1, overall goal
(1) Maternal mortality rate: It has decreased from 200 1/4 (less than 800/100000).
(2) The incidence of neonatal tetanus: controlled below 65438 0 ‰.
(3) The delivery rate of pregnant women in hospital: over 50%.
(4) Hospital delivery rate of high-risk pregnant women: over 95%.
(5) Do a good job in monitoring maternal death, children under 5 years old and birth defects.
2. Support the goal
(1) Prenatal check-up coverage of pregnant women: ≥90%.
(2) Management rate of high-risk pregnant women screening: over 70%.
(3) Aseptic delivery rate: ≥98%
(4) The qualified rate of obstetric "three basics" examination in county-level medical and health institutions and township (district) hospitals: ≥98%.
(5) awareness rate of health education among women of childbearing age: > 85%
Second, the scope and time of project implementation
(1) The project covers all townships (districts) and villages in the county.
(2) Maternal deaths are monitored throughout the county. The monitoring points for children under 5 years old are: Sangmu Town, Wenshui Town and Hua Min Township. The monitoring points of birth defects are: county people's hospital, county traditional Chinese medicine hospital and county family planning maternal and child health care center.
(3) Project implementation time: 65438+February 2005-65438+February 2006.
Three. Project task
The overall tasks of the project are: personnel training; Hospital delivery assistance for rural pregnant women; Establish and improve the "green channel" and "emergency rescue center" for pregnant women, and carry out health education, supervision and guidance; Basic obstetric equipment in township hospitals, consolidate the establishment of baby-friendly hospitals and actively create baby-friendly counties.
Four. Project measures
At this stage, the project work will be further strengthened on the basis of the previous work.
project management
1. Adjust and enrich the "reduction and elimination" project coordination leading group, give full play to the coordination, organization and management functions, and be responsible for leading the whole process of project implementation.
2, the county health bureau to adjust and enrich the project technical guidance group and supervision group, strengthen project management and business guidance.
3, the implementation of target management responsibility system. The county people's government and the member units of the leading group of the county project coordination association and the township (District) people's government signed a target responsibility letter. Each township (district) has formulated a specific implementation plan according to the implementation plan of the county's "reduction and elimination" project, combined with the actual situation of the township (district), signed a letter of responsibility step by step, and effectively implemented the project tasks at the grassroots level.
(2) Personnel training
1. management training: (notice, training record, sign-in book and other materials shall be provided for each training).
(1) responsible department: county health bureau is the main department, and county women and children working committee cooperates.
(2) Training object and content
① Training of administrative personnel: the training target is the administrative leading cadres of counties and towns (districts) and the heads of relevant departments who organize and implement the project. The training content includes the purpose and significance of the project, the responsibilities of relevant departments, project implementation and fund management, project supervision and coordination.
② Training of medical and health institutions: the training target is the leaders and staff of county-level medical and health institutions. The training content includes the purpose and significance of the project, the responsibilities and management of the project implementation and execution unit, and the establishment and operation of the maternal first aid system.
③ Training of village cadres: The training targets are village party secretaries, directors and female directors. The training contents include the purpose and significance of the project, the responsibilities of village cadres, the methods of health education, and the establishment and operation of the "green life channel" support system for rural pregnant women's first aid.
2. Business training: organized by the county health bureau. Each training includes training content, course arrangement, lecture notes, student roster and test results.
(1) county-level teacher training. The training contents include: the purpose and requirements of project training, training methods and the formulation of training plans; Maternal health care, treatment and referral of obstetric critical diseases; Relevant health technical service specifications, common obstetric technical operation specifications and emergency equipment operation specifications, equipment management and use, etc.
(2) Midwives' training in county-level medical and health institutions and township (district) hospitals: Midwives in county-level medical and health institutions and central township (district) hospitals focus on training basic knowledge, skills and technical specifications of obstetric first aid to improve their ability of obstetric first aid; Midwives in general township (district) health centers focus on training basic first aid skills in normal delivery and referral of common obstetric first aid skills. The training materials are mainly the county, township and village textbooks and question banks of the "reduction and elimination" project.
(3) Training of rural doctors, rural midwives and health workers: the focus is on systematic health care management of pregnant women, identification and management of pregnant women's risks, postpartum visit, breastfeeding and infant nutrition guidance, and health education methods. Change the function of midwife, and do a good job of propaganda, mobilization and escort for pregnant women (especially high-risk pregnant women) to give birth in hospital.
Step 3: Schedule
All kinds of training at county and township levels are completed in two stages, with professional training completed in early April 2006 and administrative training completed before June 30, 2006. In the process of project implementation, in view of the problems and deficiencies in management, obstetric clinic and maternal and child health care services, intensive training was carried out in time.
(3) Engineering supervision
1, supervised by special experts
Expert candidate: The county health bureau will coordinate with the provincial and municipal health departments (bureaus) to select the backbone of maternal and child health care and obstetrics clinical business with middle and senior professional titles and certain clinical and management experience as special experts stationed in the county.
2. Hierarchical supervision
(1) County Leading Group Office is responsible for project management and business supervision. In accordance with the principle of hierarchical supervision, during the project implementation, county-level supervision will be carried out irregularly, and the county maternal and child health care station will implement the project responsibility system, covering all townships (towns, districts) and administrative villages; Township (district) health centers should also be contracted by dicing, and guide the work in the village, and the guidance work should cover all administrative villages.
(2) Supervision content
① Organization and management of the project. Organization and leadership, coordination and project planning, matching fund implementation and project data collection of township (district) governments (administrative committees) and relevant departments;
② Personnel training, health education and publicity;
③ The operation of midwifery technical service and referral system for high-risk pregnant women in county-level emergency centers for pregnant women and township hospitals, and the standardized management of obstetrics in medical and health institutions at all levels;
(four) the management and use of maternal hospital delivery assistance funds, and the price limit charges for hospital delivery at county and township levels.
(3) Supervision requirements
(1) Supervise and guide the whole process of project implementation, and master the operation of the project implementation unit;
(2) Help grass-roots units to improve project implementation capacity and work quality;
(3) Help the grassroots to solve the difficulties and problems encountered in the project implementation process;
(4) in-depth understanding of the situation in rural areas and farmers.
(5) Supervision record, each time the supervisor fills in the project supervision record in duplicate, signed by the person in charge of the supervision unit, one for the supervision unit and one for the project office (Health Bureau) for future reference.
(4) Baby-friendly Hospital (Health Center)
On the basis of the "reduction and elimination" project (continuation period), we will continue to consolidate the achievements of baby-friendly hospitals (health centers) and carry out the activities of creating "baby-friendly counties". County People's Hospital and County Chinese Medicine Hospital should do a good job in perinatal health care in lots. Tucheng, Liangcun, Wenshui, Sang Mu, Erlang, Malin, Dapo, Chengzhai, Tongmin and Yong 'an Health Centers should actively promote the development of rural maternal and child health care while strengthening obstetric construction and service quality. Township health centers with conditions such as drinking, closing stores and Zhaiba should actively establish baby-friendly health centers.
(5) Pregnant women give birth in hospitals.
Promoting the hospital delivery of pregnant women is the top priority of the project at this stage.
1, the hospital delivery price limit is implemented.
In order to enable rural pregnant women to accept hospital delivery, county-level medical and health institutions and township (district) health centers should implement hospital delivery price limit and quasi-delivery expenses. The price limit target is: rural registered pregnant women in this county (laid-off workers and poor households in cities and towns can enter the project management with relevant certificates and certificates issued by relevant departments).
(1) 300 yuan, 200 yuan, Township Health Center;
(2) The price limit of cesarean section in county-level medical institutions is 1.5 million yuan, and that in township hospitals is 1.0 million yuan;
(3) Each project implementation unit shall post the price limit or publicize the price limit charging standard through the media.
2, to carry out hospital delivery assistance.
(1) Assistance for pregnant and lying-in women in hospital delivery: pregnant and lying-in women, poor urban households and laid-off workers who hold the rural family planning certificate of giving birth in county and township medical and health institutions with the Practice License for Maternal and Child Health Technical Services and the Practice License for Medical Institutions issued by the municipal and county health bureaus. If there is no family planning certificate to give birth to a medical service institution, the medical service institution must give feedback to the local family planning department in time and deal with it accordingly according to law.
(2) Rescue standard: The rescue fund for hospital delivery is for every pregnant woman 150 yuan, for every case of dystocia, for every case of cesarean section (with medical indications requiring special rescue) and for every case of severe obstetric complications, for every case of 500 yuan (the so-called dystocia here is: ① forceps delivery; ② transverse breech delivery; ③ Prolonged labor process needs to be handled; ④ Bleeding during labor; ⑤ Fetal distress; ⑥ Treatment of birth canal injury; ⑦ Placenta adhesion; 8 uterine contraction fatigue, etc. ).
(III) The procedures for poverty alleviation shall be handled in accordance with the requirements of the Operation Plan of Hospital Delivery Assistance Fund for Poor Pregnant Women in the "Reduction and Elimination" project of the Ministry of Health, and in combination with the Operation Plan of Hospital Delivery Assistance Fund for Poor Pregnant Women in Xishui County actually formulated by our county.
(4) Villages and towns (districts) should examine and approve the relief objects for poor pregnant women, do a good job in the publicity and mobilization of hospital delivery after posting for 7 days, submit an application form for the relief funds for poor pregnant women's hospital delivery to the county health bureau every quarter, and implement the poverty relief measures for pregnant women's hospital delivery after examination and approval.
3, the implementation of high-risk pregnant women in hospital delivery transfer subsidies
Village doctors, health workers and midwives escort a high-risk pregnant woman to a hospital or county-level medical and health institution for delivery, and give subsidies for lost time. 30 yuan is paid in advance by the delivery unit and reimbursed by the county project office (Health Bureau) every quarter.
4. County-level medical and health institutions and township (district) hospitals should strengthen obstetric quality management, rationally use drugs, avoid abuse of antibiotics, do everything possible to reduce medical expenses, improve the quality of medical services, and reduce the economic burden of hospitalized pregnant women.
(vi) Green passage of life
1. Strengthen the construction of county-level maternal emergency centers. Improve the rules and regulations, improve the first aid facilities, strengthen skills training, improve the level of treatment, and conscientiously do a good job in the first aid work of critically ill pregnant women and newborns and the transfer and treatment of pregnant women. Township (district) health centers should also strengthen obstetric construction, standardize operational skills, and strictly implement referral indications for high-risk pregnant women. Rural doctors and midwives should do a good job in maternal health care services, improve their ability to identify high-risk pregnant women, transport and escort high-risk pregnant women in time, and form a "green life channel" for maternal first aid.
2, establish and improve the maternal transport support system. Township (district) governments (administrative committees) and village committees should attach great importance to maternal transport, give full play to the skills of township and village maternal transport teams, organize and coordinate relevant departments (personnel), establish township and village "maternal hospital delivery transport" organizations, and timely transport pregnant women to hospitals or health centers for delivery treatment.
3. Improve the delivery conditions in hospital. 80% township hospitals meet the obstetric evaluation standard of township hospitals in Guizhou Province. Medical and health institutions and hospitals should standardize the setting of mother-infant sharing rooms and delivery areas, and provide convenience for pregnant women and their families to eat. The delivery room and maternal and infant room are equipped with heating facilities to create a safe, hygienic, warm and comfortable environment for pregnant women to give birth in hospital.
(7) Health education
The County Working Committee for Women and Children cooperated closely with the health department to carry out comprehensive and in-depth health education and publicity, and vigorously created a social atmosphere of "caring for maternal and child health".
1, broadcast the popular knowledge of maternal and child health care for free in county cable TV stations, townships (districts) turntables and radio stations.
2. Organize women cadres and medical personnel to go to villages and households to carry out health education and publicity activities of "taking women as the core and taking the family as the best place", and publicize and educate pregnant women on health care knowledge such as maternal health care and safe delivery.
3. County-level medical and health institutions, township (district) hospitals and village clinics should run health education and health columns well, and cooperate with the Women and Children Working Committee to carry out various forms of publicity and consultation activities on maternal and child health care.
4. Distribute and post provincial and municipal "reduction" projects and posters for prenatal and postnatal care in a timely manner, and distribute folded pictures to pregnant women's homes. Villages and towns should also make leaflets and slogans according to local conditions. Medical institutions should issue open letters to pregnant women, use the health education guidance form for hospitalized patients, vigorously publicize the popular knowledge of maternal and child health, publicize the implementation of the county's "reduction and elimination" project, and implement policies related to hospital delivery limit fees and medical assistance.
(8) Information management
County project offices (health bureaus), township project working groups (health centers) and county project implementation units should attach importance to the management of project-related information in their respective jurisdictions and units, and designate special personnel to be responsible for providing original materials reflecting the project work, such as project responsibility letters, implementation plans, meeting (regular meeting) records, supervision forms, training files and rosters, health education, publicity and consultation activities, typical cases, expenditure vouchers and documents.
Verb (abbreviation of verb) the use and arrangement of project funds
(A) the use of funds
1, central fund
In 2006, the central financial transfer payment for the eradication project was reduced by100685,000 yuan, which was mainly used for maternal hospitalization assistance, personnel training, equipment and health education, supervision and maternal and child health monitoring.
(1) Health education: 1 10,000 yuan, managed by the county women and children's working committee.
(2) Personnel training: 1 ten thousand yuan, managed by the project office. County-level training: 2928, township-level training: according to the number of administrative villages, each village subsidizes 32 yuan, a township health center, and 24 townships * * * is 7072 yuan.
(3) Equipment: 30,000 yuan. The county project office shall report the equipment plan according to the equipment name specified by the superior, and the provincial finance department and the provincial health department shall conduct unified bidding and procurement.
(4) Hospital childbirth allowance: 956,850 yuan, which will be managed by the Project Office. According to the number of live-born babies per case (the number at the end of 2004) × 150 yuan, the aid funds of each township are budgeted.
2. Project matching funds
Mainly used for project information management and project supervision.
(2) Capital and equipment management
1, in strict accordance with the provisions of the national and provincial health departments and finance departments on the management of special funds, strengthen the management of project funds and improve the efficiency of fund use.
2. The project funds shall be closed (suspended), and the subsidies for poverty alleviation and lost time shall be reimbursed to the project office by the medical and health institutions on the basis of the signature and seal of the hospitalized parturient or the accompanying personnel who have been exempted from poverty alleviation.
3, the implementation of project fund management reimbursement system, financial statements once every two months, financial statements at the end of the year. Specific in accordance with the "Guizhou Province to reduce maternal mortality and eliminate neonatal tetanus project funds financial management approach" implementation.
4, the township hospitals to establish a project maintenance registration system, the project funds must be earmarked, the county health bureau and the Finance Bureau to check the use of project funds, equipment maintenance and use in accordance with the relevant provisions, serious misappropriation.
5. The equipment provided by the project shall be distributed to township health centers by the county health bureau according to the actual demand, and the health centers shall have special personnel responsible for it and keep it in good condition.
Supervision and evaluation of intransitive verbs
(1) supervision and guidance
1, and receive supervision and guidance from superiors 2-3 times a year. County-level daily work supervision, supervision 4 times a year, covering all townships (districts) and county-level project units.
2. The contents of supervision and guidance mainly include: the project plan and the use of project funds; Hospital delivery assistance, focusing on the interests of the masses; The effect of personnel training and health education; Purchase and use of equipment; Completion of project indicators; On-site guidance and special lectures, as well as the evaluation of the project by the masses.
(2) Evaluation
During the project, the county * * * conducted two evaluations, which were divided into mid-term evaluation and final evaluation (July and 65438+February). Each township and project unit conducted a self-examination and evaluation, and the Health Bureau organized an evaluation team to re-evaluate, covering all township and county-level project units.
Seven, project organization and implementation and departmental responsibilities
(1) county level
1, responsibilities of the county "reduction" project leading group office
(1) Formulate the county project implementation plan and organize its implementation, incorporate the project work into the government work schedule, and implement the target responsibility system management;
(2) Manage the whole project, organize supervision and training, and report the progress of the project to the county government;
(3) Sign a letter of responsibility with the project execution unit to implement the project tasks;
(4) Responsible for the arrangement and use of project funds.
The office of the County Women and Children Working Committee is responsible for coordinating relevant departments of the project, organizing health education and publicity, mobilizing and escorting pregnant women to give birth in hospital, etc. County Finance Bureau is responsible for the allocation of funds, and with the cooperation of Health Bureau, strengthen the supervision and management of the use of funds.
2. Responsibilities of county-level medical and health institutions
(1) County Family Planning Maternal and Child Health Care Center
① Grasp the progress of project activities in towns (districts) in a comprehensive and timely manner, and collect, count, analyze and report project work data;
(2) Organize the case investigation and review of maternal death and neonatal tetanus cases;
(three) responsible for the training of township personnel, to assist and guide the township (District) hospitals to carry out village-level training;
(4) To be responsible for the technical guidance on the management and service of maternal and child health care in townships and villages, and assist the project technical guidance group to carry out the supervision of grass-roots projects under the arrangement of the project office (Health Bureau);
Report the progress of the project in writing to the county health bureau every month.
(2) County Emergency Center (County People's Hospital)
(1) According to the arrangement of the Health Bureau, improve the first aid organization for pregnant women and do a good job in the first aid center for pregnant women;
(2) Assist the Project Office (Health Bureau) in training township personnel;
(3) Under the arrangement of the Project Office (Health Bureau), assist the project technical guidance group to carry out grass-roots project supervision;
(4) To be responsible for guiding the obstetric construction and midwifery technical services in township (district) hospitals, guiding the analysis and evaluation of the causes of maternal and infant deaths at county level, improving intervention measures, and assisting the family planning maternal and child health care center in guiding the technical services of maternal and child health care at the grassroots level.
(2) Township level: Responsibilities of township (district) project working group (health center)
1, formulate the project work plan, put it into the government work schedule, and organize its implementation;
2, responsible for the training of village health personnel;
3. Improve the regular meeting system, hold a village doctor meeting at the township level every month, collect the work data and information of last month through the monthly meeting, arrange the work, conduct targeted management and technical training, and make regular meeting records;
4, dicing signing, county maternal and child health care station and township hospitals dicing signing, in-depth guidance in towns and villages;
5. Strengthen the obstetric construction and quality management in our hospital, improve the technical service capacity of midwifery, promote hospital delivery, and timely organize the first aid and transshipment of critically ill pregnant women;
6, strengthen the management of maternal and child health care data, master the number of women of childbearing age, the number of pregnant women, the number of high-risk pregnant women, the number of live births, the number of hospital deliveries and disinfection deliveries, the number of maternal deaths and deaths of children under 5 years old, neonatal tetanus and maternal health care services, and timely summarize and report the statistics to the county-level family planning maternal and child health care center.
(3) Village level
1. "Village delivery transfer group for hospitalized pregnant women" is composed of village head, women director, village doctor, village head assistant and influential people in the village, and is responsible for mobilizing pregnant women in the village to give birth in hospital and transfer high-risk pregnant women;
2, the village clinic is responsible for maternal and child health care and related data recording, collection, statistics and reporting;
3, village doctors should do a good job in maternal card building, prenatal examination, prenatal examination, high-risk identification screening and health education, and mobilize pregnant women to give birth in hospital. If high-risk pregnant women are found, they should report to the village Committee in time and assist in referral;
4. For pregnant women who really need to give birth at home, they should be carried out in strict accordance with the operating rules of disinfection and delivery;
5, timely grasp the maternal and children under the age of 5 deaths, neonatal tetanus cases, do a good job of registration, immediately report to the township (District) health center prevention and protection group.
Eight. Related work requirements
(a) to further strengthen the "birth certificate" management, and actively promote the improvement of hospital delivery rate. For babies born outside medical and health care institutions, a Birth Medical Certificate must be issued by a family midwife, who must hold a midwifery technical examination certificate, and the village committee must issue a certificate. County Health Bureau, township (District) people's government (Administrative Committee) must do a good job in the supervision and management of the birth medical certificate. The county public security bureau should further strengthen household registration management, and newborn babies must issue a "birth medical certificate" before they can apply for household registration.
(2) The duration of the project will be implemented until the date of writing this plan. During the continuation period, all project implementation units should conscientiously sum up the project implementation work, formulate the project work plan and practical and effective measures to ensure the normal operation of the project.