单元10-中国社会性别与卫生公平案例的启示Scarf08.11.25.ppt

China Gender & Health Equity Projects: Luoping and Zhenning,Summary of Evaluation Findings and Key Lessons Learned 评估总结和主要的经验教训 Chris Scarf Dissemination Meeting November 2008,Findings,Both projects met their goals. Substantially Make health services more responsive to womens needs Partially Viable model of gender and local governance to improve accountability of local health officials and health workers,两个项目都达到了预期的目的。 大体上 使卫生服务更顺应妇女的需要 部分地 为改善地方卫生官员及卫生工作者的问责制提供了切实可行的性别与地方治理的模式,Findings,The projects drew on excellent technical assistance providing clear ideas about what should be done and how to do it,项目得到了优秀的技术援助，清楚“应该做什么”和“怎样做”,Lesson,Three projects (Luoping, Zhenning and Dafang) provide good templates for effective improvement of GHE,三个项目（罗平，镇宁及大方）为有效地改善社会性别与卫生公平性提供了良好的范本,Findings,Extensive baseline surveys identified major issues in GHE and to some extent informed action,内容广泛的基线调查指出了社会性别卫生公平性方面的主要问题，并在某种程度上提出了行动方向,Findings,Projects exposed the depth of the commitment of local government officials to GHE and illustrate the importance of their understanding and involvement,项目揭示了地方政府官员对性别卫生公平性问题承诺的深度，阐明了官员的理解和参与对解决这些问题的重要性,Lesson,Dissemination should give high priority to demonstrating the benefits of GHE to local government leaders and to winning their commitment to the principles,宣传方面应高度重视向地方政府领导者展示关注性别卫生公平的益处并赢得他们对这一原则的承诺,Findings,Projects benefited from emerging health security policies (NCMS). The projects assisted NCMS implementation, and influenced benefit packages,项目受益于新出现的卫生保障政策（新农合） 项目促进了新型农村合作医疗体系的实施，并影响了服务包的内容,Findings,Local Health Promotion Groups (HPG) allocated funds to subsidize hospital delivery Significant increases in hospital delivery rates followed,当地的健康促进小组计划资金补贴住院分娩 住院分娩率随之有了显著的提高,Findings,The HPG and township hospitals then successfully lobbied for higher subsidies for hospital delivery in NCMS Subsequent NCMS benefit adjustments now make normal delivery free in project township hospitals,健康促进小组和乡镇卫生院进而为新农合中的住院分娩争取到了更高的补贴 相关部门随即作出了新农合受益调整，项目乡镇卫生院的住院分娩全部免费（顺产）,Lesson,Health insurance packages that include high level benefits for hospital delivery and attractive rebates for RTI management have a major impact on GHE,对住院分娩及生殖道感染诊治给予高额补贴的新农合对性别健康公平性有着很大的影响,Findings,Women and men have became informed about reproductive health issues and basic child development needs and make effective use of the knowledge,妇女和男士们都开始了解有关生殖健康和儿童基本生长需要等问题，并开始有效地利用这些知识,Findings,Health Promotion Groups and demonstration households enjoyed learning Village doctors (especially if female) played pivotal roles in HPG coordination and planning,健康促进小组及示范户都喜欢参与学习活动 村医（特别是女村医）在健康促进小组的协调和计划过程中扮演着重要的角色,Findings,Knowledge engendered confidence and won respect Long held attitudes and myths about birthing, RTI, immunization were abandoned,知识产生自信并赢得尊重 人们丢弃了对于生育、生殖道感染及免疫长久以来持有的旧观念和神秘感,Findings,Women made it clear that with this knowledge they will not accept wrong advice about birthing or RTI minimization.,妇女们宣告，有了这些知识，她们再不会接受有关生育或生殖道感染的错误建议,Findings,Good training and minor equipment has enabled primary care providers to effectively diagnose and manage reproductive health problems,良好的培训和一些简单的设施使基层医疗保健提供者能够有效地诊断并管理生殖健康问题,Findings,Projects mobilised villagers in ways that are familiar to the communities but not to the health system,项目以一种对社区而言熟悉的方式动员了村民，但这些方式并不为卫生系统所熟悉,Findings,Eyes were opened to the limitations of traditional top-down communication New ways of communicating technical information have been introduced,传统的自上而下的沟通方式已经被意识到存在着局限性 介绍了新的交流沟通技术信息的方式,Lesson,Orthodox health education methods have failed to inform illiterate rural women about basic reproductive health issues and their rights.,传统的健康教育方式无法使文盲农村妇女了解基础的生殖健康问题和她们的权利,Lesson,The projects effectively conveyed knowledge by using methods that meet the needs of those learning rather than those teaching,以满足学习者而不是教授者需求的方法，项目有效地传播了相关的知识,Findings,Womens authority over their own and their familys health has been strengthened Womens status in their families and in the community appears to be stronger,妇女们在对自己以及家人的健康问题方面的权威性得到加强 妇女们在家庭中及社区会中的地位正在提升,Findings,Many women were happy to be informed and to be able to express their opinions. Women had taken advantage of the “permission” given by the project to openly discuss their reproductive health status and to change it for the better.,妇女们很高兴能够了解一些事情并能够表达她们的观点 妇女们利用项目给予她们的“许可”公开讨论她们的生殖健康现状并使其变得更好,Findings,Men became involved in the treatment of RTI The risk of transmission of STI and HIV has been reduced when migrant husbands return to villages.,男性开始参与生殖道感染的治疗 出外务工的丈夫回村时带来的生殖道感染及艾滋病传染的风险降低了,Lessons,Informed and empowered women will take bold steps to seek safe delivery and reduce their risk of reproductive tract infection and HIV Communities will support this change,具备知识和权力的妇女将采取果敢的措施一步步寻求安全的分娩方式并降低生殖道感染及艾滋病的风险 社区将支持这一改变,Findings,Health seeking behaviour has been transformed. Women now actively seek reproductive health checks and necessary treatment,寻求健康的行为已经转变。妇女们如今主动寻求生殖健康检查以及必要的治疗,Findings,Services for birthing and reproductive health maintenance have been improved Clinical training Basic equipment supplied NCMS financial support,分娩服务以及生殖健康维护已经得到了改善 临床培训 基础设备供给 新农合资金支持,Lesson,Good information, effectively conveyed will dispel widely held taboos, misconceptions and myths,科学的信息和有效的传播会有效的消除广泛存在的禁忌、误解和神秘感,Findings,Some ACWF, FPC, BoH, MCH and other local government officials have broadened their thinking on their roles and have joined in cooperative activities,全国妇联、计划生育委员会、卫生局、妇幼保健机构及其他地方政府官员拓宽了对自身角色的定位，并开始了相互合作,Findings,Health workers have learned how to develop new relationships of trust with the community,健康工作者已开始学习如何与社区建立新的信任关系,Findings,Entrepreneurial health managers have identified opportunities to improve services and earn more revenue through GHE,通过社会性别与卫生公平项目，私营卫生机构管理者找到了机会以改善服务并赚取更多的利润,Lessons,GHE offers potential benefits to local government officials and to primary and secondary health care providers These should be actively promoted in dissemination,性别健康公平项目对地方政府官员以及基本卫生保健和更高一级的卫生保健提供者带来了潜在的利益 这些应在传播中积极倡导,Findings,The risks to sustainability from rapid turnover of leadership and economic stress in local health services has been starkly illustrated,频繁的领导人员更替及地方卫生服务的经济压力对可持续发展带来的风险已明显的显现出来,Lesson,Sustainability needs continuing support and the interest of officials together with effective HP materials,可持续发展需要连续的支持、官员的关注以及有效的健康促进材料,Summary,The projects show that GHE can be effectively advanced in remote rural China Local government leaders commitment is needed to implement and sustain change,项目揭示了在中国边远农村地区，社会性别与卫生公平性问题能够被有效地改进 创造和持续改变需要地方政府领导的承诺,Summary,Communities traditional methods of communication and knowledge sharing are effective and should be used,社会传统的沟通和分享知识的方式是有效的，应该加以利用,Summary,Women like the benefits that GHE brings Shared knowledge Open discussion Less family tension Better health status Greater confidence,妇女们欢迎性别卫生公平带来的益处 共享知识 开放讨论 减轻家庭紧张 更好的健康状况 更大的自信,Summary,Primary health workers need training in GHE and RTI management Village doctors especially women doctors can be powerful agents of change,初级卫生保健工作者需要接受性别卫生公平及生殖道感染管理的培训 村医特别是女村医可以作为强大的变革推动者,Summary,GHE is more likely to be effectively disseminated in poor rural areas when local government leaders give personal commitment and/or when it is required by higher levels.,在得到地方政府官员私人承诺和/或更高级别领导要求时，性别健康公平才更有可能在贫困的农村地区有效的传播,