社区卫生服务机构人力配置标准的测算分析

摘要

Objective To measure the gap of community health staffing and establish new norms for community health facilities by means of the WHO Workload indicator of staffing need (WISN) method,for reference of the government in evaluation and decision making of community health staffing. Methods With Xicheng District of Beijing as an example,we collected data on community health staffing and calculated the total demand,measuring the total demand and supply,and gap or surplus in the staffing.Results in 2013,the demand of community health staffing was about 1 7.18 million standard equivalents in Xicheng,while the supply was 10.5 12 million.The WISN ratio was 0.67 for community health supply and demand,in which the ratio of physicians was close to 1,while that of nurses and public health workers was far below 1.850 extra community health staff was needed to reach the total of 2 602 persons.Conclusion The demand and supply of community health service in Xicheng District was seriously unbalanced,a huge gap featuring overstaffing of nurses and inadequate public health workers.This results from the enhancement of primary public health services and rising utilization of community healthcare services in recent years,which deserves high attention from government of all levels,by increasing the staffing of community health staffing standards.%目的：利用世界卫生组织提出的工作负荷法,测算城市社区卫生人力缺口和配置标准,为各级政府及相关部门评估社区卫生人力配置问题,制定相关政策提供参考和依据。方法以北京市西城区为例,按照工作负荷法采集该地区社区卫生服务中心人力测算相关数据,测算社区卫生服务需求量、供给量和社区卫生人力缺口/过剩量。结果2013年北京市西城区样本社区卫生服务中心服务需求量约为1718万个标准当量值,供给量约为1051.2万个标准服务当量；社区卫生人力供需比为0.67,其中医疗卫生人力供需比接近1,但护理和公共卫生人员供需比远离1。北京市西城区需额外配置850名社区卫生技术人员,总数应达到2602人。结论北京市西城区社区卫生技术人员供需处于严重失衡状况,主要表现在护理人员配置过多,公共卫生人员配置严重不足。这与近年来社区基本公共卫生服务项目的强化和社区医疗服务利用率的大幅度提高有关。各级政府及相关部门应引起重视,逐步提高社区卫生人才配置标准。