世界银行贷款卫生九项目妇幼卫生部分妇幼卫生人员培训效果评估
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摘要
研究目的
通过比较项目县和非项目县的妇幼卫生培训工作,对世界银行贷款卫生九项目妇幼卫生部分培训效果进行评价,探索卫九项目培训的有效机制,为今后实施其它项目工作提供有价值、可利用、值得推广和借鉴的培训工作经验。
研究方法
采用问卷调查、定性访谈、现场档案资料查阅、现场问卷考核等方法,依据柯克帕里克(Kirkpatrick)培训评估理论从反应、学习、行为和结果四个层面全面评估项目培训效果,比较项目地区和非项目地区受训对象有关妇幼卫生服务核心知识的考核成绩、妇幼卫生综合服务能力提升情况及对培训的评价,同时了解服务对象对妇幼保健服务的反馈。
研究结果
从1999年至2006年,卫生九项目在项目地区承担了培训相关的所有费用。5个项目省完成短期培训人周数计划的172.7%、长期培训人月数计划数的121.1%,国外考察累计完成率为99.2%,国内技术援助累计完成率为97.4%。
在举办的各种培训班中,项目县妇幼卫生管理、统计信息、健康教育、妇儿综合保健知识四项内容所占的比例分别为4.35%、13.04%、11.960%和70.650%,而对照县上述内容的比例分别占0.00%、21.05%、5.26%和73.68%,两者比较差异无统计学意义(P=0.532)。师资比例中项目县地(市)级以上占36.95%、县级占63.04%,对照县则分别为5.26%和94.75%,两者差异有统计学意义(P=0.000)。项目县受训对象包括管理人员、财务人员和妇幼卫生业务人员,而非项目地区则主要以妇幼卫生业务人员培训为主。
受训对象妇幼卫生服务核心知识考核结果:项目地区县级学员妇产/妇保综合知识、产时核心知识与技能考核得分高于非项目地区(P=0.036、P=0.003),乡级学员妇产/妇保综合知识、产时、孕期核心知识与技能考核得分高于非项目地区(P=0.000、P=0.002、P=0.004)。
运用培训知识和技能开展妇幼保健服务方面,项目乡镇卫生院开展肾功能检测,正确使用产程图的比例高于对照乡(均为P=0.037),项目村护送孕产妇转诊、儿童危重症识别与转运、儿童营养监测和儿童早期发展宣传工作好于对照村(P=0.031、P=0.031、P=0.013、P=0.000)。项目县孕产妇急重症治疗总人次数2006年较1999年增长了2.8倍,而同期对照县仅增长了0.83倍。
学员及学员单位对培训的评价方面,项目县的县、乡、村级学员认为培训效果好、知识技能明显提高,效果较好、知识技能较大提高,效果一般、知识技能没有提高的分别占70.21%、25.53%和4.26%,对照县则分别占20.00%、73.33%和6.67%。两者差异有统计学意义(P=0.001)。
服务对象对培训后妇幼保健服务改善评价结果:项目县访谈对象认为乡卫生院和村卫生室医疗条件有明显变化、有一定变化、无变化的比例分别为90.00%、10.00%和0.00%,对照县分别为50%、40%和10%,两者差异有统计学意义(P=0.000)。项目县访谈对象认为医务人员服务态度好、服务态度一般、服务态度差的比例分别为80%、10%和10%,对照县分别为75.00%、15.00%和10.00%,两者差异无统计学意义(P=0.668)。项目县访谈对象认为医务人员业务水平有明显变化、有一定变化、说不清的比例为80.00%、20.00%和0.00%,对照县为30%、50%和20%,两者差异有统计学意义(P=0.000)。
目标人群健康状况改善:项目地区孕产妇死亡率从1999年的103.2/10万下降到2006年的56.7/10万,降低了45.1%;5岁以下儿童死亡率、婴儿死亡率、新生儿死亡率分别从1999年的34.8‰、27.4‰和17.6‰,下降至2006年的18.5‰、14.7‰和10.4‰,分别下降了46.8%,46.3%和40.9%,均高于全国农村地区下降幅度。孕产妇住院分娩率从1999年的48.5%提高到2006年的81.0%,提高了67.0%,高于全国农村地区提高幅度。结论和建议
项目地区按照项目文本要求开展了短期培训、长期培训、国外培训和技术援助等活动,全面完成项目培训目标。项目县培训效果在反应、学习、行为、结果4个层面好于对照县。在反应层,项目县受训对象对培训工作整体评价好于对照县。在学习层,受训对象妇产/妇保综合知识考核成绩好于对照县。在行为层,项目县受训对象妇幼卫生管理能力、孕产期、儿童保健服务好于对照县。在结果层,目标人群健康状况改善,主管部门及被服务对象对培训后服务技能改变给以予认可和肯定。建议进一步重视培训评估工作,加大培训评估工作力度,制定科学的评估系统,重视培训知识到培训实践技能的转换,并且计划适时做阶段性评估和长期的评估。
Objective
Through comparison of MCH training between prefectures with program and those without programs, to evaluate the effectiveness of nine health programs, knowing about status of mastering key knowledge in terms of obstetrics/maternal health care, pediatrics/children health care as well as the status of conducting MCH service using knowledge and techniques acquired from training.
Methods
Using questionnaire, qualitative interview, on-the-spot archive checking, on-the-spot examination, thoroughly evaluated the training effect from four levels: response, study, behavior and result. Compared the evaluation of trainees from regions with program and without program towards examination of MCH service key knowledge, overall improvement of MCH service ability as well as the training itself. Meanwhile, knew the feedback of the service objects regarding MCH service.
Results
From 1999 to 2006, in the program-conducting regions, the programs bore all training related expenses including transportation, board and lodging, etc. The payment and usage of the training funding were conducted stringently according to requirements of the World Bank. In line with the requirements of the central government, respective provinces conducted short-term trainings, long-term trainings, overseas trainings and technical aids, etc. The above activities already completed accounted for 172.7%, 121.1%, 99.2%, and 97.4% of the planned respectively.
Among various training courses in program-conducting counties, MCH management, information statistics, health education, comprehensive women & children health care knowledge made up 6.00%,13.00%,12.00% and 69.00% respectively. While in control counties, the corresponding percentages are 0.00%,21.05%,5.26% and 73.68% respectively ((P=0.532) . In program-conducting counties (cities) the distribution proportions of various inputs are 36.95% for city level and 63.04% for county level, in control counties, the corresponding proportions are 5.26% and 94.75%(P=0.000). In program-conducting counties, the trainees included administrators, financial staff and MCH staff, while in non-program-conducting regions, MCH staff made up the majority of trainees.
The result of the MCH service core knowledge examination for the trainees showed: in the examination of obstetrics/maternal health care comprehensive knowledge, core knowledge and technique during delivery, the score of county-level trainees from program-conducting regions was higher than non -program- conducting regions(P=0.036,P=0.003). While in the examination of obstetrics/maternal health care comprehensive knowledge(P=0.000,P=0.002,P=0.004), core knowledge and technique during delivery, pregnancy, infant health care, at the country level, the same thing occurred(P=0.063).
As for health care service for women and children with knowledge and technique learnt from training, the program-conducting countries had higher ratio in making kidney function checkups and correctly using delivery flow chart than control countries(P=0.037,P=0.037). In terms of escorting pregnant and lying-in women for diagnostics shift, identification of critical children diseases and conveyance, children nutrition monitoring, children inchoate development propaganda, the program-conducting village performed better than the control villages(P=0.031,P=0.031,P=0.013, P=0.000). In program-conducting counties, the total number of critical pregnant and lying-in women treated in 2006 increased 2.8 folds in comparison with 1999, while during the same period, there was only a 0.83 times increase in control counties.
As regards the evaluation from trainees and those units where they were from towards the training, in program-conducting counties, among county-level ,country-level, village-level trainees, 70.21% of them thought the training effect was very good with appreciable improved knowledge and technique; 25.53% felt it was comparatively good with moderate improvement of knowledge and technique: 4.24% of them believed it was mediocre without any improvement of knowledge and technique. In the control counties, the percentages were 20.00%, 73.33%, 6.67% respectively(P=0.001).
Evaluation from service objects about the improvement of women&children health care service after training: in program-conducting counties, 90% interviewees thought the medical treatment condition of country-level hospitals and village-level infirmaries were much better than before, and the other 10% thought there had some improvement, and no one believes that there was no change (P =0.000) . Otherwise, control counties fell into the scale of 50%, 40% and 10%. As regards the attitude of medical staff towards patient, 80%, 10%, 10% fell into the scale of good, common, bad respectively in program-conducting counties. And to control counties the data about attitude of medical staff towards patient are 75%, 15% and 10%(P=0.829). With regard to the medical technology level of country-level hospitals and village-level infirmaries, in program-conducting counties, 80% thought there was a manifest improvement, 20% held these was a relatively improvement, and 0.00% had no definite idea. And to control counties the data about medical technology level are 30%, 50% and 20% (P =0.000) .
Improvement in health of target group: in program-conducting regions, the mortality rate of pregnant and lying-in women decreased from 103.2/100,000 in 1999 to 56.7/100,000 in 2006, witnessing a 45.1% decline. The mortality rates of children under 5, infants, new-borns decreased from 34.8‰, 27.4‰, and 17.6‰in 1999 to 18.5‰, 14.7‰, 10.4‰in 2006, dropping 46.8%, 46.3% and 40.9% respectively. The above values declined with a higher extent compared with rural areas in China. The delivery rate in hospital of pregnant and lying-in women increased more than rural areas of China, rising from 48.5% in 1999 to 81.0% in 2006, a 67.0% increase..
Conclusion and Suggestion
Program-conducting counties achieved better training effect in terms of response, study, behavior, result than control counties. The program-conducting regions held short-term training, long-term training, overseas training, technical aid according to the requirement of the document and reached the training target completely. At the response level, the program-conducting counties had a better overall assessment of the trainee toward training in comparison with control counties. At the study level, the trainees achieved better scores in examination of core knowledge, mastery of comprehensive knowledge about obstetrics/maternal health care. At the level of behavior, the overall MCH service level increased. At the result level, the department in charge and the service objects gave a positive evaluation regarding the after-training change of service technique. The mortality rate of pregnant and lying-in women as well as children under 5 decreased in target groups. It is suggested that we should pay more attention to and strengthen the evaluation of training, establish a set of scientific evaluation system, attach importance to the change from training intensity to training practical technique and conduct phasic and long-term evaluations timely in accordance with plan.
通过比较项目县和非项目县的妇幼卫生培训工作,对世界银行贷款卫生九项目妇幼卫生部分培训效果进行评价,探索卫九项目培训的有效机制,为今后实施其它项目工作提供有价值、可利用、值得推广和借鉴的培训工作经验。
研究方法
采用问卷调查、定性访谈、现场档案资料查阅、现场问卷考核等方法,依据柯克帕里克(Kirkpatrick)培训评估理论从反应、学习、行为和结果四个层面全面评估项目培训效果,比较项目地区和非项目地区受训对象有关妇幼卫生服务核心知识的考核成绩、妇幼卫生综合服务能力提升情况及对培训的评价,同时了解服务对象对妇幼保健服务的反馈。
研究结果
从1999年至2006年,卫生九项目在项目地区承担了培训相关的所有费用。5个项目省完成短期培训人周数计划的172.7%、长期培训人月数计划数的121.1%,国外考察累计完成率为99.2%,国内技术援助累计完成率为97.4%。
在举办的各种培训班中,项目县妇幼卫生管理、统计信息、健康教育、妇儿综合保健知识四项内容所占的比例分别为4.35%、13.04%、11.960%和70.650%,而对照县上述内容的比例分别占0.00%、21.05%、5.26%和73.68%,两者比较差异无统计学意义(P=0.532)。师资比例中项目县地(市)级以上占36.95%、县级占63.04%,对照县则分别为5.26%和94.75%,两者差异有统计学意义(P=0.000)。项目县受训对象包括管理人员、财务人员和妇幼卫生业务人员,而非项目地区则主要以妇幼卫生业务人员培训为主。
受训对象妇幼卫生服务核心知识考核结果:项目地区县级学员妇产/妇保综合知识、产时核心知识与技能考核得分高于非项目地区(P=0.036、P=0.003),乡级学员妇产/妇保综合知识、产时、孕期核心知识与技能考核得分高于非项目地区(P=0.000、P=0.002、P=0.004)。
运用培训知识和技能开展妇幼保健服务方面,项目乡镇卫生院开展肾功能检测,正确使用产程图的比例高于对照乡(均为P=0.037),项目村护送孕产妇转诊、儿童危重症识别与转运、儿童营养监测和儿童早期发展宣传工作好于对照村(P=0.031、P=0.031、P=0.013、P=0.000)。项目县孕产妇急重症治疗总人次数2006年较1999年增长了2.8倍,而同期对照县仅增长了0.83倍。
学员及学员单位对培训的评价方面,项目县的县、乡、村级学员认为培训效果好、知识技能明显提高,效果较好、知识技能较大提高,效果一般、知识技能没有提高的分别占70.21%、25.53%和4.26%,对照县则分别占20.00%、73.33%和6.67%。两者差异有统计学意义(P=0.001)。
服务对象对培训后妇幼保健服务改善评价结果:项目县访谈对象认为乡卫生院和村卫生室医疗条件有明显变化、有一定变化、无变化的比例分别为90.00%、10.00%和0.00%,对照县分别为50%、40%和10%,两者差异有统计学意义(P=0.000)。项目县访谈对象认为医务人员服务态度好、服务态度一般、服务态度差的比例分别为80%、10%和10%,对照县分别为75.00%、15.00%和10.00%,两者差异无统计学意义(P=0.668)。项目县访谈对象认为医务人员业务水平有明显变化、有一定变化、说不清的比例为80.00%、20.00%和0.00%,对照县为30%、50%和20%,两者差异有统计学意义(P=0.000)。
目标人群健康状况改善:项目地区孕产妇死亡率从1999年的103.2/10万下降到2006年的56.7/10万,降低了45.1%;5岁以下儿童死亡率、婴儿死亡率、新生儿死亡率分别从1999年的34.8‰、27.4‰和17.6‰,下降至2006年的18.5‰、14.7‰和10.4‰,分别下降了46.8%,46.3%和40.9%,均高于全国农村地区下降幅度。孕产妇住院分娩率从1999年的48.5%提高到2006年的81.0%,提高了67.0%,高于全国农村地区提高幅度。结论和建议
项目地区按照项目文本要求开展了短期培训、长期培训、国外培训和技术援助等活动,全面完成项目培训目标。项目县培训效果在反应、学习、行为、结果4个层面好于对照县。在反应层,项目县受训对象对培训工作整体评价好于对照县。在学习层,受训对象妇产/妇保综合知识考核成绩好于对照县。在行为层,项目县受训对象妇幼卫生管理能力、孕产期、儿童保健服务好于对照县。在结果层,目标人群健康状况改善,主管部门及被服务对象对培训后服务技能改变给以予认可和肯定。建议进一步重视培训评估工作,加大培训评估工作力度,制定科学的评估系统,重视培训知识到培训实践技能的转换,并且计划适时做阶段性评估和长期的评估。
Objective
Through comparison of MCH training between prefectures with program and those without programs, to evaluate the effectiveness of nine health programs, knowing about status of mastering key knowledge in terms of obstetrics/maternal health care, pediatrics/children health care as well as the status of conducting MCH service using knowledge and techniques acquired from training.
Methods
Using questionnaire, qualitative interview, on-the-spot archive checking, on-the-spot examination, thoroughly evaluated the training effect from four levels: response, study, behavior and result. Compared the evaluation of trainees from regions with program and without program towards examination of MCH service key knowledge, overall improvement of MCH service ability as well as the training itself. Meanwhile, knew the feedback of the service objects regarding MCH service.
Results
From 1999 to 2006, in the program-conducting regions, the programs bore all training related expenses including transportation, board and lodging, etc. The payment and usage of the training funding were conducted stringently according to requirements of the World Bank. In line with the requirements of the central government, respective provinces conducted short-term trainings, long-term trainings, overseas trainings and technical aids, etc. The above activities already completed accounted for 172.7%, 121.1%, 99.2%, and 97.4% of the planned respectively.
Among various training courses in program-conducting counties, MCH management, information statistics, health education, comprehensive women & children health care knowledge made up 6.00%,13.00%,12.00% and 69.00% respectively. While in control counties, the corresponding percentages are 0.00%,21.05%,5.26% and 73.68% respectively ((P=0.532) . In program-conducting counties (cities) the distribution proportions of various inputs are 36.95% for city level and 63.04% for county level, in control counties, the corresponding proportions are 5.26% and 94.75%(P=0.000). In program-conducting counties, the trainees included administrators, financial staff and MCH staff, while in non-program-conducting regions, MCH staff made up the majority of trainees.
The result of the MCH service core knowledge examination for the trainees showed: in the examination of obstetrics/maternal health care comprehensive knowledge, core knowledge and technique during delivery, the score of county-level trainees from program-conducting regions was higher than non -program- conducting regions(P=0.036,P=0.003). While in the examination of obstetrics/maternal health care comprehensive knowledge(P=0.000,P=0.002,P=0.004), core knowledge and technique during delivery, pregnancy, infant health care, at the country level, the same thing occurred(P=0.063).
As for health care service for women and children with knowledge and technique learnt from training, the program-conducting countries had higher ratio in making kidney function checkups and correctly using delivery flow chart than control countries(P=0.037,P=0.037). In terms of escorting pregnant and lying-in women for diagnostics shift, identification of critical children diseases and conveyance, children nutrition monitoring, children inchoate development propaganda, the program-conducting village performed better than the control villages(P=0.031,P=0.031,P=0.013, P=0.000). In program-conducting counties, the total number of critical pregnant and lying-in women treated in 2006 increased 2.8 folds in comparison with 1999, while during the same period, there was only a 0.83 times increase in control counties.
As regards the evaluation from trainees and those units where they were from towards the training, in program-conducting counties, among county-level ,country-level, village-level trainees, 70.21% of them thought the training effect was very good with appreciable improved knowledge and technique; 25.53% felt it was comparatively good with moderate improvement of knowledge and technique: 4.24% of them believed it was mediocre without any improvement of knowledge and technique. In the control counties, the percentages were 20.00%, 73.33%, 6.67% respectively(P=0.001).
Evaluation from service objects about the improvement of women&children health care service after training: in program-conducting counties, 90% interviewees thought the medical treatment condition of country-level hospitals and village-level infirmaries were much better than before, and the other 10% thought there had some improvement, and no one believes that there was no change (P =0.000) . Otherwise, control counties fell into the scale of 50%, 40% and 10%. As regards the attitude of medical staff towards patient, 80%, 10%, 10% fell into the scale of good, common, bad respectively in program-conducting counties. And to control counties the data about attitude of medical staff towards patient are 75%, 15% and 10%(P=0.829). With regard to the medical technology level of country-level hospitals and village-level infirmaries, in program-conducting counties, 80% thought there was a manifest improvement, 20% held these was a relatively improvement, and 0.00% had no definite idea. And to control counties the data about medical technology level are 30%, 50% and 20% (P =0.000) .
Improvement in health of target group: in program-conducting regions, the mortality rate of pregnant and lying-in women decreased from 103.2/100,000 in 1999 to 56.7/100,000 in 2006, witnessing a 45.1% decline. The mortality rates of children under 5, infants, new-borns decreased from 34.8‰, 27.4‰, and 17.6‰in 1999 to 18.5‰, 14.7‰, 10.4‰in 2006, dropping 46.8%, 46.3% and 40.9% respectively. The above values declined with a higher extent compared with rural areas in China. The delivery rate in hospital of pregnant and lying-in women increased more than rural areas of China, rising from 48.5% in 1999 to 81.0% in 2006, a 67.0% increase..
Conclusion and Suggestion
Program-conducting counties achieved better training effect in terms of response, study, behavior, result than control counties. The program-conducting regions held short-term training, long-term training, overseas training, technical aid according to the requirement of the document and reached the training target completely. At the response level, the program-conducting counties had a better overall assessment of the trainee toward training in comparison with control counties. At the study level, the trainees achieved better scores in examination of core knowledge, mastery of comprehensive knowledge about obstetrics/maternal health care. At the level of behavior, the overall MCH service level increased. At the result level, the department in charge and the service objects gave a positive evaluation regarding the after-training change of service technique. The mortality rate of pregnant and lying-in women as well as children under 5 decreased in target groups. It is suggested that we should pay more attention to and strengthen the evaluation of training, establish a set of scientific evaluation system, attach importance to the change from training intensity to training practical technique and conduct phasic and long-term evaluations timely in accordance with plan.
引文
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