单元10-中国社会性别与卫生公平案例的启示Scarf08.11.25

ChinaGender&HealthEquityProjects:LuopingandZhenningSummaryofEvaluationFindingsandKeyLessonsLearned评估总结和主要的经验教训ChrisScarfDisseminationMeetingNovember2008FindingsBothprojectsmettheirgoals.SubstantiallyMakehealthservicesmoreresponsivetowomen’sneedsPartiallyViablemodelofgenderandlocalgovernancetoimproveaccountabilityoflocalhealthofficialsandhealthworkers两个项目都达到了预期的目的。大体上使卫生服务更顺应妇女的需要部分地为改善地方卫生官员及卫生工作者的问责制提供了切实可行的性别与地方治理的模式FindingsTheprojectsdrewonexcellenttechnicalassistanceprovidingclearideasaboutwhatshouldbedoneandhowtodoit项目得到了优秀的技术援助，清楚“应该做什么”和“怎样做”LessonThreeprojects(Luoping,ZhenningandDafang)providegoodtemplatesforeffectiveimprovementofGHE三个项目（罗平，镇宁及大方）为有效地改善社会性别与卫生公平性提供了良好的范本FindingsExtensivebaselinesurveysidentifiedmajorissuesinGHEandtosomeextentinformedaction内容广泛的基线调查指出了社会性别卫生公平性方面的主要问题，并在某种程度上提出了行动方向FindingsProjectsexposedthedepthofthecommitmentoflocalgovernmentofficialstoGHEandillustratetheimportanceoftheirunderstandingandinvolvement项目揭示了地方政府官员对性别卫生公平性问题承诺的深度，阐明了官员的理解和参与对解决这些问题的重要性LessonDisseminationshouldgivehighprioritytodemonstratingthebenefitsofGHEtolocalgovernmentleadersandtowinningtheircommitmenttotheprinciples宣传方面应高度重视向地方政府领导者展示关注性别卫生公平的益处并赢得他们对这一原则的承诺FindingsProjectsbenefitedfromemerginghealthsecuritypolicies(NCMS).TheprojectsassistedNCMSimplementation,andinfluencedbenefitpackages项目受益于新出现的卫生保障政策（新农合）项目促进了新型农村合作医疗体系的实施，并影响了服务包的内容FindingsLocalHealthPromotionGroups(HPG)allocatedfundstosubsidizehospitaldeliverySignificantincreasesinhospitaldeliveryratesfollowed当地的健康促进小组计划资金补贴住院分娩住院分娩率随之有了显著的提高FindingsTheHPGandtownshiphospitalsthensuccessfullylobbiedforhighersubsidiesforhospitaldeliveryinNCMSSubsequentNCMSbenefitadjustmentsnowmakenormaldeliveryfreeinprojecttownshiphospitals健康促进小组和乡镇卫生院进而为新农合中的住院分娩争取到了更高的补贴相关部门随即作出了新农合受益调整，项目乡镇卫生院的住院分娩全部免费（顺产）LessonHealthinsurancepackagesthatincludehighlevelbenefitsforhospitaldeliveryandattractiverebatesforRTImanagementhaveamajorimpactonGHE对住院分娩及生殖道感染诊治给予高额补贴的新农合对性别健康公平性有着很大的影响FindingsWomenandmenhavebecameinformedaboutreproductivehealthissuesandbasicchilddevelopmentneedsandmakeeffectiveuseoftheknowledge妇女和男士们都开始了解有关生殖健康和儿童基本生长需要等问题，并开始有效地利用这些知识FindingsHealthPromotionGroupsanddemonstrationhouseholdsenjoyedlearningVillagedoctors(especiallyiffemale)playedpivotalrolesinHPGcoordinationandplanning健康促进小组及示范户都喜欢参与学习活动村医（特别是女村医）在健康促进小组的协调和计划过程中扮演着重要的角色FindingsKnowledgeengenderedconfidenceandwonrespectLongheldattitudesandmythsaboutbirthing,RTI,immunizationwereabandoned知识产生自信并赢得尊重人们丢弃了对于生育、生殖道感染及免疫长久以来持有的旧观念和神秘感FindingsWomenmadeitclearthatwiththisknowledgetheywillnotacceptwrongadviceaboutbirthingorRTIminimization.妇女们宣告，有了这些知识，她们再不会接受有关生育或生殖道感染的错误建议FindingsGoodtrainingandminorequipmenthasenabledprimarycareproviderstoeffectivelydiagnoseandmanagereproductivehealthproblems良好的培训和一些简单的设施使基层医疗保健提供者能够有效地诊断并管理生殖健康问题FindingsProjectsmobilisedvillagersinwaysthatarefamiliartothecommunitiesbutnottothehealthsystem项目以一种对社区而言熟悉的方式动员了村民，但这些方式并不为卫生系统所熟悉FindingsEyeswereopenedtothelimitationsoftraditionaltop-downcommunicationNewwaysofcommunicatingtechnicalinformationhavebeenintroduced传统的自上而下的沟通方式已经被意识到存在着局限性介绍了新的交流沟通技术信息的方式LessonOrthodoxhealtheducationmethodshavefailedtoinformilliterateruralwomenaboutbasicreproductivehealthissuesandtheirrights.传统的健康教育方式无法使文盲农村妇女了解基础的生殖健康问题和她们的权利LessonTheprojectseffectivelyconveyedknowledgebyusingmethodsthatmeettheneedsofthoselearningratherthanthoseteaching以满足学习者而不是教授者需求的方法，项目有效地传播了相关的知识FindingsWomen’sauthorityovertheirownandtheirfamily’shealthhasbeenstrengthenedWomen’sstatusintheirfamiliesandinthecommunityappearstobestronger妇女们在对自己以及家人的健康问题方面的权威性得到加强妇女们在家庭中及社区会中的地位正在提升FindingsManywomenwerehappytobeinformedandtobeabletoexpresstheiropinions.Womenhadtakenadvantageofthe“permission”givenbytheprojecttoopenlydiscusstheirreproductivehealthstatusandtochangeitforthebetter.妇女们很高兴能够了解一些事情并能够表达她们的观点妇女们利用项目给予她们的“许可”公开讨论她们的生殖健康现状并使其变得更好FindingsMenbecameinvolvedinthetreatmentofRTITheriskoftransmissionofSTIandHIVhasbeenreducedwhenmigranthusbandsreturntovillages.男性开始参与生殖道感染的治疗出外务工的丈夫回村时带来的生殖道感染及艾滋病传染的风险降低了LessonsInformedandempoweredwomenwilltakeboldstepstoseeksafedeliveryandreducetheirriskofreproductivetractinfectionandHIVCommunitieswillsupportthischange具备知识和权力的妇女将采取果敢的措施一步步寻求安全的分娩方式并降低生殖道感染及艾滋病的风险社区将支持这一改变FindingsHealthseekingbehaviourhasbeentransformed.Womennowactivelyseekreproductivehealthchecksandnecessarytreatment寻求健康的行为已经转变。妇女们如今主动寻求生殖健康检查以及必要的治疗FindingsServicesforbirthingandreproductivehealthmaintenancehavebeenimprovedClinicaltrainingBasicequipmentsuppliedNCMSfinancialsupport分娩服务以及生殖健康维护已经得到了改善临床培训基础设备供给新农合资金支持LessonGoodinformation,effectivelyconveyedwilldispelwidelyheldtaboos,misconceptionsandmyths科学的信息和有效的传播会有效的消除广泛存在的禁忌、误解和神秘感FindingsSomeACWF,FPC,BoH,MCHandotherlocalgovernmentofficialshavebroadenedtheirthinkingontheirrolesandhavejoinedincooperativeactivities全国妇联、计划生育委员会、卫生局、妇幼保健机构及其他地方政府官员拓宽了对自身角色的定位，并开始了相互合作FindingsHealthworkershavelearnedhowtodevelopnewrelationshipsoftrustwiththecommun