卫生部人才交流服务中心 Health Human Resources Development Center Ministry of Health,...

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

8

Current HRH Situation (3)

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)

Category Total Reg. & Ass. Doc.

Reg. Doc. Reg. Nurses

Phar. Lab Tech.

Others

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Professor 1.8 3.9 4.6 0.1 0.5 0.4 0.6

Associate professor

6.4 12.4 15.0 1.8 2.8 3.0 2.2

Mid-qualification

25.9 30.8 37.0 25.0 23.0 22.3 10.6

Assistant 33.9 38.1 36.4 30.3 39.7 35.3 21.3

Technician 26.5 10.8 2.1 38.6 28.2 30.3 35.8

None 5.6 4.0 4.9 4.1 5.9 8.8 29.6

Technical Qualification of Health Professionals in China (%) (2010) 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 2005 2007 2008 2009 2010

Health Professional 3.57 3.76 3.92 4.15 4.37

Urban 5.82 6.44 6.68 7.15 7.62

Rural 2.69 2.69 2.80 2.94 3.04

Reg. & Ass. Doctor 1.60 1.62 1.67 1.75 1.79

Urban 2.46 2.61 2.68 2.83 2.97

Rural 1.26 1.23 1.26 1.31 1.32

Registered Nurse 1.06 1.19 1.27 1.39 1.52

Urban 2.10 2.42 2.54 2.82 3.09

Rural 0.65 0.70 0.76 0.81 0.89

14

Current HRH Situation (9)Densities of health professionals in each province (/1000population)

2-3

3-4

4-5

5-6

6+

15

Major HRH rural retention policies (1)

China’s National Guideline for Mid-long Term HRH Development (2011-2020) launched by MOH, 2011

Indicators UnitYear

2009 2015 2020

Total number million persons7.78 9.53 12.55

Reg. & Ass. Doctor

/1000 population1.75 1.88 2.1

Reg. nurse /1000 population1.39 2.07 3.14

Public health professionals

/1000 population0.53 0.68 0.83

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

25

Provincial case study (5)

76,139

89,644

65,26175,033

34,097 35,553

10,451 15,103

Y 2008 Y 2012

Comparison of Number of Health Professionals at Township Health Centers between 2008 and 2012

Total Health Workers at Town Health CentersTechnical Health Staff at Town Health Centers Medical (Asisstant) Practicioners at Town Health Centers Registered Nurses at Town Health Centers

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)

63,423 70,955

42,593 47,677

Y 2008 Y 2012

Rural doctors

Rural doctors with secondary degree or above

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% 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

30

THANK YOU!THANK YOU!jixu@nhfpc.gov.cnjixu@nhfpc.gov.cn