Primary Maternal and Child Health Network
Baoji has 4 districts, 9 counties, 156 townships and sub-district offices, and 1,723 village committees, with a total area of 18,172 square kilometers and a total population of 3.8159 million. Among the 13 counties and districts in the city, there are 4 municipal districts, 5 mountain counties, and 4 plain counties. There are 13 municipal and county maternal and child health institutions, including one municipal maternal and child health hospital and 12 county and district maternal and child health institutions. Seven have launched inpatient services and 10 have built baby-friendly hospitals. 1 maternal and child health care hospital of Grade A Grade A, 6 maternal and child health care institutions of Grade A Grade A and 1 maternal and child health care institution of Grade A Grade A will be completed. There are 915 city-level women and children health workers, 807 county-level and county-level women and children (concurrently) 192, village-level women and children 1,804, and an average of 10 women and children per 10,000 people, 1 in each township Maternal and child special or part-time, each village has a female town doctor or health worker. City, county, township, and village four-level networks are sound.
Organization and coordination
For many years, under the direct leadership of the Municipal Health and Family Planning Bureau (formerly the Health Bureau), a Maternal and Child Health Collaboration Group has been established, mainly focusing on maternity and child care hospitals, with the participation of organizations such as epidemic prevention, general hospitals, health education, family planning and first aid, to strengthen The implementation of women's and children's health care was carried out; seminars were held regularly with the heads of women's federations, the Communist Youth League, education, civil affairs and other departments to study problems and countermeasures; with the promulgation and implementation of the "Mother and Child Health Law", The municipal government leader is a leading group for the implementation of the "Mother and Child Health Law" in Baoji City, which is attended by the team leader, city health, finance, radio, television, and civil affairs departments, and issued the "Implementation Opinions on the Serious Implementation of the" Mother and Child Health Law ". Maternal and child health work was included in the city's overall national economic and social development plan, and obstetric rescues composed of specialists in obstetrics and gynecology (obstetrics), internal medicine, surgery, pediatrics, infectious diseases, pathology, and other medical care institutions at various levels were organized step by step. A team to guide the obstetrics department construction and maternal rescue work under the jurisdiction; in 2009, the former Municipal Health Bureau set up a health reform maternal and child health project in the Municipal Maternal and Child Health Hospital With the development of various projects, the Project Office has successively established a leading group for neonatal death review and an expert group; a leading group for newborn disease screening and a technical guidance group; a leading group for maternal and child health monitoring and an expert group for diagnosis of birth defects; and maternal and child health information The leading group and the maternity and child health network, and the maternal and child health institutions and other leading standards and review expert groups have strengthened the management of maternal and child health work.
In the early days of the establishment of the Maternal and Child Health Hospital, there was no standardized model for the management of grassroots maternal and child health work. There was no reference standard for various work systems, personnel responsibilities, technical specifications, management procedures, and monitoring programs. With the implementation of the World Bank ’s Health Ⅲ project in our city in the 1990s, the international trend of “mother safety, child first” and the implementation of the “two outlines” have promoted the pace of development of maternal and child health work in our city and the overall level of health Greatly improved. In 1990, in accordance with the actual situation of maternal and child health care in our city, the work responsibilities of maternal and child health staff at the city, county, township, and village levels have been formulated and improved; women's health care responsibilities and children's health care responsibilities in general hospitals, industrial hospitals, etc. Maternal and child health work meeting system and maternal and child health information management system, maternal system management and child under five system management procedures, maternal death and under five child death review system, high-risk maternal three-level referral and grading delivery system 23 systems, responsibilities, and procedures; developed the Maternal Death Surveillance Program, the Surveillance Program for Children Under Five, the Malnutrition Surveillance Program for Children Under Five, the Breastfeeding Surveillance Program, and Birth Defect Monitoring Program". After five years of organization and implementation, it was revised and improved in 1996. In 2007, it was revised again in conjunction with the work of creating a hierarchy of maternal and child health care institutions, adding new work content and printing to health care institutions at all levels. In 2009 and 2015, according to the national medical reform project and monitoring requirements, the implementation plan for maternal and child health monitoring was revised again. In 2015, it also organized and compiled the "Manual and Supervision Guidance and Evaluation Manual for Maternal and Child Health Monitoring in Baoji City" and issued it to all units to guide the work.
With the start of the establishment of standardized child health clinics in 2010, the “Implementation Plan for the Establishment of Standardized Child Health Clinics in Baoji City” was formulated and issued, and the establishment standards and acceptance scoring standards for standardized child health clinics were formulated; an organization leading group and Technical guidance group, standardizing the scope of creation, content, acceptance criteria, methods and steps, clarifying the responsibilities and requirements of institutions at all levels; training all staff of all units to be created; organizing experts to meet standards and acceptance in a timely manner; The successful standardized childcare clinic implements dynamic management and conducts spot checks every year. By the end of 2016, a total of 164 child health clinics had passed the acceptance check.
In 2006, based on the quality inspection of obstetrics, our city carried out comprehensive obstetrics construction to meet the standards. The first is to establish and improve the obstetrics network, and set up city and county-level obstetrics work leadership teams led by the directors of the Health Bureau and led by the midwifery units. Established city and county obstetric quality management centers, with offices under the obstetric quality management center, which are located in the same level of maternity and child health care hospitals; a city and county obstetric emergency network with the Baoji obstetric emergency center as the leader, and One network and three establishments are divided into a maternal and child safety responsibility network, a maternal and child safety information network, and a maternal and child safety transfer network. The second is to strengthen obstetric management. Formulated "Baoji Obstetrics Quality Management Measures", "Baoji Obstetrics Quality Control Plan (Trial)", "Obstetrics Safety Management Regulations", "Standards for Obstetrics Construction of Medical Institutions at County Level and Above", "Established Obstetrics Construction at Township-level Health Center Standards ", which carry out specific specifications in terms of institution building, personnel responsibilities, system building, quality management, and evaluation measures. Third, the Baoji City Obstetrics Work Manual was formulated and issued, which unified the work system, personnel duties, rescue procedures, and three types of registers: Obstetrics Hospital Admission Registration, Midwifery Registration, and Critical Maternal Rescue Registration. The Obstetric Quality Management Committee was established in 2002 and adjusted in 2009. In 2013, the obstetric work system and staff responsibilities were updated. The fourth is to strictly implement the obstetrics construction first-compliance and later-access system. In accordance with the Law of the People's Republic of China on Maternal and Infant Health Care and the Measures for the Implementation of the Law of the People's Republic of China on Maternal and Infant Health Care, strengthen the management of institutions, personnel and technologies that carry out special technical services for maternal and child health and strictly enforce the licensing system. The fifth is to establish a mechanism for the treatment and referral of critically pregnant women and newborns. The “Working Plan for the Treatment and Referral of Critical Pregnant Women and Newborns in Baoji City” was formulated, and the city-level core, joint-level hub, and county-level hierarchical responsibility, critical linkage, and efficient operation of critically pregnant women and Newborn Care and Referral Network. Sixth, adhere to the maternal death review system. Seventh, the supervision of the quality of obstetric work has been strengthened. Every year since 2001, obstetric experts, members of obstetric rescue teams and health managers are organized to carry out obstetric quality inspections on municipal and municipal administrations, industrial enterprises, military hospitals, county-level general hospitals, and township health centers. Through supervision, the obstetrics layout has been fundamentally improved, unreasonable settings have been rebuilt, obstetric functions have been improved, and midwifery businesses of substandard institutions have been banned. Eighth, the obstetrics quality report system was established, and the obstetrics quality information was regularly collected every quarter to accumulate first-hand information to strengthen the city's obstetrics quality management. By the end of 2016, a total of 43 health care institutions in the city had reached the obstetric construction standards.
In October 1993, the Municipal Maternal and Child Health Hospital implemented a one-stop service for breastfeeding education and guidance, and took the lead in establishing a national-level baby-friendly hospital, which kicked off the establishment of the city's "baby-friendly hospital". After that, the city organized teacher training for obstetricians and pediatricians in primary hospitals in five batches. The Municipal Health Bureau actively organized management and technical experts to tour and guide the creation work, and invited provincial and municipal review experts to review and accept the establishment of the hospital. As of 2001, 58 city- and county-level general hospitals with maternity beds, maternity and child health hospitals, and Chinese medicine hospitals have been established as baby-friendly hospitals; 76 township-level hospitals have been established as baby-friendly township health centers. In 2013, the Municipal Health Bureau organized special inspections on breastfeeding and obstetric safety management throughout the city in accordance with the requirements of the National and Provincial Departments of Health. Supervised and inspected whether the 47 midwifery institutions with the qualifications for delivery in the city participated in the promotion and donation of breast milk substitutes, the identification and transfer system of newborns, the disposal of stillbirths, dead babies and fetal appendages, and standardized the obstetrics management. In 2014, the Municipal Health Bureau carried out the review and establishment of the city's baby-friendly hospital. A total of 47 institutions in the city applied for review and establishment. After acceptance, a total of 40 units passed, and the pass rate was 85.11%. "Baby Hospital" title. Health care institutions at all levels throughout the city take the extensive implementation of breastfeeding education and guidance as a core content of baby-friendly hospital work, actively carry out baby-friendly hospital publicity activities, and make full use of traditional and new media to promote the benefits of breastfeeding and mother-to-child sharing. The advantages of using the "March 8th" Women's Day, "June 1st" Children's Day, 5.20 breastfeeding day, "World Breastfeeding Week" and other opportunities to organize mass breastfeeding publicity activities to improve breastfeeding rate.
In order to further regulate the management of maternal and child health institutions, the rating review of maternal and child health institutions was launched in 1997. In the same year, our hospital was established as a second-class maternal and child health hospital, and then Chencang District, Fengxiang County, and Long County were established as first-class maternal and child health hospitals. In 2007, the evaluation of the maternity and child health institutions was started again. In the same year, our hospital was established as a third-level first-class maternal and child health care hospital. In 2011, the Ministry of Finance and the Ministry of Health arranged a one-time arrangement for our province and the provincial finance department and the provincial department of health arranged a capacity-building subsidy of 23.6 million yuan for the city's county-level maternal and child health institutions to allocate the necessary funds for 12 county-level maternal and child health institutions in the city. Medical equipment and repairs. The county-level maternity and child health institutions that provide inpatient services and those that do not provide inpatient services will be subsidized at 2.1 million yuan and 1.7 million yuan, respectively. In 2012, the Municipal Bureau completed the bidding, procurement, maintenance and renovation of equipment in accordance with the procedures, which effectively improved the service capacity of grassroots maternity and child health institutions. In 2016, the Maternal and Child Health Hospitals of Chencang District, Qishan County and Fengxiang County were established as second-class first-class maternal and child health hospitals. So far, a total of six county-level maternal and child health institutions have been established as second-class first-class maternal and child health hospitals, accounting for the county-level maternal and child health care. 50% of the institution.
Grassroots women and children training
From the establishment of the hospital to the end of 2016, our hospital held a total of 212 training courses at various levels and trained 29,333 women and child health-related personnel. A total of 45 courses including the basic theories of maternal and child health, basic skills, basic knowledge, statistics on maternal and child health information, and "five suitable technologies", and 6 sessions of teacher training for the establishment of a baby-friendly hospital, 》 14 related trainings and 55 trainings related to the maternity and child health project. 92 trainings were provided to maternal and child health care staff, obstetrics and pediatric business staff in the city, county and township. The training is rich in content and has a large number of participants. It is a combination of long, medium, and short-term, combined with theory and practice. It has trained a large number of practical talents for the development of the city's maternal and child health cause.
Two systems management and prevention of women's and children's diseases
In the early days of the establishment of the hospital, women's health work focused on advocating and promoting the new method of delivery, and reforming the old method of delivery. By 1986, perinatal health care pilots focusing on maternal system management were implemented in the city. In 1988, paid health care was the leader. Pre-marital health care and perinatal health care, and adopted the principles of health insurance compensation, paid services and unpaid services classification guidance, and implemented the maternal system management work. The "Maternal Health Care Manual" was standardized uniformly throughout the city, and was revised in 2002, and thereafter revised every two years, bringing the systemic management of pregnant women on a track of regular healthy operation. In conjunction with the establishment of community health institutions, in 2009, the "Urban Maternal System Management Implementation Plan" was formulated to continuously standardize the maternal system management. In 2009, the city started to implement a rural hospitalization and delivery subsidy program for rural pregnant women. The hospitalization delivery rate for pregnant women and the hospitalization delivery rate for high-risk pregnant women in the city were effectively increased. Since 2010, the city has launched a basic public health maternal health management project to provide free prenatal check-up services for pregnant women and further put the maternal system management work into practice. The maternal system management rate increased from 32.8% in 1988 to 96.87% in 2016, the hospital delivery rate increased from 68.21% to 100%, and the high-risk maternal system management rate reached 100%. Maternal health care has made great progress.
Child health care was limited to annual child physical examinations and planned immunizations until 1988. In 1988, the child health insurance compensation system was introduced. In 1996, taking the opportunity to use the national unified "Medical Certificate of Birth" as an opportunity, it implemented a one-stop service for maternal system management, hospital delivery, and child system management, which comprehensively strengthened the child system management work; 2007 With the goal of establishing a graded maternity and child health hospital, gradually develop diversified child health services; in 2009, it took the “National Child Health Management Work Standards” and “0-36 Month Child Health Management Standards” issued by the Ministry of Health as its model and regularly deepened Childcare institutions conduct health care guidance, dietary nutrition analysis, health checkups, etc., and are included in the level evaluation of childcare institutions; since 2010, the city has started the work of 0-13 months of public health for children's health management projects in the basic public health area. All children from 0 to 36 months provided free health check-up services. In October 2011, the service was expanded to 6 years of age, which further expanded the scope of the service population. In 2014, according to the spirit of the central and provincial documents, a "Baoji Nursery Kindergarten" was formulated and issued. Implementation Measures for Health Care Management, formulated a health evaluation system for childcare institutions, and strengthened childcare facilities The supervision and management of health care work has improved the quality of health care for children aged 4-6 years. In 2016, the establishment of a three-year child care institution health care work demonstration park and normative park in our city was initiated, which improved the counties and districts The degree to which institutions attach great importance to health care has raised the overall level of health care management in child care institutions. The city's children's system management rate increased from 35.23% in 1988 to 94.68% in 2016.
In the prevention and treatment of women's and children's diseases, the first is to focus on the prevention and treatment of "three cancers", and every two years in the cities and every three years in the rural areas, women's diseases are checked and treated. The monitoring data show that the prevalence of various gynecological diseases has decreased from 77.31% in 1990 to 29.97% in 2016, and the prevalence of cervical cancer has decreased from 453.86 / 100,000 in 1990 to 45.01 / 100,000 in 2016, a decrease 90.1%. The second is to do a good job in the "two cancers" inspection project for rural women. In 2009, Chencang District was identified as the national breast cancer and cervical cancer inspection project counties. In 2012, Fufeng County, Long County, Qishan County and Feng County were added as project counties. Free "two cancers" screening for rural women. The third is to increase efforts to prevent and treat children's diseases. In the 1990s, the city promoted ARI standardized management technology and ORT oral rehydration therapy in one-half of the towns and villages, which reduced the death rate of infant pneumonia from 22.3% to 13.99%, reducing the age of under 5. The occurrence of childhood diarrhea combined with dehydration; carried out pediatric growth monitoring and nutrition monitoring, and formulated interventions. A neonatal asphyxia resuscitation program was launched in 2005, which drastically reduced the deaths caused by neonatal asphyxia. In 2011, a comprehensive birth defect prevention and treatment program was launched for congenital anomalies; after 2012, interventions for preterm infants, aged 0-6 years, were initiated. Screening for children with disabilities and infantile hemangiomas has increased the rate of early diagnosis and treatment of sick children.
Enforcement of the Maternal and Child Health Act
On June 1, 1995, the National People ’s Congress promulgated the “Mother and Child Health Law of the People ’s Republic of China”. The city adopted a variety of methods such as television and radio lectures, organizing propaganda vehicles, distributing videotapes, and distributing leaflets to promote publicity and create a good atmosphere At the same time, a city, county and district maternal and child health law enforcement supervision team was established.
In 2007, in combination with the implementation of the "Mother and Child Health Law", the city transferred the birth attendants in the villages of the Pingyuan County and the township hospitals to health workers, and no longer carried out delivery work; only mid-range rural villages with inaccessible traffic were allowed to have birth attendants The people who were to be employed as birth attendants were given theoretical training and technical assessment. Those who passed the exam were issued a "Family Midwife Certificate" in accordance with the law, and a group of birth attendants with backward knowledge and technology and older ages were banned. In accordance with the requirements of the Maternal and Child Health Law, a municipal-level "Maternal and Child Health Law" laws and regulations and special technical service training courses for maternal and child health are held every three years. Level teachers to conduct training and practice qualification review, and uniformly renew the municipal-level "Maternal and Child Health Technical Service Staff Qualification Certificate." As of the end of 2016, the city has issued a total of 6,238 maternal and child health technology certifications and 1,181 mother and child health technology practice licenses.
During the implementation of the "Mother and Child Health Law", in order to actively implement the "Provisions on Prohibition of Fetal Gender Identification for Non-medical Needs and Artificial Termination of Gender Selection for Non-Medical Needs" of the former National Family Planning Commission, the Ministry of Health and the former State Food and Drug Administration, the Municipal Health The bureau and the city's family planning department jointly issued the “Regulations on Prohibition of Fetal Gender Identification for Non-Medical Needs and Artificial Termination of Selective Gender Selection”, and severely cracked down on the illegal implementation of fetal gender identification and selection of artificial termination of gender selection. The Maternal and Child Health Hospital is a fixed-point diagnostic institution that requires induction of labor for pregnancy medicine over 14 weeks.
Management of Birth Medical Certificate
In the early 1990s, the city used the "Birth Medical Certificate" printed by the former Department of Health, and since 1996, the "Birth Medical Certificate" printed by the Ministry of Health has been used uniformly. In July 2005, the city renewed the management procedures for the "Birth Medical Certificate", and jointly issued the "Baoji Medical Birth Medical Certificate Management Measures", which clarified the system for the management, issuance, issuance and order of birth medical certificates. Developed "perinatal system management software" and "birth medical certificate management software", and installed application software for medical institutions at all levels in the city, realizing computer management of obstetric information and computer printing of "birth medical certificate". The province took the lead in incorporating the "Birth Medical Certificate" and obstetric quality into computer management, and implemented a direct online reporting system and a "Birth Medical Certificate" issue system with a hierarchical responsibility system and an accident investigation system. In 2009, according to the requirements of the Ministry of Health, the city began to waive the cost of "Medical Birth Certificate" from January 1, 2009. In 2010, it was jointly revised with the Public Security Bureau and issued the "Baoji City Notice on Further Strengthening the Management of Birth Medical Certificates", which further clarified the "Birth Medical Certificate" issuance and registration system, application procedures, number of receipts, issuance, and reissue 2. The procedures for reissuing and issuing the "Medical Certificate of Birth" in special circumstances shall be implemented by special personnel management, separation of badges, strict examination, regular verification, and assessment. Since January 1, 2014, the city has uniformly launched the new version of the "Birth Medical Certificate", the special seal for birth medical certification and the birth medical certificate information management system, and has realized that the city and county administrations can issue the "Birth Medical Certificate" to the issuing organization through the Internet. And the Municipal Public Security Bureau formulated and issued the “Notice on the Launch and Standard Management of the New Version of the“ Medical Certificate of Birth ””, which further standardized the issuance, replacement, and replacement of certificates. In 2016, the city's birth information registration work was started.
As of the end of 2016, a total of 656,399 birth certificates were issued in the city, and no error occurred.
1. Four major public health women and children projects
The project of supplementing folic acid to prevent neural tube defects for women of childbearing age was launched in 8 counties in Chencang District, Fengxiang County, Fufeng County, Long County, Qianyang County, Linyou County, Feng County and Taibai County in 2008. Weibin District, Jintai District, Qishan County, and Mei County have been added, and the project has achieved full coverage. Over the years, the project work has been closely focused on the task of improving the quality of the birth population. Through key training such as personnel training, social promotion and mobilization, investigation of pregnant women and pregnant women, the distribution of folic acid, follow-up monitoring of medication, and information reporting, etc. The city's awareness of receiving birth defect prevention services for pregnant women and early pregnant women has increased significantly. By the end of 2016, a total of 1.0332 million bottles of folic acid had been distributed in the city. A total of 260,171 women of childbearing age had taken folic acid tablets. The folic acid consumption rate reached 97.45%, the compliance rate was 91.46%, and the awareness rate was 97.21%.
The rural maternity hospitalization and childbirth subsidy project was piloted in Long County in 2008. Since 2009, it has been fully implemented in our city, achieving full coverage of rural maternal hospitalization and childbirth subsidies. Through the implementation of the "six unifications" of the project, that is, unified implementation plans, unified price limit standards, unified subsidy standards, unified service package contents, unified cesarean section indications, and unified through-vehicle reimbursement, it has ensured the smooth operation of the project. Adopting a combination of rural maternal hospitalization and childbirth subsidies and the New Rural Cooperative Medical Care System to determine the sharing ratio and subsidy standards to achieve free hospital delivery for rural mothers in midwifery institutions at or below the county level. With the "agricultural cooperation" funding change, The city's agricultural exemption subsidy standards have been adjusted four times. As of the end of December 2016, the total number of project subsidies was 209,547. The city's free hospital delivery rate for pregnant women was 98.36%, the total amount of subsidy was 168 million yuan, the per capita subsidy amount was 801.59 yuan, and the exemption rate was 97.69%.
The rural women's cervical cancer and breast cancer screening project was launched in Chencang District in 2009. In order to ensure the quality of the project, the city and county established a project leadership group and expert technical guidance group to carry out extensive project publicity and social mobilization. Experts participate in breast cancer examinations on-site and provide technical instruction and quality control, breast molybdenum target examinations for suspicious or positive breast cancer cases, histopathological examinations of suspicious or positive patients with cervical cancer colposcopy, and tissue experts perform semiannually Quality control of two cancer tests at once. In 2012, Fufeng County, Qishan County, Long County, and Feng County were added as project counties, and the project coverage was expanded. By the end of 2016, 334,755 cervical cancer examinations, 139 confirmed diagnoses, 25,188 breast cancer examinations, and 12 confirmed diagnoses had been completed in counties in the "Two Cancers" project counties. All abnormal diagnosed cases were followed up for treatment.
The AIDS, syphilis, and hepatitis B mother-to-child blockade project was fully launched in our city in June 2011, and Weibin District was identified as the project county. In June of the same year, the project was fully implemented in our city, and all health care institutions in the city began to implement AIDS and syphilis. Intervention and prevention measures for pregnant women and children born with hepatitis B infection, and carry out comprehensive prevention and treatment. In order to ensure the smooth implementation of the project, the city formulated and issued the "Baoji City's Implementation Plan for the Prevention of Mother-to-Child Transmission of AIDS, Syphilis and Hepatitis B"; held city-wide project training courses; formulated the project hepatitis B immunoglobulin distribution and use process; formulated and issued The notice on matters related to the use of hepatitis B immunoglobulin preparations in the prevention of mother-to-child transmission of AIDS, syphilis, and hepatitis B was issued, and the operating mechanism of the city's prevention of mother-to-child transmission of AIDS, syphilis, and hepatitis B was gradually standardized. In 2014, in order to effectively strengthen the management of AIDS maternal and babies born to mothers and babies, the “Baoji City Early Diagnosis of Infant AIDS Infection Implementation Plan” was formulated and issued (Bao Wei She She Fa  No. 620), comprehensive Implement early diagnosis of HIV infection in children born to pregnant women with HIV infection. In 2016, AIDS, syphilis, and hepatitis B mother-to-child blocking programs achieved full coverage.
By the end of 2016, a total of 215,916 pregnant women had been tested and consulted for AIDS, syphilis, and hepatitis B. The detection rate of hospitalized delivery women increased from 65.77% in 2011 to 99.51% in 2016. A total of 12 pregnant women with HIV infection were found. For example, 106 cases of syphilis-infected pregnant women were given intervention treatment; 4,499 cases of surface antigen-positive pregnant women were found, and 4013 babies born to them were injected with hepatitis B immunoglobulin for free.
2. Basic Public Health Maternal and Children 0-6 Years Health Management Project
On April 1, 2010, the basic public health service for maternal and 0-36 month child health programs was launched. In 2011, the service targets for children were expanded to 0-6 years according to national regulations. At the beginning of the project, various forms of publicity work were carried out in the city and counties. The publicity color pages and banners were printed. The publicity pages were printed uniformly in all counties and districts. The awareness rate of the project. For many years, the Municipal Project Office has consistently printed and distributed the Maternal Health Handbook and Child Health Handbook for the twelve counties. In 2016, the postpartum visit rate of pregnant women in the city reached 96.05%, the maternal health management rate was 32,577, and the system management rate was 98.68%; the neonatal visit rate was 96.60%, and the system management rate was 94.68%. Maternal and children aged 0-6 enjoy free Basic public health expenses amounted to 17.572 million yuan.
3. Free basic services for maternal health care
In 2015, under the unified arrangement of the Provincial Health and Family Planning Commission, the city integrated eight sub-projects of maternal and child health care and family planning services, and launched a pilot free basic service project of maternal system health care in Longxian, Meixian and Fengxiang counties. The project includes four projects including free pre-pregnancy health checkups, supplementation with folic acid to prevent neural tube defects, maternal health management, and free hospitalization and delivery allowances for pregnant women in rural areas. It has expanded prenatal HIV and syphilis hepatitis B screening, and newborn disease screening. The coverage of the two projects includes two new items: prenatal screening and prenatal ultrasound. Provide basic free fertility services for pregnant women during pregnancy, pregnancy, childbirth and postpartum. In the same year, the Provincial Health and Family Planning Commission held the Provincial Conference on Free Basic Services for Maternal System Health Care in Long County, and the Municipal Health and Family Planning Bureau and the Long County Health and Family Planning Bureau exchanged meetings. In 2016, the Provincial Health and Family Planning Commission added Qishan County, Fufeng County and Feng County as provincial pilot counties, and the city's funding was implemented simultaneously in other counties and districts. It has taken the lead in achieving full coverage nationwide and established a free basic birth system for urban and rural residents.
4. Newborn Disease Screening Project
In April 2007, the city established the Baoji City Neonatal Diseases Screening Center. In June of that year, the city started the neonatal disease screening work, screening all newborns with phenylketonuria and hypothyroidism. 2011 In addition, screening for adrenocortical hyperplasia and glucose hexaphosphate dehydrogenase deficiency was added in 2012; newborn hearing screening was initiated in 2012. In 2014, the National Newborn Disease Screening Program in poor areas was implemented in 5 counties including Fufeng County, Qianyang County, Long County, Linyou County, and Taibai County, and phenylketonuria and thyroid function were free of charge for newborns in the registered counties. Reduction and hearing screening; In 2015, free phenylketonuria, hypothyroidism, and hearing screening were performed on newborns with household registration in the provincial pilot districts of the free basic service project of maternal system health; in 2016, the city's registered newborns All are provided with free phenylketonuria, hypothyroidism, and hearing screening services in accordance with the regulations of each county.
Since the start of newborn disease screening, the first is to actively carry out work in strict accordance with the requirements of the Ministry of Health's "Newborn Disease Screening Technical Specifications." The second is to enable children to receive standardized and effective treatments, to avoid screening and incurable conditions, and to minimize the impact of the disease on children. Since 2009, the city's finance has allocated special funds to establish new screening-positive children Diagnosis and treatment assistance fund. Provide 96 cans of special milk powder for each child with phenylketonuria free of charge, and follow up to 6 years of age regularly; provide blood thyroid hormone levels, thyroid B ultrasound, and carpal X test services for children with hypothyroidism regularly, and Follow up to 6 years. The third is to set up a parent club for children with positive screening, establish a WeChat group for parents of children, and carry out regular activities. Fourth, the phenylketonuria medical protection work for children in the province was started on June 1, 2017. Children with phenylketonuria who purchased therapeutic food at designated treatment institutions were included in the medical insurance and NCMS outpatient chronic diseases for reimbursement. The sieve-positive fund phenylketonuria milk powder rescue work stopped immediately, focusing on the follow-up, monitoring and club activities of children. Rescue and follow-up of children with hypothyroidism continue.
Through unremitting efforts, the screening rate for neonatal diseases has gradually increased. The genetic metabolic disease has increased from 29.2% in 2007 to 98.04% in 2016. The hearing screening rate has reached 97%. The municipal new screening positive child assistance fund has accumulated. Rescued 64 children with phenylketonuria and 215 children with hypothyroidism, so that the children maintained normal mental and physical development. As of the end of December 2016, 19,415 cases of genetic metabolic diseases were screened free of charge in the five counties of the newborn disease screening project in poor areas, 3 cases were diagnosed with phenylketonuria, and 12 cases were hypothyroidism; 19,476 cases were screened for hearing, and 2 cases were confirmed. . The confirmed children are included in the city's new screening positive child rescue fund for free assistance.
V. Prenatal Screening Project
In May 2015, our city fully launched the prenatal screening program for pregnant women. Prenatal screening is to collect venous blood within 15-20 + 6 weeks of pregnancy, use time-resolved fluorescence immunoassay to determine the biochemical indicators in the serum of pregnant women, and assess the fetal risk by combining the age, gestational week, and weight of the pregnant woman. The risk of 21-trisomy syndrome (Down's syndrome) and fetal neural tube defects, 18-trisomy syndrome (Edward syndrome), focus on the management of high-risk pregnant women detected by screening, timely intervention, and reduce birth defects. Was born. Beginning in 2016, except for the county-level pregnancy-prevention and exemption project counties (Jintai District, Fengxiang County, Qishan County, Mei County, Long County, and Feng County), the remaining counties and districts will be financed by the city's finances to provide free prenatal screening for pregnant women in their jurisdictions. Since the implementation of prenatal screening in our city, through the overall arrangement, a city-wide prenatal screening network has been established with the city's maternity and child health hospital as the screening center, other midwifery institutions in the city as blood collection terminals, and county and district maternal and child health hospitals as the link. , Developed work procedures, carried out business training, and promoted the smooth development of project work. As of the end of December 2016, a total of 37,882 pregnant women were screened in the city, and 2,564 high-risk pregnant women were screened. Among them, 1959 were at high risk for Down syndrome, 592 were at high risk for neural tube defects, and 73 were for Edwards syndrome.
6. Prenatal ultrasound examination items
In 2015, the city launched the prenatal ultrasound examination project, which includes two aspects: prenatal routine ultrasound examination and prenatal system ultrasound examination. In order to ensure the smooth running of the project, the city unifiedly formulated and issued implementation plans, organized personnel to participate in training at all levels, completed the organization's qualification certification work, established a screening and referral network, and has now formed a screening center (Baoji Maternal and Child Health Hospital). , Two sub-centers (Baoji Central Hospital, Baoji People's Hospital), 21 systematic ultrasound inspection agencies, and an inspection network covering 12 counties and districts with prenatal routine ultrasound inspection. (1) Prenatal Routine Ultrasound Examination: Our city began to implement prenatal routine ultrasound examinations in May 2015. In 2015, Fengxiang County, Meixian County, and Longxian County were the project counties. In 2016, Jintai District, Qishan County, and Fengshan County were newly added. The county is the project county, and 3 free prenatal routine ultrasound examinations are performed on pregnant women with registered households in the project county. By the end of 2016, a total of 34512 free prenatal routine ultrasound examinations had been conducted, 94 cases of suspected abnormal fetal types were found, and 94 people were referred. (2) Prenatal system ultrasound examination: Our city has unifiedly managed the prenatal system ultrasound examination in the city since January 2015. From 2015 to 2016, the city has carried out a total of 50,583 prenatal system ultrasound examinations and found 764 cases of deformities. , 292 people were referred.
Seven, maternal death review project
Maternal death review is a process of systematically reviewing and analyzing cases with clear criteria and proposing improvement measures to improve the quality of health care services. In order to be able to find problems in all aspects of the maternal death process in a timely manner, and put forward targeted interventions to achieve the purpose of improving maternal system management and obstetric quality, and reducing maternal mortality, the city has begun to launch the city since 1987 Review of maternal deaths, and insist on reviewing once a year. The members of the municipal rescue team participated in and guided the assessment of the rescue and death of critical pregnant women in counties. The first is to set up a city and county level maternal death rescue expert group to clarify responsibilities and division of labor; the second is to carry out a three-year round of obstetrics construction to reach the standard; the third is to implement a one-vote veto system for maternal deaths and meet with leaders County, districts and counties with more than 2 cases of maternal deaths or more than the number of maternal deaths in the jurisdiction of the previous year canceled the advanced qualification for the year; Fourth, the city ’s maternal death review was organized and held once a year Analyze the cause of death, complete the review report, formulate interventions and organize implementation to reduce the maternal mortality rate in our city year by year.
Eighth, newborn death review project
Since 2010, the city has begun reviewing newborn deaths throughout the city and insists on reviewing once or twice a year. Members of the municipal neonatal death review expert group participate in and guide the county-level district critically ill newborn rescue and death review. The first is to establish a leading group and expert group for newborn death review, establish and improve the organizational structure, and clarify the responsibilities at all levels; the second is to formulate the "Baoji Newborn Death Review Program" and the "Newborn Death Review Work Specifications"; City and county reviewers conduct training; Fourth, the city-level, county-level, and district-level neonatal death review meetings are held every year; Fifth, the city-level experts are dispatched to participate in the guidance of county (district) -level newborn death review meetings; Issued the "Baoji City Newborn Death Review Specification"; Seventh, experts are organized every year to analyze the cause of newborn deaths in the city and various influencing factors, to formulate targeted interventions and organize implementation, so that the newborn mortality rate in our city decreases year by year.
Nine, newborn resuscitation project
In April 2004, the Department of Maternal and Child Health and Community Health of the Ministry of Health launched the National "Newborn Asphyxia Resuscitation Project". At the end of 2005, the city's first round of neonatal asphyxia resuscitation project work was launched. After the start of the project, cities and counties have formulated corresponding work plans, incorporating the theory and practice of neonatal asphyxia resuscitation into the acceptance of obstetric construction standards, implementing a one-vote veto system, and units that do not pass the asphyxia resuscitation technology cancel their obstetric construction qualifications and year-end evaluation qualifications. . In 2006, in conjunction with the project of “Reducing Maternal Mortality and Eliminating Neonatal Tetanus”, five training courses on neonatal asphyxia were organized. At the same time, the neonatal asphyxia resuscitation technology is required to be included in the city's maternal and child health post training and "three bases and three strict" assessments. In 2008, 2009 and 2012, they received national and provincial project supervision and final evaluation. In 2013, the second round of neonatal asphyxia resuscitation project was launched. In that year, 243 medical and nursing staff in the obstetrics and pediatric departments of midwifery institutions above the county level were trained for neonatal resuscitation. In 2014, more than 60 professional and technical personnel under the direct management of the city conducted training and assessment on new international concepts and standards of neonatal resuscitation technology. By the end of 2016, the cumulative number of trainings had reached 4,284, and the training passing rate had reached 96%. Deaths due to neonatal asphyxia fell from the first place in 2004 to the fifth place in 2016.
X. Maternal and Child Health Information Management
Maternal and child health annual report statistics have been implemented since 1984, and have undergone many changes. They are reported quarterly by county maternal and child health centers (institutions), and the city maternity insurance center holds two report review meetings each year. In 1999, based on the statistical report of women and children's health of the Ministry of Health, the city's "township-level standardized reports", "maternal and childbirth system management register", and "high-risk pregnancy register" were issued to all townships, thereby changing township health Information fragmentation and clutter make information give full play to its staff role. With the implementation of computer network reporting of the city's maternal and child health information in 2000, the maternal and child health information software was updated in 2005 and 2010 in accordance with national requirements. The 2014 Maternal and Child Health Annual Report was revised to a direct report on the network system.
At work: First, improve information organization and strengthen information work leadership. Established the Baoji City Maternal and Child Health Information Leading Group with the director of the City Maternal and Child Health Hospital as the group leader, and the directors of the Maternal and Child Health Hospitals of all counties and districts, and an information network group with the participation of the maternal and child health information supervisors at each county, clarifying the responsibility at all levels , Consolidating the work tasks; the second is to consolidate and improve the three-tier network of women's health. In order to ensure the relative stability of women and children and ensure the continuity of maternal and child health information, the transfer of county-level women and children's health information management staff must be trained after the city's maternity and child health hospitals. Changes in rural women's and children's professionals must be approved by the county health bureau and maternity insurance hospitals Talent changes, reserve human resources for the sustainable development of maternal and child health. The third is to establish and improve information management systems and responsibilities. The fourth is to strengthen the standardization of statements. The township-level standardized reports have been revised and printed three times, and they have been used throughout the city to change the phenomenon of town-level information films and Zhang. In 2007, the village-level standardized reports were uniformly designed and printed by counties and districts. Standardization provides important clues for ensuring data quality. Fifth, an information evaluation mechanism has been established. On the one hand, the management of maternal and child health information is included in one of the maternal and child health goals responsibility system assessment content and year-end evaluation. On the other hand, a quantitative evaluation system for maternal and child health information is established. In accordance with the "Quantitative Standards for Quality Control of Maternal and Child Health Information in Baoji City", Information quality control is conducted quarterly and municipally every six months.
Women's and children's health monitoring
In order to dynamically grasp the city's women's and children's work and women's and children's health, in accordance with the principle of random stratified cluster sampling, 24 township offices in four counties and districts were selected to establish a city's women's and children's health monitoring network and set up in the primary health care department of our hospital. The monitoring center was established and a quality control system was established. The first is to monitor maternal deaths in 12 counties and districts; the second is to monitor the death of children under the age of 5 in 24 townships in Jintai District, Fufeng County, Qianyang County, and Feng County (Bei County was adjusted to Fufeng County in 2011); The third is to carry out the monitoring of hospital birth defects in 13 health care institutions; the fourth is to undertake the national "three networks" monitoring and the monitoring of population birth defects; the fifth is that the Municipal Maternal and Child Health Hospital and the Municipal People's Hospital were identified as National Critical Maternal Hospitals in 2010 Monitoring points; Six is that Jintai District was identified as the national child nutrition and health monitoring point in 2011; Seven is a city-level child nutrition and health monitoring sampled in four counties. It won the Outstanding Prefectural-level Data Utilization Award in the 2012 National Maternal and Child Health Institution Monitoring Work Evaluation. It is the only prefecture-level city in the province to receive this award.
I. Maternal death surveillance
Since 1987, the city has started monitoring maternal deaths across the city and intervened on the causes of death. In recent years, the maternal mortality rate has gradually decreased, from 65.7 / 100,000 in 1990 to 14.71 / 100,000 in 2016, a decrease of 77.61%. Only 2004 was higher than the same period in the country, and 2012, 2014, and 2016 were higher than the same period in the province. The rest were lower than the same period in the country and the province. At present, the rural maternal mortality rate is significantly higher than the urban maternal mortality rate.
From the analysis of maternal causes of death, from 1990 to 2006, the three major causes of maternal deaths in our city were obstetric hemorrhage, pregnancy-induced hypertension, and amniotic fluid embolism. Prior to 2005, obstetric bleeding was the leading cause of maternal deaths and occurred mainly in rural areas. Hypertension during pregnancy in 2006 ranked first among causes of death. Increased mortality from 2007 to 2008 in obstetric bleeding and vascular disease in indirect obstetric causes. The top three causes of maternal deaths after 2009 are obstetric hemorrhage, amniotic fluid embolism, and pregnancy with medical and surgical diseases.
Judging from the death case review results, it is mainly avoidable deaths. The analysis results of the “Twelve” form show that the personal family and medical care factors leading to maternal death are increasingly prominent, and the level of knowledge and skills has the greatest impact. With the popularization of health knowledge and the strengthening of maternal health care, there is still much room for reducing maternal mortality.
Monitoring of deaths of children under 5 years of age
The death monitoring of children under the age of 5 in our city was comprehensively carried out on the existing monitoring outlets in 1990 based on the perinatal mortality monitoring. The monitoring outlets were adjusted proportionately every 3 years. With the continuous improvement of the monitoring system, the monitoring quality continued Get improved. The overall mortality rate of children under the age of 5 in our city showed a downward trend, from 47.07 ‰ in 1990 to 5.57 ‰ in 2016, a decrease of 88.17%. Prior to 1999, it was between the province and the country, and after 2000 it was always lower than the national and provincial level. The rural area is significantly higher than the city, which is 2-3 times that of the city.
From the cause of death analysis, the cause of death for children under 5 years old in our city before 2006 was neonatal asphyxia, pneumonia, premature birth, congenital abnormalities and accidental causes. Congenital abnormalities (including congenital heart disease) from 2006 to 2015 caused In 2016, the number of deaths caused by premature birth and low birth weight exceeded that of congenital anomalies for the first time.
Monitoring of birth defects
1. Hospital birth defect monitoring
In 1996, our city sampled the central hospital, the city's traditional Chinese medicine hospital, the city's people's hospital, the city's maternal and child health hospital, Jintai hospital, Meixian maternal and child health hospital, Meixian people's hospital, Qianyang county people's hospital, Qianyang county maternal and child health hospital, The 10 midwifery institutions of Fengxian County Hospital are the monitoring points; in 2011, Meixian County was adjusted to Fufeng County, Fufeng County People's Hospital and Fufeng County Maternal and Child Health Hospital were included in the monitoring points; in 2015, Meixian County Maternal and Child Health Hospital and Fengxiang County Hospital were added. , Long County People's Hospital; In 2016, Qianyang County Maternal and Child Health Hospital was restructured to Linyou County Hospital. At present, 13 midwifery institutions in the city have been identified as birth defect hospital monitoring points. The monitoring results show that the overall incidence of birth defects in our city shows a downward trend, from 190.50 / 10,000 in 1996 to 85.57 / 10,000 in 2016, a decrease of 55.8%, which is lower than the national and provincial levels over the same period. In 2016, the incidence of birth defects was 118.05 per 10,000 in urban areas and 75.72 per 10,000 in rural areas, which was higher than that in rural areas. The diagnosis of malformations was 59.50% of those diagnosed within 28 weeks, and the proportion of ultrasound diagnosis was 73.46%. These two ratios All of them increased year by year; the incidence of birth defects in pregnant women over 35 years of age was significantly higher than in other age groups; the top five incidences of birth defects in single diseases were polydactylia, congenital heart disease, cleft lip and palate, and congenital cerebral effusion. Water, horseshoe varus and shortened limbs tied for fifth place.
2. Population birth defect monitoring
In 2006, the city's birth defect monitoring was initiated in the city. Seven street offices in Xiguan, West Zhongshan Road, Zhongshan East Road, Zhongshan Road, Dongfeng Road, Shilipu, and Wolong Temple in Jintai District were identified as national monitoring points. In 2016, four townships, namely Jieshi Town, Jinhe Town, Chencang Town, and Jielong Town, Jintai District were added as monitoring points. At this point, population birth defects monitoring in Jintai District has covered all 11 townships and sub-district offices. In 2016, there were 3143 perinatal infants and 8 children with birth defects. The incidence of birth defects was 25.45 / 10,000. The monitoring results over the years showed that the incidence of birth defects in the population was lower than that in hospitals.
Fourth, child nutrition and health monitoring
From October 1, 2011, the National Monitoring Office has determined that the four townships (streets) of the Shilipu Community Health Service Center, Minzhong Road Community Health Service Center, Xunshi Township Health Center, and Xunlong Township Health Center in Jintai District of our city are national. Children's nutrition and health monitoring point. The monitoring objects are all children under 5 years old who live in the monitoring village (neighborhood) committees at the monitoring points. The monitoring content includes: growth and development and nutritional status of children under 5 years of age, feeding status, mothers of children under 2 years of age, and the prevalence of children under 5 years of age.
The city's child nutrition and health monitoring began in 1992 as the earliest. Based on an extensive baseline survey, it divided the child nutrition and breastfeeding into two major parts, using a retrospective survey to fill in a questionnaire for monitoring, and conducted a summary analysis each year. The administrative department has formulated interventions to improve children's nutrition and breastfeeding rate, and provide evidence. After nearly 20 years of monitoring and intervention, the prevalence of moderate and severe malnutrition among children under the age of 5 in our city has decreased significantly, from 18.52% in 1992 to 6.25 %% in 2013; breastfeeding rates have increased significantly, from 1992 Increased from 54.5% to 89.78% in 2013.
In 2014, in accordance with the requirements of the National Maternal and Child Health Surveillance Office's Child Nutrition and Health Monitoring Program, our city revised its monitoring program to integrate "monitoring of nutritional status of children under 5 years of age" and "monitoring of breastfeeding status" into "under 5 years of age" "Child Nutrition and Health Monitoring", at the same time, the "incidence rate of malnutrition" in the development of children under 5 years of age was refined into five indicators, such as low body weight rate, stunting rate, overweight rate, obesity rate, and wasting rate. In the past three years, the overall prevalence of malnutrition among children under the age of 5 in the city fluctuated slightly between 6.50-% 6.82%, with no significant difference; the exclusive breastfeeding rate for the period from 0 to June 2016 was 91.36%, a decrease from 93.91% in 2014 It was 2.71%; the breastfeeding rate in December-December 2016 was 79.27%, an increase of 0.45% from 78.91% in 2014.
V. Surveillance of Critical Maternal Hospital
In October 2010, the city started the monitoring work of the National Critical Maternal Hospital. The Municipal Maternal and Child Health Hospital and the Municipal People's Hospital were identified as monitoring points. All pregnant women admitted to the obstetric department of the monitoring hospital or pregnant women who entered the ICU and all departments in the hospital died. All pregnant women fill out case investigation forms as required.
The monitoring results show that the incidence of critically ill pregnant women in our city was 11.09 ‰ in 2016 and 7.93 ‰ in 2012, an increase of 39.85%; the complication rate of complications in 2016 was 86.68%, and in 2012 it was 60.60%, an increase of 42.98% ; It should be related to the improvement of monitoring quality, the decline of underreporting rate, and the implementation of comprehensive two-child policy. The top three complication rates were anemia (64.09%), obstetric bleeding (11.43%), and diabetes (7.72%). Cesarean birth control has achieved certain results. The proportion of cesarean section has decreased from 43.14% in 2012 to 40.75% in 2016, a decrease of 5.54%. The proportion of women undergoing uterine delivery has increased year by year, from 31.48% in 2012 to 39.02% in 2016, an increase of 23.95%.