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1、China Gender & Health Equity Projects: Luoping and ZhenningSummary of Evaluation Findings and Key Lessons Learned 评估总结和主要的经验教训评估总结和主要的经验教训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两个项目都达到了预两个项目都达到了预期的目的。期的目的。 大体上大体上l使卫生服务更顺应妇使卫生服务更顺应妇女的需要女的需要部分地部分地l为改善地方卫生官员为改善地方卫生官员及卫生工作者的问责及卫生工作者的问责制提供了切实可行的制提供了切实可行的性别与地方治理的模性别与地方治理的模式式FindingsThe projects drew on excellent techni
3、cal assistance providing clear ideas about what should be done and how to do it项目得到了优秀的技项目得到了优秀的技术援助，清楚术援助，清楚“应该应该做什么做什么”和和“怎样做怎样做”LessonThree projects (Luoping, Zhenning and Dafang) provide good templates for effective improvement of GHE三个项目（罗平，镇三个项目（罗平，镇宁及大方）为有效地宁及大方）为有效地改善社会性别与卫生改善社会性别与卫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内容广泛的基线调查内容广泛的基线调查指出了社会性别卫生指出了社会性别卫生公平性方面的主要问公平性方面的主要问题，并在某种程度上题，并在某种程度上提出了行动方向提出了行动方向FindingsProjects exposed the depth of the commitment of local government officials to GHE and illust
5、rate the importance of their understanding and involvement项目揭示了地方政府项目揭示了地方政府官员对性别卫生公平官员对性别卫生公平性问题承诺的深度，性问题承诺的深度，阐明了官员的理解和阐明了官员的理解和参与对解决这些问题参与对解决这些问题的重要性的重要性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宣传方面应高度重视宣传方面应高度重视向地方政府领导者展向地方政府领导者展示关注性别卫生公平示关注性别卫生公平的益处并赢得他们对的益处并赢得他们对这一原则的承诺这一原则的承诺FindingsProjects benefited from emerging health security policies (NCMS). The projects assisted NCMS implementation, and influenced benefit packages项目受益于新出现的项目受益于新出现的卫生保障政策（新农卫生保障政策（新农合）合）项目促进了新型农村项
7、目促进了新型农村合作医疗体系的实施，合作医疗体系的实施，并影响了服务包的内并影响了服务包的内容容FindingsLocal Health Promotion Groups (HPG) allocated funds to subsidize hospital deliverySignificant increases in hospital delivery rates followed当地的健康促进小组当地的健康促进小组计划资金补贴住院分计划资金补贴住院分娩娩住院分娩率随之有了住院分娩率随之有了显著的提高显著的提高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 健康促进小组和乡镇健康促进小组和乡镇卫生院进而为新农合卫生院进而为新农合中的住院分娩争取到中的住院分娩争取到了更高的补贴了更高的补贴相关部门随即作出了相关部门随即作出了新农合受益调整，项新农合受益调整，项目乡镇卫生院的住院目乡镇卫生院的住院分娩全部免费（顺
9、产）分娩全部免费（顺产）LessonHealth insurance packages that include high level benefits for hospital delivery and attractive rebates for RTI management have a major impact on GHE对住院分娩及生殖道对住院分娩及生殖道感染诊治给予高额补感染诊治给予高额补贴的新农合对性别健贴的新农合对性别健康公平性有着很大的康公平性有着很大的影响影响FindingsWomen and men have became informed about reproduc
10、tive health issues and basic child development needs and make effective use of the knowledge妇女和男士们都开始妇女和男士们都开始了解有关生殖健康和了解有关生殖健康和儿童基本生长需要等儿童基本生长需要等问题，并开始有效地问题，并开始有效地利用这些知识利用这些知识FindingsHealth Promotion Groups and demonstration households enjoyed learningVillage doctors (especially if female) played p
11、ivotal roles in HPG coordination and planning 健康促进小组及示范健康促进小组及示范户都喜欢参与学习活户都喜欢参与学习活动动村医（特别是女村医）村医（特别是女村医）在健康促进小组的协在健康促进小组的协调和计划过程中扮演调和计划过程中扮演着重要的角色着重要的角色FindingsKnowledge engendered confidence and won respectLong held attitudes and myths about birthing, RTI, immunization were abandoned 知识产生自信并赢得知识产生自
12、信并赢得尊重尊重人们丢弃了对于生育、人们丢弃了对于生育、生殖道感染及免疫长生殖道感染及免疫长久以来持有的旧观念久以来持有的旧观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. 妇女们宣告，有了这妇女们宣告，有了这些知识，她们再不会些知识，她们再不会接受有关生育或生殖接受有关生育或生殖道感染的错误建议道感染的错误建议FindingsGood training and minor equ
13、ipment has enabled primary care providers to effectively diagnose and manage reproductive health problems良好的培训和一些简良好的培训和一些简单的设施使基层医疗单的设施使基层医疗保健提供者能够有效保健提供者能够有效地诊断并管理生殖健地诊断并管理生殖健康问题康问题FindingsProjects mobilised villagers in ways that are familiar to the communities but not to the health system项目以一种对社
14、区而项目以一种对社区而言熟悉的方式动员了言熟悉的方式动员了村民，但这些方式并村民，但这些方式并不为卫生系统所熟悉不为卫生系统所熟悉FindingsEyes were opened to the limitations of traditional top-down communicationNew ways of communicating technical information have been introduced传统的自上而下的沟传统的自上而下的沟通方式已经被意识到通方式已经被意识到存在着局限性存在着局限性介绍了新的交流沟通介绍了新的交流沟通技术信息的方式技术信息的方式Lesson
15、Orthodox health education methods have failed to inform illiterate rural women about basic reproductive health issues and their rights. 传统的健康教育方式传统的健康教育方式无法使文盲农村妇女无法使文盲农村妇女了解基础的生殖健康了解基础的生殖健康问题和她们的权利问题和她们的权利LessonThe projects effectively conveyed knowledge by using methods that meet the needs of thos
16、e learning rather than those teaching 以满足学习者而不是以满足学习者而不是教授者需求的方法，教授者需求的方法，项目有效地传播了相项目有效地传播了相关的知识关的知识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妇女们在对自己以及妇女们在对自己以及家人的健康问题方面家人的健康问题方面的权
17、威性得到加强的权威性得到加强妇女们在家庭中及社妇女们在家庭中及社区会中的地位正在提区会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.妇女们很高兴能够了妇女
18、们很高兴能够了解一些事情并能够表解一些事情并能够表达她们的观点达她们的观点妇女们利用项目给予妇女们利用项目给予她们的她们的“许可许可”公开公开讨论她们的生殖健康讨论她们的生殖健康现状并使其变得更好现状并使其变得更好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.男性开始参与生殖道男性开始参与生殖道感染的治疗感染的治疗出外务工的丈夫回村出外务工的丈
19、夫回村时带来的生殖道感染时带来的生殖道感染及艾滋病传染的风险及艾滋病传染的风险降低了降低了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具备知识和权力的妇具备知识和权力的妇女将采取果敢的措施女将采取果敢的措施一步步寻求安全的分一步步寻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、风险感染及艾滋病的风险社区将支持这一改变社区将支持这一改变FindingsHealth seeking behaviour has been transformed. Women now actively seek reproductive health checks and necessary treatment 寻求健康的行为已经寻求健康的行为已经转变。妇女们如今主转变。妇女们如今主动寻求生殖健康检查动寻求生殖健康检查以及必要的治疗以及必要的治疗FindingsServices for birthing and reproductive health maintenance have be
21、en improvedlClinical traininglBasic equipment suppliedlNCMS financial support分娩服务以及生殖健分娩服务以及生殖健康维护已经得到了改康维护已经得到了改善善l临床培训临床培训l基础设备供给基础设备供给l新农合资金支持新农合资金支持LessonGood information, effectively conveyed will dispel widely held taboos, misconceptions and myths科学的信息和有效的科学的信息和有效的传播会有效的消除广传播会有效的消除广泛存在的禁忌、误解泛存
22、在的禁忌、误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全国妇联、计划生育全国妇联、计划生育委员会、卫生局、妇委员会、卫生局、妇幼保健机构及其他地幼保健机构及其他地方政府官员拓宽了对方政府官员拓宽了对自身角色的定位，并自身角色的定位，并开始了相互合作开始了相互合作FindingsHealth workers ha
23、ve learned how to develop new relationships of trust with the community健康工作者已开始学健康工作者已开始学习如何与社区建立新习如何与社区建立新的信任关系的信任关系FindingsEntrepreneurial health managers have identified opportunities to improve services and earn more revenue through GHE通过社会性别与卫生通过社会性别与卫生公平项目，私营卫生公平项目，私营卫生机构管理者找到了机机构管理者找到了机会以改善服务
24、并赚取会以改善服务并赚取更多的利润更多的利润LessonsGHE offers potential benefits to local government officials and to primary and secondary health care providers These should be actively promoted in dissemination性别健康公平项目对性别健康公平项目对地方政府官员以及基地方政府官员以及基本卫生保健和更高一本卫生保健和更高一级的卫生保健提供者级的卫生保健提供者带来了潜在的利益带来了潜在的利益这些应在传播中积极这些应在传播中积极倡导倡导
25、FindingsThe risks to sustainability from rapid turnover of leadership and economic stress in local health services has been starkly illustrated频繁的领导人员更替频繁的领导人员更替及地方卫生服务的经及地方卫生服务的经济压力对可持续发展济压力对可持续发展带来的风险已明显的带来的风险已明显的显现出来显现出来LessonSustainability needs continuing support and the interest of officials t
26、ogether with effective HP materials可持续发展需要连续可持续发展需要连续的支持、官员的关注的支持、官员的关注以及有效的健康促进以及有效的健康促进材料材料SummaryThe projects show that GHE can be effectively advanced in remote rural ChinaLocal government leaders commitment is needed to implement and sustain change项目揭示了在中国边项目揭示了在中国边远农村地区，社会性远农村地区，社会性别与卫生公平性问题别与
27、卫生公平性问题能够被有效地改进能够被有效地改进创造和持续改变需要创造和持续改变需要地方政府领导的承诺地方政府领导的承诺SummaryCommunities traditional methods of communication and knowledge sharing are effective and should be used社会传统的沟通和分社会传统的沟通和分享知识的方式是有效享知识的方式是有效的，应该加以利用的，应该加以利用SummaryWomen like the benefits that GHE bringslShared knowledgelOpen discussion
28、lLess family tensionlBetter health statuslGreater confidence妇女们欢迎性别卫生妇女们欢迎性别卫生公平带来的益处公平带来的益处l共享知识共享知识l开放讨论开放讨论l减轻家庭紧张减轻家庭紧张l更好的健康状况更好的健康状况l更大的自信更大的自信SummaryPrimary health workers need training in GHE and RTI managementVillage doctors especially women doctors can be powerful agents of change初级卫生保健工作者
29、初级卫生保健工作者需要接受性别卫生公需要接受性别卫生公平及生殖道感染管理平及生殖道感染管理的培训的培训村医村医特别是女村医特别是女村医可以作为强大的变可以作为强大的变革推动者革推动者SummaryGHE is more likely to be effectively disseminated in poor rural areas when local government leaders give personal commitment and/or when it is required by higher levels. 在得到地方政府官员在得到地方政府官员私人承诺和私人承诺和/或更高或更高级别领导要求时，性级别领导要求时，性别健康公平才更有可别健康公平才更有可能在贫困的农村地区能在贫困的农村地区有效的传播有效的传播
