Department of Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia.
Front Public Health. 2021 Oct 4;9:760124. doi: 10.3389/fpubh.2021.760124. eCollection 2021.
Accessible, equitable, and efficient pediatric service is critical to achieve optimal child health. This study aimed to evaluate the effectiveness of a multi-component intervention on the pediatric health system over two different periods in Guangzhou. Based on the World Health Organization (WHO) "six building blocks" model and Donabedian's "Structure-Process-Outcomes" framework, an intervention package was developed to increase financial and human resouce investment to strengthen basic health care and strive for a better quality of pediatric care. This multi-component intervention package was conducted in Guangzhou to improve the pediatric service delivery during two stages (2011-2014 and 2016-2019). The main outcome indicators were the changes in the allocation of pediatricians and pediatric beds, pediatric service efficiency, and the impact of pediatricians on child mortality. We found that pediatricians per 1,000 children (PPTC) and pediatric beds per 1,000 children (PBPTC) increased from 1.07 and 2.37 in 2010 to 1.37 and 2.39 in 2014, then to 1.47 and 2.93 in 2019, respectively. Infant mortality rate (IMR) and under-5 mortality rate (U5MR) dropped from 5.46‰ and 4.04‰ in 2010 to 4.35‰ and 3.30‰ in 2014 then to 3.26‰ and 2.37‰ in 2019. The Gini coefficients of PPTC and PBPTC decreased from 0.48 and 0.38 in 2010, to 0.35 and 0.28 in 2014, then to 0.35 and 0.22 in 2019, respectively, representing the improvement of pediatric resources distribution according to service population. However, equalities in the spatial distribution were not improved much. The average efficiency of pediatric service fluctuated from 2010 to 2019. A unit increase in PPTC was associated with an 11% reduction in IMR and a 16% reduction in U5MR. Findings suggest this multi-component intervention strategy is effective, particularly on the reduction of child mortality. In future, more rigorous and multi-faceted indicators should be integrated in a comprehensive evaluation of the intervention.
提供可及、公平且高效的儿科服务对于实现儿童健康的最佳状态至关重要。本研究旨在评估多组分干预措施在广州两个不同时期对儿科卫生系统的有效性。
本研究基于世界卫生组织（WHO）的“六个组成部分”模型和 Donabedian 的“结构-过程-结果”框架，制定了一揽子干预计划，以增加财政和人力资源投入，加强基础保健，并努力提高儿科护理质量。该多组分干预措施在广州实施，以改善两个阶段（2011-2014 年和 2016-2019 年）的儿科服务提供。主要结局指标是儿科医生和儿科床位的分配变化、儿科服务效率以及儿科医生对儿童死亡率的影响。
我们发现，每千名儿童的儿科医生人数（PPTC）和每千名儿童的儿科床位数量（PBPTC）从 2010 年的 1.07 和 2.37 分别增加到 2014 年的 1.37 和 2.39，再到 2019 年的 1.47 和 2.93。婴儿死亡率（IMR）和 5 岁以下儿童死亡率（U5MR）从 2010 年的 5.46‰和 4.04‰下降到 2014 年的 4.35‰和 3.30‰，再到 2019 年的 3.26‰和 2.37‰。PPTC 和 PBPTC 的基尼系数从 2010 年的 0.48 和 0.38 分别下降到 2014 年的 0.35 和 0.28，再到 2019 年的 0.35 和 0.22，这表明根据服务人口分配，儿科资源的分布得到了改善。然而，空间分布的公平性并没有得到很大改善。儿科服务的平均效率从 2010 年到 2019 年波动不定。PPTC 每增加一个单位，IMR 降低 11%，U5MR 降低 16%。
研究结果表明，这种多组分干预策略是有效的，特别是在降低儿童死亡率方面。在未来，应综合更多严格和多方面的指标，对干预措施进行全面评估。
