基于项目实践探索政府购买男同社区组织服务模式研究

发布时间：2018-05-26 15:49

本文选题：政府购买服务 + HIV/AIDS　；参考：《中国疾病预防控制中心》2015年博士论文

【摘要】：背景我国艾滋病疫情虽处于低流行态势,但是MSM人群传播比例持续增高。社区组织逐渐参与到MSM人群艾滋病防治工作中并发挥了重要作用。在全国大力推广政府购买服务之际,政府购买MSM社区组织艾滋病防治服务是必然趋势,但是具体的“政府购买服务模式”还需要进一步探索。目的基于艾滋病防治项目实践和对MSM社区组织的深入分析,了解其生存发展状况、工作内容及效果、成本支出,从而确定政府购买服务内容、价格标准,提出政府购买社区组织MSM人群艾滋病防治服务的参考模式。方法本研究以中盖艾滋病项目为数据收集平台,结合现场调查,采用定量研究和定性研究相结合的方法,对MSM草根社区组织进行了深入分析,采用德尔菲法确定模式构建核心步骤及影响因素,结合研究结果,构建政府购买服务模式。定量研究,一是分析2008-2012年中盖艾滋病项目的MSM社区组织的工作产出及效果、获得的单位经费支持标准；二是自行设计调查问卷,通过现场调查收集分析MSM社区组织的生存发展现状,并测算2013年MSM社区组织的运行成本。定性研究,自行制定访谈提纲,根据研究目的确定访谈对象,进行面对面深入访谈,疾控部门共访谈27人,MSM社区组织共访谈26人。资料分析采用扎根理论边收集资料、边进行编码分析,最后对社区组织的发展过程及工作现状进行总结归纳,并收集测算其工作直接成本支出。结果2008-2012年,14项目城市及上海、杭州和重庆的社区组织MSM人群HIV动员检测人次数和感染者关怀人数均逐年增加,对当地MSM人群HIV阳性发现的累计贡献率分别达到54.1%、46.9%、54.7%和55.8%,协助筛查阳性结果告知、确认检测、新发现阳性结果告知的比例均在80.0%以上。草根社区组织的贡献占到50.0%以上。本研究现场调查的11个MSM社区组织,均为草根社区组织,2012年动员检测人次数分别占到当地全部社区组织的53.8%、57.4%和76.6%。11个MSM社区组织中,3个工商注册、1个民政注册；人员以兼职人员和志愿者为主,招募方式以活动中加入和社会招聘为主；经费主要来源于国际合作项目,各项资源整合使用；其生存模式可分为项目依赖型和相对独立型,以相对独立型发展比较成熟。社区组织参与的MSM人群艾滋病防治工作内容以干预、HIV动员检测和感染者关怀为主,各项工作基本形成了固定模式。2013年MSM社区组织的运行成本从2.7万元到43.54万元不等,不同地区MSM社区组织的运行成本不同。重庆MSM社区组织HIV动员检测工作直接单位成本平均为110.0元/人次(中位数),上海MSM社区组织开展感染者关怀工作直接单位成本约492.6元/人/年。通过内容规划、经费核算与管理、工作督导与评估三个相互关联的关键环节,本研究构建了以产出为导向,依托规划、引入绩效、过程与结果并重的政府购买MSM社区组织艾滋病防治服务的参考模式,该模式的核心即将购买内容界定为MSM人群“干预及HiV动员检测”和“感染者关怀及治疗促进”两个服务包,通过“关键指标”“动员检测人次数”、“新发现阳性人数”和“建立个人随访档案并接受CD4检测人数”考核服务工作产出,预期目标为每年动员检测人次数增加3%,新发现人数增加6%,购买价格标准为HIV动员检测100元/人、从中新发现阳性者500元/人、感染者关怀550元/人,总经费中给予10-20%支持组织运行成本支出,经费拨付采用报账制,并由第三方审计监督实际使用,同时加强干预过程督导与效果评估以指导工作方向和购买策略。结论参与过中盖艾滋病项目的MSM社区组织部分已发展比较成熟,已基本具备参与“政府购买服务”的承接能力,承接内容包括MSM人群“干预及HIV动员检测”和“感染者关怀”。本研究提出了政府购买社区组织MSM人群艾滋病防治服务的以产出为导向,依托规划、引入绩效、过程与结果并重的参考模式,明确界定了购买内容和考核指标,采用绩效经费,明确了对组织运行成本支出的经费支持及比例,提出过程督导与结果评估并重。
[Abstract]:Background although the epidemic situation of AIDS in China is in a low epidemic situation, the spread ratio of the MSM population continues to increase. Community organizations gradually participate in the AIDS prevention and control work of the MSM population and play an important role. The government purchase of the MSM community to organize AIDS prevention and control service is an inevitable trend, but the specific trend, but specific, is specific. The "government purchase service model" needs further exploration. Objective based on the practice of AIDS prevention and control projects and the in-depth analysis of MSM community organization, to understand its survival and development status, work content and effect, cost expenditure, so as to determine the government purchase service content, the price standard, and put forward the government to purchase the community organization MSM population AIDS prevention and control. In this study, based on the data collection platform of the medium cover AIDS project, combined with the field investigation and the method of combining quantitative research and qualitative research, the MSM grass root community organization was deeply analyzed, the core steps and the influencing factors were constructed by Delphy Fa's determination model, and the government was constructed with the results of the study. Purchase service mode. Quantitative research, one is to analyze the work output and effect of MSM community organization of AIDS project in 2008-2012 years, obtain the standard of unit fund support, two is self-designed questionnaire, collect and analyze the present situation of MSM community organization through field survey, and calculate the operation of MSM community organization in 2013. In the qualitative study, the interview outline was formulated by ourselves. The interview subjects were determined according to the purpose of the study. The interview was conducted in depth. 27 people were interviewed by the disease control department, and 26 people were interviewed by the MSM community organization. The data analysis was collected by the theory of grounded theory, and then the coding analysis was carried out. Finally, the development process and work status of the community organization were summed up. For 2008-2012 years, the number of HIV mobilized people and the number of people infected with MSM in the 14 project cities and Shanghai, Hangzhou and Chongqing were increased year by year, and the cumulative contribution rate of HIV positive findings to local MSM population was 54.1%, 46.9%, 54.7% and 55.8%. The sex results were informed that the proportion of the positive results was more than 80%. The contribution of the grass-roots community organizations was over 50%. The 11 MSM community organizations investigated in this study were grass-roots community organizations, and the number of people mobilized in 2012 accounted for 53.8%, 57.4% and 76.6%.11 MSM communities in the local community organizations, respectively. In the organization, 3 industrial and commercial registrations and 1 Civil Affairs registrations are given mainly by part-time personnel and volunteers. The recruitment methods are mainly involved in activities and social recruitment. The funds are mainly derived from international cooperation projects and the resources are integrated. Their survival patterns can be divided into project dependent and relatively independent type, which are relatively independent development. The content of AIDS prevention and control of the MSM population involved in the community organization is intervention, HIV mobilization testing and the concern of the infected people. The work has basically formed a fixed mode.2013 MSM community organization operating costs ranging from 27 thousand yuan to 435 thousand and 400 yuan, and the operating costs of MSM community organizations in different regions are different. The HIV movement of the MSM community organization in Chongqing The average cost of the direct unit is 110 yuan per person per person (median). The direct unit cost of the MSM community organization in Shanghai is about 492.6 yuan per person / year. Through the content planning, the accounting and management, the work supervision and evaluation of the three key links, the study constructs the output oriented and supporting rules. The government purchased the MSM community to organize the reference model of AIDS prevention and control service in the MSM community. The core of the model was defined as the MSM crowd "intervention and HiV mobilization testing" and "infection care and treatment promotion", and "key indicators", "mobilizing the number of people", " The number of newly discovered positive people "and" the establishment of personal follow-up files and the number of CD4 testing people "was used to assess the service output. The expected target was to increase the number of people to mobilize the test 3%, the number of new discoveries increased by 6%, the purchase price standard was 100 yuan per person for HIV mobilization, from which 500 yuan per person was discovered and the total cost of the infected person was 550 yuan per person. 10-20% supports the operation cost of the organization, the appropriation of funds is used, and the third party audit supervision is actually used. At the same time, the supervision and effect evaluation of the intervention process are strengthened to guide the work direction and purchase strategy. Conclusion the MSM community group, which has participated in the middle cover AIDS project, has developed more mature and has been basically involved. The acceptance of "government purchase service", including "intervention and HIV mobilization testing" and "concern for infected people" of MSM population, proposed a reference model that government purchase of community organization MSM population to AIDS prevention and control services, relying on planning, introducing performance, both the process and the results, clearly defined the purchase. Buying content and assessment indicators, adopting performance funds, and clarified the financial support and proportion of organization operation cost expenditure, and put forward equal emphasis on process supervision and result evaluation.
【学位授予单位】：中国疾病预防控制中心
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R512.91

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