate the health inspection agencies of Hunan provincial, 14 municipal(state), 122 counties(cities, districts). Use objective description, the absolute number of major factor, mean and its constitute mix, to carry out a descriptive statistical analysis, and to compare with the overall level of the country or the national standard.
Results: To the end of 2007, the province's total provincial, municipal, and county levels of health inspection agencies are 138 (including Hongjiang District). Among them, 16 belong to the civil service management, 122 are full institution, and the personnel management mainly by institutions preparation, municipal accounting for 58% and county accounting for 91%. The total population in Hunan is about 67,970,000 (as the end of 2007), there are 3,345 health supervisor among then, average per ten thousand people have 0.49 health supervisor to give service. The mainly educational background of provincial health supervisors is undergraduate which accounted for 61.25%. In the municipal and county-level, specialist qualifications are constituted in the ratio of the highest, respectively, 55.31% and 40.79%. In the provincial health supervision agency, the senior accounted for the highest proportion, accounting for 52.5%. Municipal institutions are intermediate grade-oriented, which accounting for 44.29%. Junior titles are the main body of the county-level agencies, accounting for 43.15%. Staffs mainly concentrated in the age between 26 to 45 years, of which a maximum of 36 to 45 years, accounting for 41.21% of the total number, less than 25 years old and more than 56 years old accounting for the smallest proportion, are 3.50%. Provincial, municipal and county-level medical-related professionals in the respective proportions of 75%, 34.25% and 68.97%. In 2007, provincial, municipal and county's financial allocation amounting to 86,298,700 Yuan,of which the provincial health supervision institutions' financial allocation amounting to 3,815,000 yuan, city-level health supervision institutions' financial allocation amounting to 28,894,600 yuan, and county-level's amounting to 53,589,100 yuan. The health inspection agencies of Hunan provincial have no construction land, no property rights. In all 14 municipal health supervision agencies, only Yongzhou City and Chenzhou City have their own property office space currently. Loudi City has got building area, and the remaining 11 cities are borrowed or rented for office space. In all the 123 health inspection agencies which have approved, together with the newly formed District of Quyuan, Datong Lakes, there only 5 agencies have their own property rights. Compare to 2006, in the food special rectification operation of 2007, supervision of the rate, detection of the frequency, rate of growth of food poisoning fell by 18.2% and 21.3% and a decrease of 37.8%.
Conclusions: Health Inspection and Supervision system in Hunan has been initially established, but there are still some problems: the government investment is not adequate, part of health supervision institutions facing predicament; the running of health supervision institutions lack protection mechanism; the level of health supervisors need to be improved; the health supervision system is not smooth, the responsibilities of it is not clear and have no uniform power and responsibility; the infrastructure construction of housing lags behind and the instrument and equipment is backward, so it is hardly afford to the onerous task of health supervision. To solve these problems and realize the cause of health supervision for sustainable development, first of all, we must uphold the scientific concept of development, from the system to solve the problem of organizational structure ,internal management structure and personnel structure; government at all levels must change their ideas, strengthen the government functions in public health services; implementation financial safeguards and increased funding; strengthen infrastructure construction of health supervision institutions, unite the name of the health supervision institutions in Hunan; strengthen coordination with other law enforcement agencies.
方法:于2008年4～7月份,采取文献查阅、现况调查、实地调研、召开座谈会等方式,调查了湖南省省级、14个市(州)级、122个县(市、区)级卫生监督机构,以客观描述和主要因素绝对数、均数及其构成比等进行描述性统计分析,并与全国总体水平或与国家标准进行比较。
结果:截止2007年底,全省共有省、市、县三级卫生监督机构138个(含洪江区)。属公务员管理16个,全额事业单位122个,人员管理主要为事业单位编制,市级占58%,县级占91%。我省总人口约为6797万人(截至2007年底),有卫生监督员3345人,平均每万人配置卫生监督员为0.49。省级卫生监督人员中以本科学历为主,占61.25%;在市级和县级中均以专科学历构成比为最高,分别为40.79%和55.31%。省级卫生监督机构高级职称者占的比例最高,占52.5%,市级机构中以中级职称为主,占44.29%,县级机构以初级职称为主,占43.15%。年龄主要集中在26-45岁之间,其中36-45岁者最多,占总数的41-21%,25岁以下和56岁以上年龄的构成比最低,均为3.50%。省级、市级和县级医学相关专业人员所占比例分别为75%、34.25%和68.97%。2007年省、市、县拨款总额为8629.87万元,其中省级卫生监督所为381.5万元,市级卫生监督机构为2889.46万元,县级卫生监督机构为5358.91万元。省卫生监督机构无建设用地,无房屋产权;14个市州卫生监督机构目前仅郴州市和永州市拥有自主产权的办公用房,娄底市已取得了建设用地面积,其余11个市州均是借用或租用的场地进行办公,均未取得政府批复的建设用地。已批复成立的县、区卫生监督机构123家,加上新成立的屈原区、大通湖区卫生监督所共125家,目前仅5家单位具有自主产权的办公用房。2007年食品专项整治中其监督率、检测频次、食物中毒下降率比2006年分别增长18.2%和21.3%和下降了37.8%。
结论:湖南省卫生监督体系已经初步建立,但仍存在一些问题:政府投入不足,部分卫生监督机构面临困境;卫生监督机构运行的保障机制缺乏;卫生监督员队伍有待提高;卫生监督体制不顺畅,职责不明确,权与责不统一;房屋基础设施建设滞后,仪器设备落后,难以承担繁重的卫生监督任务。要解决这些问题,实现卫生监督事业的可持续发展,首先必须坚持科学发展观,从体制上解决组织体制、内部管理体制、人员体制的问题;各级政府要转变观念,强化公共卫生服务的政府职能;落实财政保障措施,加大经费投入;加强卫生监督机构基础设施建设,统一全省卫生监督机构名称;加强与其他执法部门的协调。
Objective: By the cross-sectional study on all levels of the Health Inspection and Supervision system in Hunan in 2007 and discuss the important reasons which impact it, put forward policy proposals. Both for provide a theoretical basis to the formulation of policy, and a decision-making reference to deepening structural reforms and speed up development for the system.
Methods: From April to July in 2008, take some approach such as literature search, status survey, field research, holding forums,etc, to investigate the health inspection agencies of Hunan provincial, 14 municipal(state), 122 counties(cities, districts). Use objective description, the absolute number of major factor, mean and its constitute mix, to carry out a descriptive statistical analysis, and to compare with the overall level of the country or the national standard.
Results: To the end of 2007, the province's total provincial, municipal, and county levels of health inspection agencies are 138 (including Hongjiang District). Among them, 16 belong to the civil service management, 122 are full institution, and the personnel management mainly by institutions preparation, municipal accounting for 58% and county accounting for 91%. The total population in Hunan is about 67,970,000 (as the end of 2007), there are 3,345 health supervisor among then, average per ten thousand people have 0.49 health supervisor to give service. The mainly educational background of provincial health supervisors is undergraduate which accounted for 61.25%. In the municipal and county-level, specialist qualifications are constituted in the ratio of the highest, respectively, 55.31% and 40.79%. In the provincial health supervision agency, the senior accounted for the highest proportion, accounting for 52.5%. Municipal institutions are intermediate grade-oriented, which accounting for 44.29%. Junior titles are the main body of the county-level agencies, accounting for 43.15%. Staffs mainly concentrated in the age between 26 to 45 years, of which a maximum of 36 to 45 years, accounting for 41.21% of the total number, less than 25 years old and more than 56 years old accounting for the smallest proportion, are 3.50%. Provincial, municipal and county-level medical-related professionals in the respective proportions of 75%, 34.25% and 68.97%. In 2007, provincial, municipal and county's financial allocation amounting to 86,298,700 Yuan,of which the provincial health supervision institutions' financial allocation amounting to 3,815,000 yuan, city-level health supervision institutions' financial allocation amounting to 28,894,600 yuan, and county-level's amounting to 53,589,100 yuan. The health inspection agencies of Hunan provincial have no construction land, no property rights. In all 14 municipal health supervision agencies, only Yongzhou City and Chenzhou City have their own property office space currently. Loudi City has got building area, and the remaining 11 cities are borrowed or rented for office space. In all the 123 health inspection agencies which have approved, together with the newly formed District of Quyuan, Datong Lakes, there only 5 agencies have their own property rights. Compare to 2006, in the food special rectification operation of 2007, supervision of the rate, detection of the frequency, rate of growth of food poisoning fell by 18.2% and 21.3% and a decrease of 37.8%.
Conclusions: Health Inspection and Supervision system in Hunan has been initially established, but there are still some problems: the government investment is not adequate, part of health supervision institutions facing predicament; the running of health supervision institutions lack protection mechanism; the level of health supervisors need to be improved; the health supervision system is not smooth, the responsibilities of it is not clear and have no uniform power and responsibility; the infrastructure construction of housing lags behind and the instrument and equipment is backward, so it is hardly afford to the onerous task of health supervision. To solve these problems and realize the cause of health supervision for sustainable development, first of all, we must uphold the scientific concept of development, from the system to solve the problem of organizational structure ,internal management structure and personnel structure; government at all levels must change their ideas, strengthen the government functions in public health services; implementation financial safeguards and increased funding; strengthen infrastructure construction of health supervision institutions, unite the name of the health supervision institutions in Hunan; strengthen coordination with other law enforcement agencies.
引文
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[4]卫生部卫生监督局,卫生监督体系三年建设情况评价研究报告,人民卫生出版社,2008
[5]卫生部卫生监督局,卫生监督体系建设与发展研究报告,人民卫生出版社,2008
[6]刘国湘,2007年湖南省经济和社会事业发展情况新闻发布会发布辞,湖南省统计信息网,2008
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[1]陈晓明,山东省卫生监督资源配置现况研究
[2]卫生部,卫生监督体系三年建设情况评价研究报告,人民卫生出版社
[3]卫生部,卫生监督体系建设与发展研究报告,人民卫生出版社
[4]当代中国卫生事业大事记编写组,当代中国卫生事业大事记,人民卫生出版社,1993
[5]新中国预防医学历史经验编委会,新中国预防医学历史经验,人民卫生出版社,1991
[6]关于城镇医药卫生体制改革指导意见,国办发(2000)16号
[7]杨健,卫生监督体制改革现状分析[J].中国卫生监督杂志。2004,11(6):376-378
[8]国家发改委,卫生部,《关于突发公共卫生事件医疗救治体系建设规划实施意见》,发改社会[2003]1438号.2003,10,10.
[9]卫生部卫生监督局,卫生监督体制改革和体系建设文件汇编(2008年版)
[10]曹劲松等,卫生监督机构监督员现状分析[J].中国公共卫生管理,2002,3(18):182.
[11]牛丽,吉林市卫生监督体制改革的探究
[12]王义等,北京市卫生监督执法能力现状及对策研究,中国卫生监督杂志(2006)06-0342-05
[13]孙国新等,上海市卫生监督队伍建设探讨,上海预防医学杂志,2007年第19卷第五期
[14]张辉等,我国卫生监督体系建设的现状和特点,中国公共卫生管理 2007年第23卷第2期
[15]顾月明,卫生监督机构建设与管理探讨,浙江预防医学2006年第18卷第12期
[16]卫生部、国家中医药管理局,全国卫生系统“四五”普法培训教材。北京:法律出版社,2002
[35]Hoover.K.D(1998),The new Marcroeconomics[M].Oxford:Black well
[17]Allen.R. (1999), New public Management: Pitfalls for Gentral and Eastern Erope[J]. Public Management for ruml(4).
[18] Herry R Mason. Manpower needs by specialty[J]. JAMA, 2004, 219, 1972:1621-1626.
[19] M. Wheeler, V. N. Ngcongco. Health manpower planning in Botswama[J]. World health forum, 2004, 11:394-404.
[20]Avi Yacar Ellencweig,Analyzing Health Systems: a modular approach, Oxford University Press, 1~(st) ed., 1992
[21]Murphy KR, Psychological testing:principles and applications. Eaglewood Cliffs NJ.Prentice Hall, 1994.
[2]荆丽梅,王雪凝,孟庆跃,黄思桂,卫生监督机构人力资源现状调查分析[J],卫生经济研究,2007,10:32-34
[3]中华人民共和国卫生部1中国2000年预防保健战略目标制定研究[M]1北京B中国科学技术出版社,1991,221
[4]卫生部卫生监督局,卫生监督体系三年建设情况评价研究报告,人民卫生出版社,2008
[5]卫生部卫生监督局,卫生监督体系建设与发展研究报告,人民卫生出版社,2008
[6]刘国湘,2007年湖南省经济和社会事业发展情况新闻发布会发布辞,湖南省统计信息网,2008
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[1]陈晓明,山东省卫生监督资源配置现况研究
[2]卫生部,卫生监督体系三年建设情况评价研究报告,人民卫生出版社
[3]卫生部,卫生监督体系建设与发展研究报告,人民卫生出版社
[4]当代中国卫生事业大事记编写组,当代中国卫生事业大事记,人民卫生出版社,1993
[5]新中国预防医学历史经验编委会,新中国预防医学历史经验,人民卫生出版社,1991
[6]关于城镇医药卫生体制改革指导意见,国办发(2000)16号
[7]杨健,卫生监督体制改革现状分析[J].中国卫生监督杂志。2004,11(6):376-378
[8]国家发改委,卫生部,《关于突发公共卫生事件医疗救治体系建设规划实施意见》,发改社会[2003]1438号.2003,10,10.
[9]卫生部卫生监督局,卫生监督体制改革和体系建设文件汇编(2008年版)
[10]曹劲松等,卫生监督机构监督员现状分析[J].中国公共卫生管理,2002,3(18):182.
[11]牛丽,吉林市卫生监督体制改革的探究
[12]王义等,北京市卫生监督执法能力现状及对策研究,中国卫生监督杂志(2006)06-0342-05
[13]孙国新等,上海市卫生监督队伍建设探讨,上海预防医学杂志,2007年第19卷第五期
[14]张辉等,我国卫生监督体系建设的现状和特点,中国公共卫生管理 2007年第23卷第2期
[15]顾月明,卫生监督机构建设与管理探讨,浙江预防医学2006年第18卷第12期
[16]卫生部、国家中医药管理局,全国卫生系统“四五”普法培训教材。北京:法律出版社,2002
[35]Hoover.K.D(1998),The new Marcroeconomics[M].Oxford:Black well
[17]Allen.R. (1999), New public Management: Pitfalls for Gentral and Eastern Erope[J]. Public Management for ruml(4).
[18] Herry R Mason. Manpower needs by specialty[J]. JAMA, 2004, 219, 1972:1621-1626.
[19] M. Wheeler, V. N. Ngcongco. Health manpower planning in Botswama[J]. World health forum, 2004, 11:394-404.
[20]Avi Yacar Ellencweig,Analyzing Health Systems: a modular approach, Oxford University Press, 1~(st) ed., 1992
[21]Murphy KR, Psychological testing:principles and applications. Eaglewood Cliffs NJ.Prentice Hall, 1994.