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目的:探索乡村两级卫生机构在国家基本公共卫生服务项目中的职责分工明细。方法:运用文献法、专家咨询法和逻辑测验法制定调查问卷,对中西部4省10个乡镇卫生院和22个村卫生室进行调查,并对数据进行分析。结果:41个国家基本公共卫生服务项目二级项目指标中,乡村两级存在分歧的有24个,占58.53%;乡村承担差值均>0,其中≥20%达70.73%;乡级认为项目总体承担比例为乡级0.72,村级0.28,所有项目承担比例均≥50%;而村级认为比例为乡级0.43,村级0.57,有29个项目承担比例≥50%,占70.73%;探索结果显示承担比例为乡级0.61,村级0.39;乡级主承担项目,村级协助完成项目。结论:乡村两级对项目承担比例分歧较大,一级指标缺乏可操作性,应该将职责分工细化至二级指标,二级指标更加能够指导乡村协作开展基本公共卫生服务。
Objective: To explore the division of responsibilities of rural health institutions at two levels in the national basic public health services. Methods: By means of literature review, expert consultation and logical test, a questionnaire was made to investigate 10 township hospitals and 22 village clinics in 4 central western provinces and to analyze the data. Results: Among the 41 national basic public health service project secondary project indicators, there are 24 differences between the two levels of the village (58.53%); the difference between the villages is> 0, of which ≥20% reaches 70.73%; and the township level considers that the project The overall commitment ratio is 0.72 for the township level and 0.28 for the village level, and all the projects bear the proportion of 50% or more; while the village level considers that the ratio is 0.43 for the township level and 0.57 for the village level, and 29 projects bear the proportion of 50% or 70.73% The results show that the commitment ratio is 0.61 for the township level and 0.39 for the village level; the township-level host undertakes the project and the village-level assistance completes the project. Conclusion: There are many differences between the two levels in rural areas, such as large proportion of project commitment, lack of maneuverability of first-level indicators, refinement of division of responsibilities to second-level indicators, and second-level indicators to guide rural coordination of basic public health services.