單元中國(guó)社會(huì)性別與衛(wèi)生公平案例的啟示

ChinaGender&HealthEquityProjects:LuopingandZhenningSummaryofEvaluationFindingsandKeyLessonsLearned評(píng)估總結(jié)和主要的經(jīng)驗(yàn)教訓(xùn)FindingsBothprojectsmettheirgoals. SubstantiallyMakehealthservicesmoreresponsivetowomen’sneedsPartiallyViablemodelofgenderandlocalgovernancetoimproveaccountabilityoflocalhealthofficialsandhealthworkers兩個(gè)項(xiàng)目都達(dá)到了預(yù)期的目的。大體上使衛(wèi)生服務(wù)更順應(yīng)婦女的需要部分地為改善地方衛(wèi)生官員及衛(wèi)生工作者的問責(zé)制提供了切實(shí)可行的性別與地方治理的模式FindingsTheprojectsdrewonexcellenttechnicalassistanceprovidingclearideasaboutwhatshouldbedoneandhowtodoit項(xiàng)目得到了優(yōu)秀的技術(shù)援助，清楚“應(yīng)該做什么”和“怎樣做”LessonThreeprojects(Luoping,ZhenningandDafang)providegoodtemplatesforeffectiveimprovementofGHE三個(gè)項(xiàng)目（羅平，鎮(zhèn)寧及大方）為有效地改善社會(huì)性別與衛(wèi)生公平性提供了良好的范本FindingsExtensivebaselinesurveysidentifiedmajorissuesinGHEandtosomeextentinformedaction內(nèi)容廣泛的基線調(diào)查指出了社會(huì)性別衛(wèi)生公平性方面的主要問題，并在某種程度上提出了行動(dòng)方向FindingsProjectsexposedthedepthofthecommitmentoflocalgovernmentofficialstoGHEandillustratetheimportanceoftheirunderstandingandinvolvement項(xiàng)目揭示了地方政府官員對(duì)性別衛(wèi)生公平性問題承諾的深度，闡明了官員的理解和參與對(duì)解決這些問題的重要性LessonDisseminationshouldgivehighprioritytodemonstratingthebenefitsofGHEtolocalgovernmentleadersandtowinningtheircommitmenttotheprinciples宣傳方面應(yīng)高度重視向地方政府領(lǐng)導(dǎo)者展示關(guān)注性別衛(wèi)生公平的益處并贏得他們對(duì)這一原則的承諾FindingsProjectsbenefitedfromemerginghealthsecuritypolicies(NCMS).TheprojectsassistedNCMSimplementation,andinfluencedbenefitpackages項(xiàng)目受益于新出現(xiàn)的衛(wèi)生保障政策（新農(nóng)合）項(xiàng)目促進(jìn)了新型農(nóng)村合作醫(yī)療體系的實(shí)施，并影響了服務(wù)包的內(nèi)容FindingsLocalHealthPromotionGroups(HPG)allocatedfundstosubsidizehospitaldeliverySignificantincreasesinhospitaldeliveryratesfollowed當(dāng)?shù)氐慕】荡龠M(jìn)小組計(jì)劃資金補(bǔ)貼住院分娩住院分娩率隨之有了顯著的提高FindingsTheHPGandtownshiphospitalsthensuccessfullylobbiedforhighersubsidiesforhospitaldeliveryinNCMSSubsequentNCMSbenefitadjustmentsnowmakenormaldeliveryfreeinprojecttownshiphospitals健康促進(jìn)小組和鄉(xiāng)鎮(zhèn)衛(wèi)生院進(jìn)而為新農(nóng)合中的住院分娩爭(zhēng)取到了更高的補(bǔ)貼相關(guān)部門隨即作出了新農(nóng)合受益調(diào)整，項(xiàng)目鄉(xiāng)鎮(zhèn)衛(wèi)生院的住院分娩全部免費(fèi)（順產(chǎn)）LessonHealthinsurancepackagesthatincludehighlevelbenefitsforhospitaldeliveryandattractiverebatesforRTImanagementhaveamajorimpactonGHE對(duì)住院分娩及生殖道感染診治給予高額補(bǔ)貼的新農(nóng)合對(duì)性別健康公平性有著很大的影響FindingsWomenandmenhavebecameinformedaboutreproductivehealthissuesandbasicchilddevelopmentneedsandmakeeffectiveuseoftheknowledge婦女和男士們都開始了解有關(guān)生殖健康和兒童基本生長(zhǎng)需要等問題，并開始有效地利用這些知識(shí)FindingsHealthPromotionGroupsanddemonstrationhouseholdsenjoyedlearningVillagedoctors(especiallyiffemale)playedpivotalrolesinHPGcoordinationandplanning健康促進(jìn)小組及示范戶都喜歡參與學(xué)習(xí)活動(dòng)村醫(yī)（特別是女村醫(yī)）在健康促進(jìn)小組的協(xié)調(diào)和計(jì)劃過程中扮演著重要的角色FindingsKnowledgeengenderedconfidenceandwonrespectLongheldattitudesandmythsaboutbirthing,RTI,immunizationwereabandoned知識(shí)產(chǎn)生自信并贏得尊重人們丟棄了對(duì)于生育、生殖道感染及免疫長(zhǎng)久以來持有的舊觀念和神秘感FindingsWomenmadeitclearthatwiththisknowledgetheywillnotacceptwrongadviceaboutbirthingorRTIminimization.婦女們宣告，有了這些知識(shí)，她們?cè)俨粫?huì)接受有關(guān)生育或生殖道感染的錯(cuò)誤建議FindingsGoodtrainingandminorequipmenthasenabledprimarycareproviderstoeffectivelydiagnoseandmanagereproductivehealthproblems良好的培訓(xùn)和一些簡(jiǎn)單的設(shè)施使基層醫(yī)療保健提供者能夠有效地診斷并管理生殖健康問題FindingsProjectsmobilisedvillagersinwaysthatarefamiliartothecommunitiesbutnottothehealthsystem項(xiàng)目以一種對(duì)社區(qū)而言熟悉的方式動(dòng)員了村民，但這些方式并不為衛(wèi)生系統(tǒng)所熟悉FindingsEyeswereopenedtothelimitationsoftraditionaltop-downcommunicationNewwaysofcommunicatingtechnicalinformationhavebeenintroduced傳統(tǒng)的自上而下的溝通方式已經(jīng)被意識(shí)到存在著局限性介紹了新的交流溝通技術(shù)信息的方式LessonOrthodoxhealtheducationmethodshavefailedtoinformilliterateruralwomenaboutbasicreproductivehealthissuesandtheirrights.傳統(tǒng)的健康教育方式無法使文盲農(nóng)村婦女了解基礎(chǔ)的生殖健康問題和她們的權(quán)利LessonTheprojectseffectivelyconveyedknowledgebyusingmethodsthatmeettheneedsofthoselearningratherthanthoseteaching以滿足學(xué)習(xí)者而不是教授者需求的方法，項(xiàng)目有效地傳播了相關(guān)的知識(shí)FindingsWomen’sauthorityovertheirownandtheirfamily’shealthhasbeenstrengthenedWomen’sstatusintheirfamiliesandinthecommunityappearstobestronger婦女們?cè)趯?duì)自己以及家人的健康問題方面的權(quán)威性得到加強(qiáng)婦女們?cè)诩彝ブ屑吧鐓^(qū)會(huì)中的地位正在提升FindingsManywomenwerehappytobeinformedandtobeabletoexpresstheiropinions.Womenhadtakenadvantageofthe“permission”givenbytheprojecttoopenlydiscusstheirreproductivehealthstatusandtochangeitforthebetter.婦女們很高興能夠了解一些事情并能夠表達(dá)她們的觀點(diǎn)婦女們利用項(xiàng)目給予她們的“許可”公開討論她們的生殖健康現(xiàn)狀并使其變得更好FindingsMenbecameinvolvedinthetreatmentofRTITheriskoftransmissionofSTIandHIVhasbeenreducedwhenmigranthusbandsreturntovillages.男性開始參與生殖道感染的治療出外務(wù)工的丈夫回村時(shí)帶來的生殖道感染及艾滋病傳染的風(fēng)險(xiǎn)降低了LessonsInformedandempoweredwomenwilltakeboldstepstoseeksafedeliveryandreducetheirriskofreproductivetractinfectionandHIVCommunitieswillsupportthischange具備知識(shí)和權(quán)力的婦女將采取果敢的措施一步步尋求安全的分娩方式并降低生殖道感染及艾滋病的風(fēng)險(xiǎn)社區(qū)將支持這一改變FindingsHealthseekingbehaviourhasbeentransformed.Womennowactivelyseekreproductivehealthchecksandnecessarytreatment尋求健康的行為已經(jīng)轉(zhuǎn)變。婦女們?nèi)缃裰鲃?dòng)尋求生殖健康檢查以及必要的治療FindingsServicesforbirthingandreproductivehealthmaintenancehavebeenimprovedClinicaltrainingBasicequipmentsuppliedNCMSfinancialsupport分娩服務(wù)以及生殖健康維護(hù)已經(jīng)得到了改善臨床培訓(xùn)基礎(chǔ)設(shè)備供給新農(nóng)合資金支持LessonGoodinformation,effectivelyconveyedwilldispelwidelyheldtaboos,misconceptionsandmyths科學(xué)的信息和有效的傳播會(huì)有效的消除廣泛存在的禁忌、誤解和神秘感FindingsSomeACWF,FPC,BoH,MCHandotherlocalgovernmentofficialshavebroadenedtheirthinkingontheirrolesandhavejoinedincooperativeactivities全國(guó)婦聯(lián)、計(jì)劃生育委員會(huì)、衛(wèi)生局、婦幼保健機(jī)構(gòu)及其他地方政府官員拓寬了對(duì)自身角色的定位，并開始了相互合作FindingsHealthworkershavelearnedhowtodevelopnewrelationshipsoftrustwiththecommunity健康工作者已開始學(xué)習(xí)如何與社區(qū)建立新的信任關(guān)系FindingsEntrepreneurialhealthmanagershaveidentifiedopportunitiestoimproveservicesandearnmorerevenuethroughGHE通過社會(huì)性別與衛(wèi)生公平項(xiàng)目，私營(yíng)衛(wèi)生機(jī)構(gòu)管理者找到了機(jī)會(huì)以改善服務(wù)并賺取更多的利潤(rùn)LessonsGHEofferspotentialbenefitstolocalgovernmentofficialsandtoprimaryandsecondaryhealthcareprovidersTheseshouldbeactivelypromotedindissemination性別健康公平項(xiàng)目對(duì)地方政府官員以及基本衛(wèi)生保健和更高一級(jí)的衛(wèi)生保健提供者帶來了潛在的利益這些應(yīng)在傳播中積極倡導(dǎo)FindingsTheriskstosustainabilityfromrapidturnoverofleadershipandeconomicstressinlocalhealthserviceshasbeenstarklyillustrated頻繁的領(lǐng)導(dǎo)人員更替及地方衛(wèi)生服務(wù)的經(jīng)濟(jì)壓力對(duì)可持續(xù)發(fā)展帶來的風(fēng)險(xiǎn)已明顯的顯現(xiàn)出來LessonSustainabilityneedscontinuingsupportandtheinterestofofficialstogetherwitheffectiveHPmaterials可持續(xù)發(fā)展需要連續(xù)的支持、官員的關(guān)注以及有效的健康促進(jìn)材料SummaryTheprojectsshowthatGHEcanbeeffectivelyadvancedinremoteruralChinaLocalgovernmentleaders’commitmentisneededtoimplementandsustainchange項(xiàng)目揭示了在中國(guó)邊遠(yuǎn)農(nóng)村地區(qū)，社會(huì)性別與衛(wèi)生公平性問題能夠被有效地改進(jìn)創(chuàng)造和持續(xù)改變需要地方政府領(lǐng)導(dǎo)的承諾SummaryCommunities’traditionalmetho