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Functions and Human Resources of China's Primary Health Care

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Functions and Human Resources of China's Primary Health Care CCHDS WORKING REPORT 002 Functions and Human Resources of China’s Primary Health Care System in the Early Stage of Health Systems Reform China Center for Health Development Studies (CCHDS) Peking University Center for Health Management and Policy (CHMP) Shandong University November, 2011 Research Team： Team leader: MENG Qingyue Team Members: SUN Xiaojie, LI Hui, SONG Kuimeng, YUAN Jing, WANG Haipeng, CHANG Jie Acknowledgements: The report is part of a research project commissioned by the Center for Health Statistics and Information, Ministry of Health. We would like to extend our gratitude to the leaders and experts from Ministry of Health for their valuable advice and guidance in evaluation scheme development and report formulation process. We would like to thank the local health administrative departments of the research sites for their support. We also want to thank all people involved in the survey and data work. About CCHDS: China Center for Health Development Studies (CCHDS), Peking University, is a joint effort by Peking University Health Science Center and China Medical Board (CMB). Founded in April 2010, the mission of the CCHDS is to advance the health of the Chinese people by achieving academic excellence in production and dissemination of knowledge and by catalyzing and promoting health policy and systems research in China. This entails research, education, and intellectual exchange on long-term and fundamental health systems issues including measurement of health transitions and determinants, studies on development and evaluation of health systems performance, and promotion of academic exchange both within China and internationally. CCHDS focuses its research priorities on health systems research, especially in the areas of health financing, human resources, and health care delivery. CCHDS’ research products include academic publications, policy briefs, and working reports. This report is one of the efforts from CCHDS. More information about CCHDS: www.cchds.pku.edu.cn 1 Table of Contents Executive Summary .............................................................................................. 3 Part I: Background ............................................................................................... 10 Part II: Data Sources and Methods ....................................................................... 13 2.1 Data Sources and Study Site .............................................................................. 13 2.2 Survey Methodology of the Special Research ................................................... 13 Part III: Infrastructures of the Primary Health System ........................................... 18 3.1 Input in and financial Conditions of Primary Health Institutions ...................... 18 3.2 Financial Operation of Primary Health Institutions .......................................... 20 3.3 Equipment Configuration of Primary Health Institutions ................................. 21 3.4 Discussions ........................................................................................................ 23 Part IV: Functions of the Primary Health Institutions ............................................ 25 4.1 Definition of Primary Health Institutions Basic Service Function ..................... 25 4.2 Implementation of Primary Health Institutions Service Functions ................... 28 4.3 Analysis of Implementation Situation of Public Health Services ...................... 33 4.4 Discussions ........................................................................................................ 35 Part V: Human Resources for Primary Health Care ............................................... 39 5.1 Number and Stability of Primary Health Institutions Personnel ....................... 39 5.2 Knowledge & Capability and Training of Primary Health Personnel ................. 41 5.3 Workload and Time Distribution of Primary Health Professionals ................... 46 5.4 Discussions ........................................................................................................ 49 2 Functions and Human Resources of China’s Primary Health Care System in the Early Stage of Health Systems Reform Executive Summary The main purpose of this study is to find out changes of the primary health institutions system construction, service functions and human resources after the health system reform and make policy recommendations based on problems found. The data comes from the national survey and the special survey carried out in five provinces. The national survey has covered 294 township health centers and 127 community health centers while the special survey has included 30 township health centers, 18 community health centers and 151 village clinics. The respondents not only have included the institutions survey by the questionnaire, but also have included 823 health professionals surveyed by questionnaires and 194 key personnel interviewed. Analysis of system construction and functions, etc. mainly uses the data of the national survey and human resources analysis mainly uses the data of the special survey. 1. Main Progress of the Health System Reform 1.1 Construction of the Primary Health Service System [1] Government financial policy for primary health providers has undergone fundamental changes. The government’s leading role in financing of primary health institutions has begun to show and the trend of relying on business income such as medicines has come to a turning point. Compared with 2008, the percentages of the health centers totally funded by the government in the country increased by 14.9 and the percentages of the community health centers increased by 10.2 in 2011. The proportion of government subsidies income of primary health institutions has increased, with an increase of 17.7%, 12.4% and 13.3% respectively in community health centers, central township health centers and general township health centers. [2] With input in system construction enlarged, equipment conditions of primary health institutions further strengthened and faster hardware construction speed, it has reached the basic level for provision of medical services. Compared with 2008, the percentages of rural township health centers by ownership of various types of equipment all increased in 2011. The percentages of community health centers also all increased, except individual equipment. [3] There has been significant growth in public health service input and government input in western regions has continuously increased, which ensures the completion of the health system reform of primary health system. 3 Compared with 2008, government budgetary expenditure on public health increased by 139% in 2010. 1.2 Functions of the Primary Health Institutions [1] In quite a short time, primary health institutions have largely strengthened their service functions and rapidly expanded their service scope. Especially, in the aspect of basic public health services, most primary health institutions were able to provide basic public health services. The equalization of basic public health services has played an important leading and driving role. Township heath centers and community health centers on average could carry out about 80% of basic health services, with about 85% of basic public health services projects being carried out while village clinics on average could carry out about 80% of basic health services, with 86% of basic public health services projects being carried out. For township health centers, the percentage of basic health services projects carried out increased by 23.7 in 2010 compared with 2007. And for community health centers, the percentage increased by 14.5. [2] The situation of primary health institutions taking disease treatment seriously but taking disease prevention lightly has begun to be reversed. Due to policy incentives, primary health institutions have paid more and more attention to public health services. Before the reform, due to lack of subsidy policy, primary health institutions mainly relied on medical services, having no driving force for carrying out public health services and also could hardly get guarantee of compensation. The health system reform has improved the situation of basic public health services provision by primary health institutions in two aspects of capital funding and policy requirements. Many interviewees felt that the attitude of health institutions has changed from “I have to provide public health services” to “I must provide public health services”. In terms of percentage point changes of service programs carried out by community health centers during the past two years in different regions, the improvement in central regions was most obvious, with an overall increase of 21.6, while in western regions, there was an overall increase of 13.8 and in eastern regions less than 9. [3] The change of primary health institutions service functions has laid a basis for active prevention and treatment of chronic diseases and other major health problems. The health service system in China as a whole still lacks the capacity for effective prevention and treatment of chronic diseases, particularly the case with primary health institutions. Though chronic diseases prevention and treatment quality of primary health institutions still needs to be improved, during the early stage of the health system reform, the awareness of chronic diseases prevention and treatment of primary health institutions has been strengthened and the technical level has been improved.
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