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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,对中西部四省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 between the two levels of rural health institutions in the national basic public health services. Methods The questionnaire was drawn up by means of literature review, expert consultation and logical test, and the survey was conducted on 10 township hospitals and 22 village clinics in four central and western provinces of China. The data were analyzed. Results There were 24 disagreements at the country and village levels, accounting for 58.53% of the 41 national basic public health service project secondary projects. The difference between the villages was> 0, of which ≥20% reached 70.73%. The township level considered the overall project Commitment ratio is 0.72 for the township level, 0.28 for the village level, and 50% for all the projects. The proportion of the villages is 0.43 for the township level and 0.57 for the village level. 29 projects bear the proportion of 50% or 70.73%, and the exploration results Show commitment ratio for the township level 0.61, village level 0.39; township main commitment projects, village-level assistance to complete the project. Conclusions There are many differences between the two levels in rural areas on project commitment, lack of maneuverability of first-level indicators, division of responsibilities into second-level indicators, and second-level indicators to guide rural coordination to carry out basic public health services.