Embed Size (px)
Citation preview
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
