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  1. Some Practices of Managing Workforce Distribution in ChinaDo 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) 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)

  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

  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)

  26. Provincial case study (6)

  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)

  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! jixu@nhfpc.gov.cn