ارزيابي تجربه برون‌سپاري خدمات بهداشتي در شهر: امكانات و خدمات ارايه شده در پايگاه‌هاي بهداشتي دولتي و برون‌سپاري شده تحت پوشش دانشگاه علوم پزشكي تهران

Assessing Experiences of Outsourcing Urban Health Posts: Facilities and Services Offered in Publicly Owned and Outsourced Health Posts in Tehran University of Medical Sciences

مقدمه: گسترش بخش دولتي براي ارايه خدمات بهداشتي در شهرها به دليل ممنوعيت ايجاد واحدهاي جديد، نبودن منابع براي تملك، احداث يا خريد ساختمان و استخدام نيرو، دشوار است. خريد خدمت از بخش غيردولتي (برون‌سپاري خدمت) مي‌تواند بستر لازم را براي بهره‌مندي جمعيت از خدمات استاندارد فراهم كند. هدف اين مطالعه مقايسه امكانات ارايه خدمت در پايگاه‌هاي برون‌سپاري شده و پايگاه‌هاي دولتي بود. روش كار: در اين مطالعه مقطعي، در دي ماه 1388 كليه پايگاه‌هاي بهداشتي تحت پوشش دانشگاه بررسي شدند. پرسشنامه‌اي با 26 سؤال با حضور فرد جمع‌آوري كننده در پايگاه تكميل شد. پس از ورود داده‌ها به نرم‌افزار، تحليل‌هاي آماري تك متغيره صورت گرفت. نتيجه‌گيري: نحوه نظارت و استانداردهاي نظارتي بر رفتار بخش خصوصي تأثير مستقيم دارد. از آن جايي كه ناظران، بيشتر به ساختار فيزيكي و استانداردهاي تجهيزاتي اهميت داده‌اند، بخش خصوصي نيز آن را رعايت كرده است. پايگاه­ها وظايف ذاتي شبكه بهداشت را مانند بخش دولتي انجام داده بودند.

Introduction: The expansion of public sector capacity in public health is difficult due to legal limitations and limited financial and staff resources. Outsourcing services to the private sector provides opportunity to provide health services to public. This study aimed to assess and compare the capacity and services in publicly run and outsourced urban health posts. Methods: This cross-sectional study was carried out in all health posts affiliated to the university. Data were collected using a 26-items questionnaire and were analyzed using the univariate analyses. Results: Among 74 health posts, 48 health posts (64.9%) were outsourced and 26 (35.1%) were managed by the public sector. Medical doctors managed 43.7% and midwives 45.8% of the outsourced health posts. Midwives managed 73.0% and health officers 23.0% of the public sector posts. 61.5% and 77.1% of the outsourced and publically managed health posts were located in appropriately structured buildings. Over 92% of the clients walked to the health posts. On average, public health posts covered 8954 individuals and outsourced health posts covered 12158 individuals. No differences were observed in health program related knowledge of the staff in two centers. Conclusion: Supervision approaches has a direct effect on behaviors of the private sector. Since the supervisors mostly noted the physical structure and standards of equipments, these had adequate standards. There were no differences between public and private health posts in health care indices and those services that had been provided by similar staff from the two health post groups.