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Equity and Satisfaction of Community Health Services in Tongliao City, Inner Mongolia

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Equity and Satisfaction of Community Health Services in Tongliao City, Inner Mongolia COMMUNITY HEALTH SERVICES IN INNER MONGOLIA EQUITY AND SATISFACTION OF COMMUNITY HEALTH SERVICES IN TONGLIAO CITY, INNER MONGOLIA Li-Jun Yu, Wen-Hai Zhao, Zhi-Fei Fan and Yue-Hui Bai Medicinal Chemistry and Pharmacology Institute, Inner Mongolia University for the Nationalities, China Abstract. We aimed to describe the human resources and apparatuses of commu- nity health service (CHS) in Tongliao City of China and investigate the differences between CHS centers and stations. Field investigations and questionnaire-based surveys were conducted in 120 CHS organizations of Tongliao City, which were selected by a stratified multistage random cluster sampling method. Data were collected on the human resources, medical apparatuses, and satisfaction of covered residents. We found that the total number, educational background, and profes- sional titles of staff were lower at stations than at centers. Although the categories of providing health services were comparable between centers and stations, sta- tions provided fewer health services than centers did. In addition, stations owned fewer apparatuses compared with centers. The percentages of satisfaction on many items were lower among residents covered by stations than among those covered by centers. Desired health services provided by CHS organizations have been partially accomplished in Tongliao City. Attracting more highly educated professionals and purchasing more valuable apparatuses may be helpful to im- prove the unbalanced distribution in human resources and apparatuses between centers and stations. Appropriate modifications of corresponding policies should be taken into consideration by the local government in the future. Keywords: community health care, health equity, public health system, China INTRODUCTION 2008b), while 92.4 million suffer from diabetes (Yang et al, 2010). The second China is a rapidly developing country problem is the uneven distribution of facing several important public health limited medical resources and profes- problems. The first is continuously in- sionals among different areas. A previ- creasing prevalence of chronic diseases. ous study showed that in China, uneven According to the data published in 2008 distribution of medical staff is higher in and 2010, about 177 million Chinese adults within-province than in between-province suffer from hypertension (Yang et al, (Anand et al, 2008). The third problem is that China has entered the stage of an Correspondence: Li-Jun Yu, Medicinal Chem- istry and Pharmacology Institute, Inner Mon- aging society. According to the National golia University for the Nationalities, Tongliao Bureau of Statistics of China in 2011, the 028000, Inner Mongolia, China. number of people aged 60 years and older E-mail: [email protected] has risen to 185 million (Zhang et al, 2012). Vol 46 No. 6 November 2015 1077 SOUTHEAST ASIAN J TROP MED PUBLIC HEALTH Fig 1–Map of the Inner Mongolia Autonomous Region showing the location of study site. It is necessary for China to provide suffi- station provides services to about 10,000 cient health care for this aged population. populations (Luo et al, 2010). Generally, China introduced a community health the center collects and processes data from service (CHS) system in the 1990s to pro- the stations, and then reports them to the vide basic clinical and primary health care local health administration department. for the people. The composition of the CHS Both CHS center and station are completely organization can be described as ‘1 body, supported by an allocation from the gov- 6 aspects’ (Yang et al, 2008a). The ‘body’ ernment (Dib et al, 2010). refers to the CHS organization, while the Tongliao is a typical large Mongolian ‘6 aspects’ include basic clinical services, city in the eastern Inner Mongolia Autono- prevention, health education, women and mous Region, in which the Mongol national- children’s care, elderly care, immuniza- ity forms the largest ethnic minority (Fig 1). tions, and physical rehabilitation. As first Because the area of this city is wide and designed, the CHS system consisted of the population is unevenly distributed, centers and stations, both of which had there are limited accurate data on the CHS similar functions but a little difference in in this city. Therefore, the purpose of this target populations. A CHS center regulates study was to provide more information for 3-to-6 stations and provides services to modification and improvement of CHS in a population of 30,000-100,000, while a Tongliao City of Inner Mongolia. 1078 Vol 46 No. 6 November 2015 COMMUNITY HEALTH SERVICES IN INNER MONGOLIA MATERIALS AND METHODS lot survey. We conducted the pilot survey on three CHS organizations randomly se- Respondents lected from each stratum respectively, and Of all of the 1,243,215 people serviced then confirmed the reliability and validity by the 120 CHS organizations, 2,486 (0.2%) of our questionnaire. All questionnaire- subjects were randomly selected, and based surveys were conducted by face- finally, 2,139 subjects recruited for the to-face interviews between interviewers satisfaction survey by using a standard and anonymous interviewees. All field CHS satisfaction questionnaire. investigations were confirmed again by Ethical considerations telephone interviews. Two independent interviewers dually entered the data to Design and all procedures of this ensure accuracy. study were in accordance with the Decla- ration of Helsinki. The Ethics Committee Data analysis of the Inner Mongolia University for the Data were presented as numbers or Nationalities approved this study (Ref No percentages as appropriate. Descriptive IMUNEC032010031502; 2010 Mar 15), and statistical analyses were performed with all participants signed informed consent SPSS® (version 16.0; SPSS, Chicago, IL). forms. Sampling and survey RESULTS To ensure the sample representative, Human resource and apparatus we adopted a stratified multistage ran- Compared with CHS centers, sta- dom cluster sampling method. Briefly, tions had fewer medical staff (Table 1). all CHS organizations in this city were There were not only fewer doctors and classified into three strata according to nurses, but also other technicians such as their capacity and financial situation, and laboratorians and imaging technicians. then 120 CHS organizations (18 centers The doctor-nurse ratio was higher at CHS and 102 stations) were randomly selected centers (ratio = 3.1) than at stations (ratio from each stratum. = 1.3). Staff at centers had higher profes- Data on human resources and appa- sional titles (Table 2) and higher degrees ratuses in 2010 were obtained from field (Table 3) than those at stations. investigations. We conducted this study The categories of provided public from January 2011 to June 2012. Well- health services were comparable between trained interviewers and investigators centers and stations. All centers and sta- performed all surveys and investigations tions provided general clinical service and in our study. immunization; however, centers provided Training and quality control more health services than stations did in Three epidemiologists and two spe- most other categories, such as home visits, cialists of CHS organizations designed and health education and information a standard satisfaction questionnaire, a (Table 4). As summarized in Table 5, CHS training manual, and interview methods centers also had a more adequate number for the training program before this study. of valuable apparatuses compared with All interviewers and investigators evalu- stations. Obviously, CHS centers had ated the questionnaire and designed a pi- greater average numbers of doctors and Vol 46 No. 6 November 2015 1079 SOUTHEAST ASIAN J TROP MED PUBLIC HEALTH Table 1 Average number and composition percentage of different staff positions. Staff position Center Station n (%) n (%) Doctor 8.6 (47.3) 1.7 (38.6) Assistant doctor 2.5 (13.7) 0.4 (9.1) Nurse 2.8 (15.4) 1.3 (29.5) Pharmacist 1.1 (6.0) 0.4 (9.1) Laboratorian 0.7 (3.8) 0.1 (2.3) Imaging technician 0.3 (1.6) 0.0 (0.0) Others 2.2 (12.1) 0.5 (11.4) Table 2 Average designation and composition percentage of professional status. Professional status Center Station n (%) n (% Senior level 2.9 (15.9) 1.3 (29.5) Middle level 5.4 (29.7) 1.1 (25.0) Junior level 8.5 (46.7) 1.1 (25.0) No title 1.4 (7.7) 0.9 (20.5) Table 3 Average education levels and composition percentage. Education level Center Station n (%) n (%) Master or higher 3.5 (19.2) 0.8 (18.2) Bachelor 5.3 (29.1) 1.3 (29.5) Lower than bachelor 9.4 (51.6) 2.3 (52.3) of material resources per square kilometer est CHS organizations and were satisfied and per thousand capita than stations did with the cost of CHS. However, compared (Table 6). with those covered by centers, subjects covered by stations had lower satisfaction Satisfaction of CHS organizations levels on several items, such as environ- Data derived from the satisfaction ment, service attitude, medical technol- survey are summarized in Table 7. We ogy, and had fewer chronic disease related found that most subjects knew the near- activities at CHS organizations. 1080 Vol 46 No. 6 November 2015 COMMUNITY HEALTH SERVICES IN INNER MONGOLIA Table 4 Public health services provided by CHS organizations. Public health services Center Station n (%) n (% Child care 16 (88.9) 78 (76.5) Chinese traditional medicine 16 (88.9) 84 (82.4) Dental and oral care 17 (94.4) 83 (81.4) Emergency rescue service 15 (83.3) 76 (74.5) General clinic 18 (100.0) 102 (100.0) Geriatric care 15 (83.3) 86 (84.3) Health education and information 18 (100.0) 97 (95.1) Home visit 17 (94.4) 70 (68.6) Terminal care 15 (83.3) 78 (76.5) Immunization 18 (100.0) 102 (100.0) Maternal care 17 (94.4) 82 (80.4) Psychological consult 14 (77.8) 75 (73.5) Rehabilitative care 15 (83.3) 79 (77.5) Table 5 Apparatus in CHS organizations of Tongliao.
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