單元10-中國社會性別與衛(wèi)生公平案例的啟示Scarf08.11.25

1、china gender & health equity projects: luoping and zhenningsummary of evaluation findings and key lessons learned 評估總結和主要的經(jīng)驗教訓評估總結和主要的經(jīng)驗教訓chris scarfdissemination meetingnovember 2008findingsboth projects met their goals.substantiallylmake health services more responsive to womens needs partiallylvi

2、able model of gender and local governance to improve accountability of local health officials and health workers兩個項目都達到了預兩個項目都達到了預期的目的。期的目的。 大體上大體上l使衛(wèi)生服務更順應婦使衛(wèi)生服務更順應婦女的需要女的需要部分地部分地l為改善地方衛(wèi)生官員為改善地方衛(wèi)生官員及衛(wèi)生工作者的問責及衛(wèi)生工作者的問責制提供了切實可行的制提供了切實可行的性別與地方治理的模性別與地方治理的模式式findingsthe projects drew on excellent techni

3、cal assistance providing clear ideas about what should be done and how to do it項目得到了優(yōu)秀的技項目得到了優(yōu)秀的技術援助，清楚術援助，清楚“應該應該做什么做什么”和和“怎樣做怎樣做”lessonthree projects (luoping, zhenning and dafang) provide good templates for effective improvement of ghe三個項目（羅平，鎮(zhèn)三個項目（羅平，鎮(zhèn)寧及大方）為有效地寧及大方）為有效地改善社會性別與衛(wèi)生改善社會性別與衛(wèi)生公平性提供了良好

4、的公平性提供了良好的范本范本findingsextensive baseline surveys identified major issues in ghe and to some extent informed action內容廣泛的基線調查內容廣泛的基線調查指出了社會性別衛(wèi)生指出了社會性別衛(wèi)生公平性方面的主要問公平性方面的主要問題，并在某種程度上題，并在某種程度上提出了行動方向提出了行動方向findingsprojects exposed the depth of the commitment of local government officials to ghe and illust

5、rate the importance of their understanding and involvement項目揭示了地方政府項目揭示了地方政府官員對性別衛(wèi)生公平官員對性別衛(wèi)生公平性問題承諾的深度，性問題承諾的深度，闡明了官員的理解和闡明了官員的理解和參與對解決這些問題參與對解決這些問題的重要性的重要性lessondissemination should give high priority to demonstrating the benefits of ghe to local government leaders and to winning their commitment t

6、o the principles宣傳方面應高度重視宣傳方面應高度重視向地方政府領導者展向地方政府領導者展示關注性別衛(wèi)生公平示關注性別衛(wèi)生公平的益處并贏得他們對的益處并贏得他們對這一原則的承諾這一原則的承諾findingsprojects benefited from emerging health security policies (ncms). the projects assisted ncms implementation, and influenced benefit packages項目受益于新出現(xiàn)的項目受益于新出現(xiàn)的衛(wèi)生保障政策（新農(nóng)衛(wèi)生保障政策（新農(nóng)合）合）項目促進了新型農(nóng)村項

7、目促進了新型農(nóng)村合作醫(yī)療體系的實施，合作醫(yī)療體系的實施，并影響了服務包的內并影響了服務包的內容容findingslocal health promotion groups (hpg) allocated funds to subsidize hospital deliverysignificant increases in hospital delivery rates followed當?shù)氐慕】荡龠M小組當?shù)氐慕】荡龠M小組計劃資金補貼住院分計劃資金補貼住院分娩娩住院分娩率隨之有了住院分娩率隨之有了顯著的提高顯著的提高findingsthe hpg and township hospitals

8、then successfully lobbied for higher subsidies for hospital delivery in ncmssubsequent ncms benefit adjustments now make normal delivery free in project township hospitals 健康促進小組和鄉(xiāng)鎮(zhèn)健康促進小組和鄉(xiāng)鎮(zhèn)衛(wèi)生院進而為新農(nóng)合衛(wèi)生院進而為新農(nóng)合中的住院分娩爭取到中的住院分娩爭取到了更高的補貼了更高的補貼相關部門隨即作出了相關部門隨即作出了新農(nóng)合受益調整，項新農(nóng)合受益調整，項目鄉(xiāng)鎮(zhèn)衛(wèi)生院的住院目鄉(xiāng)鎮(zhèn)衛(wèi)生院的住院分娩全部免費（順

9、產(chǎn)）分娩全部免費（順產(chǎn)）lessonhealth insurance packages that include high level benefits for hospital delivery and attractive rebates for rti management have a major impact on ghe對住院分娩及生殖道對住院分娩及生殖道感染診治給予高額補感染診治給予高額補貼的新農(nóng)合對性別健貼的新農(nóng)合對性別健康公平性有著很大的康公平性有著很大的影響影響findingswomen and men have became informed about reproduc

10、tive health issues and basic child development needs and make effective use of the knowledge婦女和男士們都開始婦女和男士們都開始了解有關生殖健康和了解有關生殖健康和兒童基本生長需要等兒童基本生長需要等問題，并開始有效地問題，并開始有效地利用這些知識利用這些知識findingshealth promotion groups and demonstration households enjoyed learningvillage doctors (especially if female) played p

11、ivotal roles in hpg coordination and planning 健康促進小組及示范健康促進小組及示范戶都喜歡參與學習活戶都喜歡參與學習活動動村醫(yī)（特別是女村醫(yī)）村醫(yī)（特別是女村醫(yī)）在健康促進小組的協(xié)在健康促進小組的協(xié)調和計劃過程中扮演調和計劃過程中扮演著重要的角色著重要的角色findingsknowledge engendered confidence and won respectlong held attitudes and myths about birthing, rti, immunization were abandoned 知識產(chǎn)生自信并贏得知識產(chǎn)生自

12、信并贏得尊重尊重人們丟棄了對于生育、人們丟棄了對于生育、生殖道感染及免疫長生殖道感染及免疫長久以來持有的舊觀念久以來持有的舊觀念和神秘感和神秘感findingswomen made it clear that with this knowledge they will not accept wrong advice about birthing or rti minimization. 婦女們宣告，有了這婦女們宣告，有了這些知識，她們再不會些知識，她們再不會接受有關生育或生殖接受有關生育或生殖道感染的錯誤建議道感染的錯誤建議findingsgood training and minor equ

13、ipment has enabled primary care providers to effectively diagnose and manage reproductive health problems良好的培訓和一些簡良好的培訓和一些簡單的設施使基層醫(yī)療單的設施使基層醫(yī)療保健提供者能夠有效保健提供者能夠有效地診斷并管理生殖健地診斷并管理生殖健康問題康問題findingsprojects mobilised villagers in ways that are familiar to the communities but not to the health system項目以一種對社

14、區(qū)而項目以一種對社區(qū)而言熟悉的方式動員了言熟悉的方式動員了村民，但這些方式并村民，但這些方式并不為衛(wèi)生系統(tǒng)所熟悉不為衛(wèi)生系統(tǒng)所熟悉findingseyes were opened to the limitations of traditional top-down communicationnew ways of communicating technical information have been introduced傳統(tǒng)的自上而下的溝傳統(tǒng)的自上而下的溝通方式已經(jīng)被意識到通方式已經(jīng)被意識到存在著局限性存在著局限性介紹了新的交流溝通介紹了新的交流溝通技術信息的方式技術信息的方式lesson

15、orthodox health education methods have failed to inform illiterate rural women about basic reproductive health issues and their rights. 傳統(tǒng)的健康教育方式傳統(tǒng)的健康教育方式無法使文盲農(nóng)村婦女無法使文盲農(nóng)村婦女了解基礎的生殖健康了解基礎的生殖健康問題和她們的權利問題和她們的權利lessonthe projects effectively conveyed knowledge by using methods that meet the needs of thos

16、e learning rather than those teaching 以滿足學習者而不是以滿足學習者而不是教授者需求的方法，教授者需求的方法，項目有效地傳播了相項目有效地傳播了相關的知識關的知識findingswomens authority over their own and their familys health has been strengthened womens status in their families and in the community appears to be stronger婦女們在對自己以及婦女們在對自己以及家人的健康問題方面家人的健康問題方面的權

17、威性得到加強的權威性得到加強婦女們在家庭中及社婦女們在家庭中及社區(qū)會中的地位正在提區(qū)會中的地位正在提升升findingsmany 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.婦女們很高興能夠了婦女

18、們很高興能夠了解一些事情并能夠表解一些事情并能夠表達她們的觀點達她們的觀點婦女們利用項目給予婦女們利用項目給予她們的她們的“許可許可”公開公開討論她們的生殖健康討論她們的生殖健康現(xiàn)狀并使其變得更好現(xiàn)狀并使其變得更好findingsmen became involved in the treatment of rti the risk of transmission of sti and hiv has been reduced when migrant husbands return to villages.男性開始參與生殖道男性開始參與生殖道感染的治療感染的治療出外務工的丈夫回村出外務工的丈

19、夫回村時帶來的生殖道感染時帶來的生殖道感染及艾滋病傳染的風險及艾滋病傳染的風險降低了降低了lessonsinformed and empowered women will take bold steps to seek safe delivery and reduce their risk of reproductive tract infection and hivcommunities will support this change具備知識和權力的婦具備知識和權力的婦女將采取果敢的措施女將采取果敢的措施一步步尋求安全的分一步步尋求安全的分娩方式并降低生殖道娩方式并降低生殖道感染及艾滋病的

20、風險感染及艾滋病的風險社區(qū)將支持這一改變社區(qū)將支持這一改變findingshealth seeking behaviour has been transformed. women now actively seek reproductive health checks and necessary treatment 尋求健康的行為已經(jīng)尋求健康的行為已經(jīng)轉變。婦女們如今主轉變。婦女們如今主動尋求生殖健康檢查動尋求生殖健康檢查以及必要的治療以及必要的治療findingsservices for birthing and reproductive health maintenance have be

21、en improvedlclinical traininglbasic equipment suppliedlncms financial support分娩服務以及生殖健分娩服務以及生殖健康維護已經(jīng)得到了改康維護已經(jīng)得到了改善善l臨床培訓臨床培訓l基礎設備供給基礎設備供給l新農(nóng)合資金支持新農(nóng)合資金支持lessongood information, effectively conveyed will dispel widely held taboos, misconceptions and myths科學的信息和有效的科學的信息和有效的傳播會有效的消除廣傳播會有效的消除廣泛存在的禁忌、誤解泛存

22、在的禁忌、誤解和神秘感和神秘感findingssome acwf, fpc, boh, mch and other local government officials have broadened their thinking on their roles and have joined in cooperative activities全國婦聯(lián)、計劃生育全國婦聯(lián)、計劃生育委員會、衛(wèi)生局、婦委員會、衛(wèi)生局、婦幼保健機構及其他地幼保健機構及其他地方政府官員拓寬了對方政府官員拓寬了對自身角色的定位，并自身角色的定位，并開始了相互合作開始了相互合作findingshealth workers ha

23、ve learned how to develop new relationships of trust with the community健康工作者已開始學健康工作者已開始學習如何與社區(qū)建立新習如何與社區(qū)建立新的信任關系的信任關系findingsentrepreneurial health managers have identified opportunities to improve services and earn more revenue through ghe通過社會性別與衛(wèi)生通過社會性別與衛(wèi)生公平項目，私營衛(wèi)生公平項目，私營衛(wèi)生機構管理者找到了機機構管理者找到了機會以改善服務

24、并賺取會以改善服務并賺取更多的利潤更多的利潤lessonsghe offers potential benefits to local government officials and to primary and secondary health care providers these should be actively promoted in dissemination性別健康公平項目對性別健康公平項目對地方政府官員以及基地方政府官員以及基本衛(wèi)生保健和更高一本衛(wèi)生保健和更高一級的衛(wèi)生保健提供者級的衛(wèi)生保健提供者帶來了潛在的利益帶來了潛在的利益這些應在傳播中積極這些應在傳播中積極倡導倡導

25、findingsthe risks to sustainability from rapid turnover of leadership and economic stress in local health services has been starkly illustrated頻繁的領導人員更替頻繁的領導人員更替及地方衛(wèi)生服務的經(jīng)及地方衛(wèi)生服務的經(jīng)濟壓力對可持續(xù)發(fā)展?jié)鷫毫沙掷m(xù)發(fā)展帶來的風險已明顯的帶來的風險已明顯的顯現(xiàn)出來顯現(xiàn)出來lessonsustainability needs continuing support and the interest of officials t

26、ogether with effective hp materials可持續(xù)發(fā)展需要連續(xù)可持續(xù)發(fā)展需要連續(xù)的支持、官員的關注的支持、官員的關注以及有效的健康促進以及有效的健康促進材料材料summarythe projects show that ghe can be effectively advanced in remote rural chinalocal government leaders commitment is needed to implement and sustain change項目揭示了在中國邊項目揭示了在中國邊遠農(nóng)村地區(qū)，社會性遠農(nóng)村地區(qū)，社會性別與衛(wèi)生公平性問題別與衛(wèi)生公平性問題能夠被有效地改進能夠被有效地改進創(chuàng)造和持續(xù)改變需要創(chuàng)造和持續(xù)改變需要地方政府領導的承諾地方政府領導的承諾summarycommunities traditional m