Wang Manli, Fang Haiqing, Bishwajit Ghose, Xiang Yuanxi, Fu Hang, Feng Zhanchun
School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China.
Int J Environ Res Public Health. 2015 Oct 29;12(11):13843-60. doi: 10.3390/ijerph121113843.
China's Ministry of Health has enacted Rural Primary Health Care Program (2001-2010) (HCP) guidelines to improve the quality of people's health. However, the program's success in Western China remains unevaluated. Thus, this study aims to begin to fill that gap by analyzing the provision and utilization of Rural Primary Health Care (RPHC) in Western China.
A cross-sectional study was conducted to collect secondary data on the socio-economic characteristics, system construction, services use and implementation of RPHC, and the residents' health status of the sampled areas. Four hundred counties from 31 provinces in China were selected via stratified random sampling, including 171 counties from 12 Western provinces. Twenty-seven analysis indicators, covering system construction, services use and implementation of RPHC were chosen to assess Western China's primary health quality. Analysis of Variance (ANOVA) and Least Significant Difference (LSD) methods were used to measure the RPHC disparities between Western and Eastern and Central China. Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) was used to rank Western, Eastern and Central internal provinces regarding quality of their RPHC.
Of the 27 indicators, 13 (48.15%) were below the standard in Western China. These focused on rural health service system construction, Chinese medicine services, and public health. In the comparison between Western, Central and Eastern China, 12 indicators had statistical significance (p < 0.05), and using LSD to compare between Western and Eastern China, all indicators were statistically significant (p < 0.05), demonstrating regional disparities. Xinjiang Province's RPHC ranked highest overall, and Yunnan Province ranked the lowest, indicating the internal differences within the 12 Western provinces; and Western provinces' Ci value was lower than that of Eastern and Central China overall.
Western China's RPHC has proceeded well, but remains weaker than that of Eastern and Central China. Differences within Western internal provinces threaten the successful implementation of RPHC.
中国卫生部颁布了《农村初级卫生保健规划（2001 - 2010年）》（HCP）指南，以提高人民健康水平。然而，该规划在西部地区的成效尚未得到评估。因此，本研究旨在通过分析中国西部农村初级卫生保健（RPHC）的提供与利用情况来填补这一空白。
开展一项横断面研究，收集有关抽样地区社会经济特征、农村初级卫生保健系统建设、服务利用与实施情况以及居民健康状况的二手数据。通过分层随机抽样从中国31个省份中选取400个县，其中包括来自12个西部省份的171个县。选取涵盖农村初级卫生保健系统建设、服务利用与实施情况的27项分析指标，以评估中国西部的初级卫生保健质量。采用方差分析（ANOVA）和最小显著差法（LSD）来衡量中国西部与东部和中部地区农村初级卫生保健的差异。运用逼近理想解排序法（TOPSIS）对西部、东部和中部内部省份的农村初级卫生保健质量进行排名。
在27项指标中，中国西部有13项（48.15%）未达标准。这些指标集中在农村卫生服务体系建设、中医药服务和公共卫生方面。在西部、中部和东部地区的比较中，12项指标具有统计学意义（p < 0.05），使用LSD法比较西部和东部地区时，所有指标均具有统计学意义（p < 0.05），表明存在地区差异。新疆维吾尔自治区的农村初级卫生保健总体排名最高，云南省排名最低，表明12个西部省份内部存在差异；总体而言，西部省份的Ci值低于东部和中部地区。
中国西部的农村初级卫生保健工作进展良好，但仍弱于东部和中部地区。西部内部省份之间的差异威胁到农村初级卫生保健规划的成功实施。
