Satisfaction of Village Doctors with the Township and Village Health Services Integration Policy in the Western Minority-inhabited Areas of China

Township and Village Health Services Integration Management（TVHSIM） is an essential form of China＇s two-tiered health service integration plan at the township and village level. Its main purpose, also one of the target goals in China＇s new healthcare reform, is to gradually integrate rural health services and appropriately allocate rural health resources. This study aims to assess the village doctors＇ satisfaction with the TVHSIM and provide scientific base to further improve TVHSIM. A cross-sectional study was carried out in which 162 village doctors from Qinghai, Inner Mongolia and Xinjiang in western China were interviewed. Descriptive analysis, independent t-test, one-way ANOVA, Spearman rank correlation and multiple linear regression were used to analyze the difference and relevance between village doctors＇ personal characteristics and their satisfaction with TVHSIM and six subscales. Village doctors with different years of practice, social insurance status and essential medical knowledge level showed statistically significant differences in their satisfaction levels（all P〈0.05）. Age（P〈0.05） and years of practice（P〈0.01） were negatively correlated with Drug and Medical Device Management and Financing Management. Essential medical knowledge level（P〈0.05） was negatively correlated with Operations Management as well. However, social insurance status（P〈0.05） was positively correlated with Human Resources Management and Drug and Medical Device management. Gender, age and years of practice respectively had significant influence on village doctors＇ satisfaction with TVHSIM（P〈0.01）. In conclusion, in order to further promote TVHSIM policy in rural China, a well-rounded social insurance model for village doctors is urgently needed. In addition, the development of TVHSIM is regionally imbalanced. Efficient and effective measures aiming at rationalizing gender and age structure and enhancing essential medical training should be carefully considered.

Meeting the Health-care Needs of the Rural Elderly:The Unique Role of Village Doctors

Despite their recent deterioration, village clinics have historically been an important source of health care for the poor and elderly in rural China. In this paper, we examine the current role of village clinics, the patients who use them and some of the services they provide. We focus specifically on the role of village clinics in meeting the health-care needs of the rural poor and elderly. We find that although clinics are continuing to decline financially, they remain a source of care for the rural elderly and poor. We estimate that the elderly are 10-15 percent more likely than young individuals to seek care at a clinic. We show that clinics provide many unique services to support the rural elderly （and the elderly poor）, such as in-home patient care, the option for patients to pay on credit, and free and discounted services.

Delivery of public health services by community health workers(CHWs)in primary health care settings in China:a systematic review(1996–2016)

Background:Community Health Workers(CHWs)have been widely used in response to the shortage of skilled health workers especially in resource limited areas.China has a long history of involving CHWs in public health intervention project.CHWs in China called village doctors who have both treatment and public health responsibilities.This systematic review aimed to identify the types of public health services provided by CHWs and summarized potential barriers and facilitating factors in the delivery of these services.Methods:We searched studies published in Chinese or English,on Medline,PubMed,Cochrane,Google Scholar,and CNKI for public health services delivered by CHWs in China,during 1996-2016.The role of CHWs,training for CHWs,challenges,and facilitating factors were extracted from reviewed studies.Results:Guided by National Basic Public Health Service Standards,services provided by CHW covered five major areas of noncommunicable diseases(NCDs)including diabetes and/or hypertension,cancer,mental health,cardiovascular diseases,and common NCD risk factors,as well as general services including reproductive health,tuberculosis,child health,vaccination,and other services.Not many studies investigated the barriers and facilitating factors of their programs,and none reported cost-effectiveness of the intervention.Barriers challenging the sustainability of the CHWs led projects were transportation,nature of official support,quantity and quality of CHWs,training of CHWs,incentives for CHWs,and maintaining a good rapport between CHWs and target population.Facilitating factors included positive official support,integration with the existing health system,financial support,considering CHW’s perspectives,and technology support.Conclusion:CHWs appear to frequently engage in implementing diverse public health intervention programs in China.Facilitators and barriers identified are comparable to those identified in high income countries.Future CHWs-led programs should consider incorporating the common barriers and facilitators identified in the current study to maximize the benefits of these programs.

Annual Checkup

Zhu Xinlian,a village doctor in Ningxia Hui Autonomous Region,has received a significant salary raise：earning 70,000 yuan（$10,606）in 2015 after earning less than 5,000yuan（$758）a year in the late 2000’s.Graduating from Ningxia Medical School in 1996,Zhu has witnessed the dramatic change of the village clinic in the past years.