本文選題：政府購買服務 + HIV/AIDS��； 參考：《中國疾病預防控制中心》2015年博士論文

【摘要】：背景我國艾滋病疫情雖處于低流行態(tài)勢,但是MSM人群傳播比例持續(xù)增高。社區(qū)組織逐漸參與到MSM人群艾滋病防治工作中并發(fā)揮了重要作用。在全國大力推廣政府購買服務之際,政府購買MSM社區(qū)組織艾滋病防治服務是必然趨勢,但是具體的“政府購買服務模式”還需要進一步探索。目的基于艾滋病防治項目實踐和對MSM社區(qū)組織的深入分析,了解其生存發(fā)展狀況、工作內容及效果、成本支出,從而確定政府購買服務內容、價格標準,提出政府購買社區(qū)組織MSM人群艾滋病防治服務的參考模式。方法本研究以中蓋艾滋病項目為數據收集平臺,結合現(xiàn)場調查,采用定量研究和定性研究相結合的方法,對MSM草根社區(qū)組織進行了深入分析,采用德爾菲法確定模式構建核心步驟及影響因素,結合研究結果,構建政府購買服務模式。定量研究,一是分析2008-2012年中蓋艾滋病項目的MSM社區(qū)組織的工作產出及效果、獲得的單位經費支持標準；二是自行設計調查問卷,通過現(xiàn)場調查收集分析MSM社區(qū)組織的生存發(fā)展現(xiàn)狀,并測算2013年MSM社區(qū)組織的運行成本。定性研究,自行制定訪談提綱,根據研究目的確定訪談對象,進行面對面深入訪談,疾控部門共訪談27人,MSM社區(qū)組織共訪談26人。資料分析采用扎根理論邊收集資料、邊進行編碼分析,最后對社區(qū)組織的發(fā)展過程及工作現(xiàn)狀進行總結歸納,并收集測算其工作直接成本支出。結果2008-2012年,14項目城市及上海、杭州和重慶的社區(qū)組織MSM人群HIV動員檢測人次數和感染者關懷人數均逐年增加,對當地MSM人群HIV陽性發(fā)現(xiàn)的累計貢獻率分別達到54.1%、46.9%、54.7%和55.8%,協(xié)助篩查陽性結果告知、確認檢測、新發(fā)現(xiàn)陽性結果告知的比例均在80.0%以上。草根社區(qū)組織的貢獻占到50.0%以上。本研究現(xiàn)場調查的11個MSM社區(qū)組織,均為草根社區(qū)組織,2012年動員檢測人次數分別占到當地全部社區(qū)組織的53.8%、57.4%和76.6%。11個MSM社區(qū)組織中,3個工商注冊、1個民政注冊；人員以兼職人員和志愿者為主,招募方式以活動中加入和社會招聘為主；經費主要來源于國際合作項目,各項資源整合使用；其生存模式可分為項目依賴型和相對獨立型,以相對獨立型發(fā)展比較成熟。社區(qū)組織參與的MSM人群艾滋病防治工作內容以干預、HIV動員檢測和感染者關懷為主,各項工作基本形成了固定模式。2013年MSM社區(qū)組織的運行成本從2.7萬元到43.54萬元不等,不同地區(qū)MSM社區(qū)組織的運行成本不同。重慶MSM社區(qū)組織HIV動員檢測工作直接單位成本平均為110.0元/人次(中位數),上海MSM社區(qū)組織開展感染者關懷工作直接單位成本約492.6元/人/年。通過內容規(guī)劃、經費核算與管理、工作督導與評估三個相互關聯(lián)的關鍵環(huán)節(jié),本研究構建了以產出為導向,依托規(guī)劃、引入績效、過程與結果并重的政府購買MSM社區(qū)組織艾滋病防治服務的參考模式,該模式的核心即將購買內容界定為MSM人群“干預及HiV動員檢測”和“感染者關懷及治療促進”兩個服務包,通過“關鍵指標”“動員檢測人次數”、“新發(fā)現(xiàn)陽性人數”和“建立個人隨訪檔案并接受CD4檢測人數”考核服務工作產出,預期目標為每年動員檢測人次數增加3%,新發(fā)現(xiàn)人數增加6%,購買價格標準為HIV動員檢測100元/人、從中新發(fā)現(xiàn)陽性者500元/人、感染者關懷550元/人,總經費中給予10-20%支持組織運行成本支出,經費撥付采用報賬制,并由第三方審計監(jiān)督實際使用,同時加強干預過程督導與效果評估以指導工作方向和購買策略。結論參與過中蓋艾滋病項目的MSM社區(qū)組織部分已發(fā)展比較成熟,已基本具備參與“政府購買服務”的承接能力,承接內容包括MSM人群“干預及HIV動員檢測”和“感染者關懷”。本研究提出了政府購買社區(qū)組織MSM人群艾滋病防治服務的以產出為導向,依托規(guī)劃、引入績效、過程與結果并重的參考模式,明確界定了購買內容和考核指標,采用績效經費,明確了對組織運行成本支出的經費支持及比例,提出過程督導與結果評估并重。
[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.
【學位授予單位】：中國疾病預防控制中心
【學位級別】：博士
【學位授予年份】：2015
【分類號】：R512.91

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