Presentation on theme: "卫生部人才交流服务中心 Health Human Resources Development Center Ministry of Health, People’s Republic of China 世界卫生组织卫生人力资源合作中心（中国） WHO Collaborating Center for."— Presentation transcript:
卫生部人才交流服务中心 Health Human Resources Development Center Ministry of Health, People’s Republic of China 世界卫生组织卫生人力资源合作中心（中国） WHO Collaborating Center for Human Resources for Health (China) Some Practices of Managing Workforce Distribution in China Do existing policies work on reversing the effect of geographic maldistribution of HRH, and how? JI Xu, MD. MSc. Health Human Resources Development Center Ministry of Health
2 Outline Background: health system reform Current HRH situation in China Major HRH rural retention policies Case study: provincial implementation Conclusion
3 Background (1) Launch of healthcare system reform, April 2009 Guidelines on Deepening the Reform of Healthcare System issued by CPC and State Council Reform goal: to establish a nationwide basic healthcare network to every Chinese people by 2020 AUS$ 152 billion investment in healthcare reform during 2009-2011, and a three-year plan
4 Background (2) Five priorities of a three-year plan (2009-11) To strengthen the public health system To extend health insurance coverage To establish the national essential drug system To enhance the healthcare delivery system To pilot public hospital reform
5 Background (3) Primary health facilities have been remarkably improved by the end of 2011 2,200 county hospitals and 33,000 primary health care institutions were renovated 70% township hospitals and 85% community health centers reached national standards after upgrading About 70% counties had at least one county hospital at secondary level A A number of high-quality HRH are required in rural areas !
6 Current HRH Situation (1) Quantity Quality Distribution
7 Current HRH Situation (2) Quantity (2011): 8.21m HRH in total 5.88m Health professionals 1.09m Village doctors Doctor/Nurse = 1.18 Health workforce Health professionals Reg. & Assi. doctors Reg. Nurses Pharmacists Lab technicians** Others*** Village doctors and assistant Other technical professionals* Administrators Other service workers
9 Current HRH Situation (4) Quantity Quality Distribution
10 Current HRH Situation (5) At the primary health level, the percentage of urban health professionals with bachelor‘s degree or above is 19.0%, which is almost 3.4 times higher than that of rural counterparts (5.6%).
11 Current HRH Situation (6) CategoryTotalReg. & Ass. Doc. Reg. Doc.Reg. Nurses Phar.Lab Tech.Others Total100.0 Professor22.214.171.124.10.50.40.6 Associate professor 6.412.415.01.82.83.02.2 Mid- qualification 25.930.837.025.023.022.310.6 Assistant33.938.136.430.339.735.321.3 Technician26.510.82.138.628.230.335.8 None5.64.04.94.15.98.829.6 Technical Qualification of Health Professionals in China (%) (2010) At the primary health level, the percentage of urban health professionals with middle technical qualification or above is 29.9%, nearly twice higher than that of their rural counterparts (15.3%).
12 Current HRH Situation (7) Quantity Quality Distribution
13 Current HRH Situation (8) Health professional geo-distribution between urban and rural areas (/1000 population) Year 20052007200820092010 Health Professional3.573.763.924.154.37 Urban5.826.446.687.157.62 Rural2.69 2.802.943.04 Reg. & Ass. Doctor1.601.621.671.751.79 Urban2.462.612.682.832.97 Rural1.261.231.261.311.32 Registered Nurse1.061.191.271.391.52 Urban2.102.422.542.823.09 Rural0.650.700.760.810.89
14 Current HRH Situation (9) Densities of health professionals in each province (/1000population)
15 Major HRH rural retention policies (1) China’s National Guideline for Mid-long Term HRH Development (2011-2020) launched by MOH, 2011 IndicatorsUnit Year 200920152020 Total numbermillion persons 7.789.5312.55 Reg. & Ass. Doctor /1000 population 1.751.882.1 Reg. nurse/1000 population 1.392.073.14 Public health professionals /1000 population 0.530.680.83
16 Major HRH rural retention policies (2) Policy Intervention 1: Counterpart technical assistance between urban and rural areas Year: 2005 - present Participants: urban health professionals Beneficiaries: county hospitals Outcome: Improved management, technical skills and service quality Relevance to WHO Guideline: B3 compulsory service; D3 outreach support
17 Major HRH rural retention policies (3) Policy Intervention 2: Rural recruitment at township level Year: 2007 - present Participants: MoH & MoF Beneficiaries: township health centers Outcome: Improved HRH quality at primary health facilities in rural areas Relevance to WHO Guideline: B3 compulsory service; C1 appropriate financial incentives
18 Major HRH rural retention policies (4) Policy Intervention 3: Capacity building for rural health professionals (selected one) Year: 2010 - present Participants: MoH and urban hospitals Beneficiaries: county hospitals Outcome: enhanced the skills of rural health professionals, new technologies were introduced to deal with common diseases Relevance to WHO Guideline: A5 continuous professional development for rural health workers; D4 career development programs
19 Major HRH rural retention policies (5) Policy Intervention 4: Contracted medical students with benefit package Year: 2010 - present Participants: MoH and medical universities Beneficiaries: rural health facilities Outcome: will follow up Relevance to WHO Guideline: A3 students from rural backgrounds; B3 compulsory services
20 Major HRH rural retention policies (6) Whether existing policy interventions of HRH rural retention can help reach required goals?
21 Provincial case study (1) Sichuan province 80.42m population Rank 1st in China with 53,796 village health stations and 4,618 health centers at township level HRH quantity deficiency and low- level quality, maldistribution
22 Provincial case study (2) Guideline for rural HRH implementation Fully initiated health care system reform followed by the HRH development guideline of “increasing the total quantity, improving the qualification and adjusting the structure of HRH”
23 Provincial case study (3) Undertaking projects The “Hundred, Thousand and Ten Thousand” rural health talents program; (To recruit at least one licensed doctor for each of 100 county hospitals, 1000 health centers and 10000 village clinics) Recruiting licensed doctors for township health centers; Fee-free enrollment of medical student with rural background; and “Ten Thousand Doctors Aid for Rural Health” program (Counterpart technical support). Local and national training programs for rural HRH
24 Provincial case study (4) Undertaking capacity building projects Rotation training for GPs and standardized training for resident physicians In-service training for rural health staff Degree education for rural doctors Develop rural health talents for ethnic regions Develop TCM practitioners for rural areas Develop health professional leaders for rural areas
26 Provincial case study (6) No. of Total Health Workers in Township Health Centers No. of Health Professionals in Township Health Centers No. of Licensed (Assistant) Doctors in Township Health Centers No. of Registered Nurses in Township Health Centers Increase rate (2008 - 2012) 17.7% 15.0%4.3%44.5% Average Monthly Outpatient & Ambulance Treatments at Township Health Centers Average Monthly Discharges from Township Health Centers Increase rate (2008 - 2012) 10.0% 21.2%
27 Provincial case study (7) Comparison of Health Worker Number and Service Quantity at Village Clinics between 2008 and 2012
28 Provincial case study (8) No. of Rural Doctors No. of Rural Doctors with Secondary Degree or Above No. of Rural Doctors with Licensed (Assistant) Practitioner Qualification Average no. of Monthly Diagnoses and Treatments at Village Clinics Increase rate (from 2008 to 2012) 11.9% 36.5%25.9%
29 Conclusion Sustainability of policy interventions Township recruitment VS GPs training program Coordination among stakeholders Contracted medical students with benefit package Evidence for supporting research In-depth researches required