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Luo H, Gong H, Luo F, Xing Y, Wang X, Huang J, Ding M, Lin D, Lan Y. Core competence of midwives in township hospitals and its influencing factors-A cross-sectional study. Heliyon 2024; 10:e25475. [PMID: 38327397 PMCID: PMC10848002 DOI: 10.1016/j.heliyon.2024.e25475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/09/2024] Open
Abstract
Objective This study aimed to assess the core competence of midwives in township hospitals through a self-assessment questionnaire. The relationship between professional identity and core competence and the factors influencing midwives' core competence was also investigated. Method Convenience sampling was conducted in 77 township hospitals in Ganzhou, Jiangxi Province, China, with 150 participants. The questionnaires were distributed online in November 2021. We conducted a descriptive data analysis, a correlation analysis of the two variables of professional identity and core competencies, and multivariate linear regression to analyse the influencing factors, including the sociodemographic information, the Midwife Core Competence Scale, and the Nurses' Professional Identity Scale scores. Results The mean score for the core competence was 206.43 (±37.45) out of 270. The highest score was for pregnancy care (3.97 ± 0.70) and the lowest was for newborn care (3.72 ± 0.78). The independent sample t-test results and one-way analysis of variance showed that qualifications, midwifery training situation, and midwifery working years had differential effects on midwives' core competencies (P < 0.05). Multiple linear regression showed that qualifications, midwifery working years, and level of professional identity were influencing factors (P < 0.05). Conclusions The core competencies of midwives in township hospitals were lower than those reported in other studies. Advancements in education, midwifery working years, and professional identity may increase midwives' core competencies.
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Affiliation(s)
- Huiyi Luo
- College of Nursing, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Huping Gong
- College of Nursing, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Feng Luo
- Department of Obstetrics, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Ying Xing
- College of Nursing, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Xin Wang
- College of Nursing, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Jingwen Huang
- College of Nursing, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Mei Ding
- College of Nursing, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Dongmei Lin
- College of Nursing, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Yanli Lan
- College of Nursing, Gannan Medical University, Ganzhou, Jiangxi, China
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Demissie M, Abera N, Gebremeskel L, Tadesse D, Dadi TL, Zebere T, Tigabu S, Fentaye FW, Alemayehu YK, Teklu AM, Medhin G, Zeleke S. Ethiopian Health Extension Workers' Training Status and Perceived Competency. Ethiop J Health Sci 2023; 33:49-62. [PMID: 38362476 PMCID: PMC10866291 DOI: 10.4314/ejhs.v33i1.6s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 01/24/2023] [Indexed: 02/17/2024] Open
Abstract
Background Training and work experience are critical inputs for delivering quality health services. However, no nationwide assessment has been conducted on the status of training and the competency of Health Extension Workers (HEWs). Therefore, this study aimed to assess HEWs' pre-service training status and perceived competency in Ethiopia. Methods The study was conducted in all regions and all HEWs training institutions in Ethiopia. We used cross-sectional study design with a mixed method approach that included 585 HEWs, 1,245 HEW trainees, 192 instructors, and 43 key informants. Descriptive statistics and thematic analysis were used to analyse quantitative and quantitative data respectively. Result Twenty-six percent of the HEWs said that they were competent to deliver all the HEP activities, and 73% of the HEWs said that they could confidently deliver 75% of the HEP activities. Receiving in-service training and having level III/IV qualifications are positively associated with the competency of HEWs. Similarly, HEP trainees perceived themselves as highly competent in executing their professional work, except in using computer and mobile health technology. Both instructors and trainees rated the quality of the curriculum and course materials positively. However, basic services and facilities in most training institutions were perceived to be inadequate. Additionally, individual learning, problem-solving, case-analysis, and assessment methods such as project work and portfolios were rarely practiced. Conclusions Although the perceived competence of HEW trainees is high, the HEWs' training is not provided as per the curriculum because of limited resources. All the necessary resources should be made available to produce competent HEWs.
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Affiliation(s)
- Mekdes Demissie
- College of Health and Medical Sciences, Haramaya University, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Studies for Africa (CDT-Africa), College of Health Science, Addis Ababa University
| | - Netsanet Abera
- College of Medicine and Health Sciences, Hawassa University, Ethiopia
| | | | | | - Tegene Legese Dadi
- College of Medicine and Health Sciences, Hawassa University, Ethiopia
- MERQ Consultancy PLC, Addis Ababa, Ethiopia
| | - Tadele Zebere
- College of Social Sciences and Humanities, Hawassa University, Ethiopia
| | | | | | - Yibeltal Kiflie Alemayehu
- MERQ Consultancy PLC, Addis Ababa, Ethiopia
- Department of Health Policy and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
- Department of Health Policy and Management; Jimma University, Ethiopia
| | | | - Gimay Medhin
- MERQ Consultancy PLC, Addis Ababa, Ethiopia
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Ethiopia
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Wu Y, Zhu L, Yu T, Zhang S. A Comprehensive Evaluation of Township Hospitals in the Severely Cold Areas of China. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 14:93-113. [PMID: 34000857 DOI: 10.1177/19375867211010268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aims of this study are to establish an evaluation system and find the existing problems in the architectural design of township hospitals in the severely cold regions of China. BACKGROUND Due to the geographical location and economic factors, development still has some key problems, such as inadequate construction, old facilities, and backward technology, which are more prominent in the severely cold regions. METHODS First, evaluation factors have been selected and determined by literature review and on-site investigation. Evaluation rules have been determined using fuzzy membership function. Then, the analytic hierarchy process is used to determine the weights of the evaluation factors at all levels. Finally, take a township hospital as an example to calculate the comprehensive evaluation results. RESULTS A comprehensive evaluation index system with 28 elements and 76 factors for the township hospitals in severely cold regions including the basic health service capacity, the emergency capacity, and the climate fitness. CONCLUSIONS The establishment of the comprehensive evaluation system of township hospitals in severely cold areas in this study aims to find out the problems through the evaluation of the existing township hospitals in the severely cold areas and provide guidance for the transformation of existing township hospitals in the severely cold areas. By comparing the scheme evaluation for building hospitals, we shall look for the optimal solution to provide reference for future development in the construction of township hospitals.
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Affiliation(s)
- Yue Wu
- Key Laboratory of Cold Region Urban and Rural Human Settlement Environment Science and Technology, School of Architecture, 47822Harbin Institute of Technology, China
| | - Lei Zhu
- Key Laboratory of Cold Region Urban and Rural Human Settlement Environment Science and Technology, School of Architecture, 47822Harbin Institute of Technology, China
| | - Tingting Yu
- Key Laboratory of Cold Region Urban and Rural Human Settlement Environment Science and Technology, School of Architecture, 47822Harbin Institute of Technology, China
| | - Shanshan Zhang
- Key Laboratory of Cold Region Urban and Rural Human Settlement Environment Science and Technology, School of Architecture, 47822Harbin Institute of Technology, China
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Mao Y, Hu Y, Feng Z, Wang R, Chen X, Zhang W, Yang G. Job burnout and correlated factors of three-tiered public health workers: A cross-sectional study in China. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1241-1251. [PMID: 32128900 DOI: 10.1111/hsc.12957] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 01/15/2020] [Accepted: 01/25/2020] [Indexed: 05/22/2023]
Abstract
This study aimed to reveal burnout levels and its potential influencing factors among three-tiered public health workers in China. A total of 1,328 public health workers from cities, counties and townships in Henan and Hubei provinces participated. Cumulative logistic regressions were used to determine job burnout predictors. Township workers (β = 0.276, p = .046) showed higher levels of emotional exhaustion (EE) than city workers. Municipal workers showed higher levels of depersonalisation (DP) (β = -0.439, p = .004) and lack of personal accomplishment (LPA) (β = -0.343, p = .005) than township workers. Compared with those who had better results, township workers with average levels of interpersonal relationships (β = 0.703, p = .014) exhibited higher EE degrees. Municipal (β = 1.050, p < .001) and county (β = 1.359, p < .001) workers with moderate training satisfaction had higher levels of burnout than those with a high degree of training satisfaction. Municipal (β = 3.933, p < .001) and county (β = 1.218, p = .018) workers earning 2,000 RMB and below every month were more likely to have higher burnout levels than those earning 4,001 RMB and above. Township respondents exhibited high EE levels, given the low-level education of their services' target audience. Similarly affected by interpersonal relationships, township workers require interpersonal and emotional intervention programmes. City respondents showed a high level of DP and LPA, which was attributed to considerable differences between public health workers and medical workers in cities. Hence, apart from narrowing the reward gap between clinicians and public health workers, improving public health workers' social cognition and status by various channels was found necessary. The burnout of municipal and county respondents were influenced by income and training. Improving the role of income as incentive and reforming trainings programmes would be necessary.
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Affiliation(s)
- Yiqing Mao
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yue Hu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhanchun Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ruoxi Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaoyu Chen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Weiping Zhang
- Health Commission of Henan Province, Zhengzhou, Henan, China
| | - Gaiying Yang
- Center for Disease Control and Prevention in Henan Province, Zhengzhou, Henan, China
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Tong C, Cui C, Li Y, Wang L. The Effect of Workplace Violence on Depressive Symptoms and the Mediating Role of Psychological Capital in Chinese Township General Practitioners and Nurses: A Cross-Sectional Study. Psychiatry Investig 2019; 16:896-903. [PMID: 31698555 PMCID: PMC6933129 DOI: 10.30773/pi.2019.0095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/06/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The most existing research has predominantly focused on city rather than township hospitals. This study aimed to explore depressive symptoms and its associated factors among general practitioners and nurses in Chinese township hospitals. METHODS This cross-sectional study was carried out in Liaoning, China in 2016. 2,000 general practitioners and nurses in Chinese township hospitals were recruited and 1,736 of them became final subjects (effective response rate: 86.8%). Data on depressive symptoms, workplace violence (WPV), psychological capital (PsyCap), and demographic factors were collected through questionnaires. Hierarchical multiple regression was used to explore the factors related to depressive symptoms. Asymptotic and resampling strategies were applied to examine the potential mediating effect of PsyCap. RESULTS The prevalence of depressive symptoms among the participants was 49.9%. Workplace violence was positively associated with depressive symptoms, whereas psychological capital and its components of hope, optimism and resilience were negatively associated with depressive symptoms. Psychological capital and its components of hope, optimism and resilience all played partial mediating roles between workplace violence and depressive symptoms. CONCLUSION Nearly half of general practitioners and nurses surveyed suffered from depressive symptoms. Reduction of workplace violence and development of psychological capital can be targeted for interventions to combat depressive symptoms.
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Affiliation(s)
- Chi Tong
- School of Continuing Education, China Medical University, Shenyang, China.,Department of Social Medicine, School of Public Health, China Medical University, Shenyang, China
| | - Chunying Cui
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, China
| | - Yifei Li
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, China
| | - Lie Wang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, China
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Liang S, Deng H, Liu S, Wang G, Li L, Wang M, Pu J, Xing W, Luo X, Ehiri J, Xiang Y, Li Y. Competency building for lay health workers is an intangible force driving basic public health services in Southwest China. BMC Health Serv Res 2019; 19:596. [PMID: 31443648 PMCID: PMC6708187 DOI: 10.1186/s12913-019-4433-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 08/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Providing universal basic public health services (BPHS) for residents is the main goal of the new health reform in China. Lay health workers (LHWs) in primary health care (PHC) sectors play key roles in BPHS delivery. The competency of LHWs is critical to quality BPHS. This study assessed LHWs' competency to deliver BPHS and related training in resource-limited Southwest China. METHODS A mixed research method combining in-depth interviews with secondary data collection was used to collect data in this cross-sectional study. Fifty-four LHWs and 16 leaders in 16 PHC sectors were recruited for in-depth interviews. Secondary data on 198 LHWs were collected through standard forms. RESULTS Both the interviews and secondary data suggested that all PHC sectors did not have sufficient LHWs and lacked qualified LHWs to deliver BPHS overall, particularly in relatively low economic rural areas in Guizhou province. Furthermore, PHC sectors had difficulties retaining existing LHWs due to low incomes and fewer opportunities for self-development. In-depth interviews discovered that, although numerous training opportunities have been provided for LHWs since 2009, the trainings did not achieve the expected outcome in LHW competency building, as LHWs actually did not have access to the trainings and the training design was unresponsive to the actual needs of LHWs. Both LHWs and leaders expressed an urgent need for effective training for LHWs based on systematic needs assessments and the use of qualified trainers and materials. CONCLUSIONS The shortage of qualified LHWs in PHC sectors became the bottleneck for BPHS delivery in Southwest China. Recent trainings for LHWs were less effective with regard to LHW competency building. A need-based professional training programme for LHWs by qualified trainers was expected by both LHWs and leaders in PHC sectors.
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Affiliation(s)
- Shengxiang Liang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba district, Chongqing, 400038, China
| | - Haoyue Deng
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba district, Chongqing, 400038, China
| | - Shili Liu
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba district, Chongqing, 400038, China
| | - Geng Wang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba district, Chongqing, 400038, China
| | - Li Li
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba district, Chongqing, 400038, China
| | - Mei Wang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba district, Chongqing, 400038, China
| | - Jie Pu
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba district, Chongqing, 400038, China
| | - Wei Xing
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba district, Chongqing, 400038, China
| | - Xingneng Luo
- Department of TB control, Center of Disease Control in Shapingba District, Chongqing, China
| | - John Ehiri
- Division of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health University of Arizona, Tucson, AZ, USA
| | - Yueying Xiang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba district, Chongqing, 400038, China.
| | - Ying Li
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), No.30 Gaotanyan Road, Shapingba district, Chongqing, 400038, China.
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Determinants and Differences of Township Hospital Efficiency among Chinese Provinces. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091601. [PMID: 31067779 PMCID: PMC6539220 DOI: 10.3390/ijerph16091601] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/25/2019] [Accepted: 04/29/2019] [Indexed: 12/27/2022]
Abstract
This study aimed to measure the efficiency and change in efficiency over time of township hospitals among Chinese provinces, to decompose the difference in efficiency between districts, and to study the correlations between the difference in efficiency and its determinants. Based on Chinese provincial panel data, the empirical analysis was established using data envelopment analysis (DEA), Malmquist index, Theil index decomposition method and Grey correlation analysis method. First, it was found that the township hospitals in most provinces were operating in an inefficient state, and the township hospitals in most provinces achieved gains in efficiency. Second, from 2003 to 2016 the shrinkage of the difference in provincial efficiency of township hospitals progressed slowly. Intra-regional difference is the main cause of the overall provincial efficiency difference of Chinese township hospitals, while inter-regional difference is the minor cause of the overall difference. Third, the correlation between the difference of overall provincial efficiency and the difference of economic development level is the highest among all the correlations, while other determinants rank second to seventh place in their degree of correlation with respect to the overall difference in provincial efficiency. Furthermore, the correlations between the intra-regional difference of provincial efficiency of Chinese township hospitals and its determinants vary tremendously across regions. Based on our findings, we can conclude, first, that efforts should be made to improve the overall provincial difference in efficiency of Chinese township hospitals, and enhance the utilization level of input resources, and to reduce resource waste. Second, in order to shrink the overall provincial efficiency of Chinese township hospitals, the most important measure that should be taken is to improve the economic development level in relatively backward provinces in order to lay a solid economic foundation for the improvement of efficiency and shrink the differences in efficiency between provinces. Third, more attention should be paid to the shrinkage of intra-regional efficiency differences in Chinese township hospitals, while the narrowing of inter-regional efficiency difference should not be ignored. For each region, it is necessary to recognize the difference in the relative importance of determinants, and to make development strategies according to local conditions so as to make full use of local characteristics and advantages.
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Supprasert W, Khajornchaikul P, Harncharoen K, Taechaboonsermsak P, Pitikultang S, Kulapichitr U. Factors affecting the capabilities of family development centre staff regarding promotion of pre-school language learning amongst parents in Thailand. JOURNAL OF HEALTH RESEARCH 2019. [DOI: 10.1108/jhr-05-2018-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
The purpose of this paper is to investigate the factors contributing to the competencies and capabilities of Family Development Center (FDC) staff in order to promote pre-school language developmental support amongst parents.
Design/methodology/approach
A cross-sectional study was conducted amongst 260 FDC staff under the supervision of Thai local authorities in the rural province of Suphanburi in Thailand from July to September 2016. Self-administered questionnaires were used. Eligible participants with at least a year’s experience on the FDC committee were purposively selected. Analyses were performed by descriptive statistics, Pearson’s correlation, Spearman’s correlation, χ2 test and stepwise multiple regression.
Findings
Only 23.5 percent of staff had a high level of capability. The respondents’ perceptions of their self-capability were influenced by motivation, attitudes toward promoting language learning amongst parents, self-efficacy, sufficient budget and receiving constructive appraisal support (r=0.387, 0.328, 0.366, 0.106 and 0.104, respectively). Marital status was negatively associated with FDC staff capability (r=−0.172). The multivariate analysis showed that 23.9 percent of the variability of FDC staff’s self-capability could be explained by their motivation for working, attitude, self-efficacy and marital status (p<0.001).
Originality/value
Research findings could be used to improve motivation for working, positive attitudes and self-efficacy regarding parenting promotion for pre-school language development to achieve standardized quality performance. Results of this study could also form the basis for designing effective training programs for FDC staff in the context of the specific organization and community.
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Jing L, Liu K, Zhou X, Wang L, Huang Y, Shu Z, Lou J, Fan J, Sun X. Health-personnel recruitment and retention target policy for health care providers in the rural communities: A retrospective investigation at Pudong New Area of Shanghai in China. Int J Health Plann Manage 2018; 34:e157-e167. [PMID: 30168615 DOI: 10.1002/hpm.2618] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/13/2018] [Accepted: 07/13/2018] [Indexed: 12/28/2022] Open
Abstract
To tackle the shortage of health personnel in the rural areas of Pudong New Area of Shanghai, the local government issued an incentive policy as one of the medical reforms. The current investigation focused on the relevant incentive measures and their corresponding effects and problems with a view to providing referential and useful experiences for those who are engaged in addressing the same problem at home and abroad. The details of the incentive policy were derived from the government document, and the related data about the flow of the rural community health care providers, from the institutional investigation. As indicated by the current investigation, the incentive policy produced some positive effect in attracting health care providers to work in the rural community health centers, especially general practitioners, nurses, MS/MD degree holders, and intermediate professional title holders to be employed in the farther ones. However, it was turned out that the population of high quality health care providers was still not sufficient enough to cover the whole rural areas, which suggested that it was still hard to draw such qualified medical individuals. To conclude in the current investigation, we made three recommendations for the policymakers to take into account in terms of policy maintenance, benefits for health personnel, and guarantee of their lawful rights and interests.
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Affiliation(s)
- Limei Jing
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Pudong Institute for Health Development, Shanghai, China
| | - Kun Liu
- Division of Research and Development, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Xuhong Zhou
- Health and Family Planning Commission of Pudong New Area, Shanghai, China
| | - Li Wang
- Health and Family Planning Commission of Pudong New Area, Shanghai, China
| | - Yao Huang
- Pudong New Area Health Service Center for Human Resources, Shanghai, China
| | - Zhiqun Shu
- Pudong Institute for Health Development, Shanghai, China.,Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Fudan University, Shanghai, China
| | - Jiquan Lou
- Pudong Institute for Health Development, Shanghai, China
| | - Jincheng Fan
- Health and Family Planning Commission of Pudong New Area, Shanghai, China
| | - Xiaoming Sun
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Pudong Institute for Health Development, Shanghai, China.,Fudan University, Shanghai, China
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Li Z, Yang J, Wu Y, Pan Z, He X, Li B, Zhang L. Challenges for the surgical capacity building of township hospitals among the Central China: a retrospective study. Int J Equity Health 2018; 17:55. [PMID: 29720175 PMCID: PMC5932883 DOI: 10.1186/s12939-018-0766-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 04/16/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND China's rapid transition in healthcare service system has posed considerable challenges for the primary care system. Little is known regarding the capacity of township hospitals (THs) to deliver surgical care in rural China with over 600 million lives. We aimed to ascertain its current performance, barriers, and summary lessons for its re-building in central China. METHODS This study was conducted in four counties from two provinces in central China. The New Rural Cooperative Medical System (NRCMS) claim data from two counties in Hubei province was analyzed to describe the current situation of surgical care provision. Based on previous studies, self-administered questionnaire was established to collect key indicators from 60 THs from 2011 to 2015, and social and economic statuses of the sampling townships were collected from the local statistical yearbook. Semi-structured interviews were conducted among seven key administrators in the THs that did not provide appendectomy care in 2015. Determinants of appendectomy care provision were examined using a negative binominal regression model. RESULTS First, with the rapid increase in inpatient services provided by the THs, their proportion of surgical service provision has been nibbled by out-of-county facilities. Second, although DY achieved a stable performance, the total amount of appendectomy provided by the 60 THs decreased to 589 in 2015 from 1389 in 2011. Moreover, their proportion reduced to 26.77% in 2015 from 41.84% in 2012. Third, an increasing number of THs did not provide appendectomy in 2015, with the shortage of anesthesiologists and equipment as the most mentioned reasons (46.43%). Estimation results from the negative binomial model indicated that the annual average per capita disposable income and tightly integrated delivery networks (IDNs) negatively affected the amount of appendectomy provided by THs. By contrast, the probability of appendectomy provision by THs was increased by performance-related payment (PRP). Out-of-pocket (OOP) cost gap of appendectomy services between the two different levels of facilities, payment method, and the size of THs presented no observable improvement to the likelihood of appendectomy care in THs. CONCLUSION The county-level health system did not effectively respond to the continuously increasing surgical care need. The surgical capacity of THs declined with the surgical patterns' simplistic and quantity reduction. Deficits and critical challenges for surgical capacity building in central China were identified, including shortage of human resources and medical equipment and increasing income. Moreover, tight IDNs do not temporarily achieve capacity building. Therefore, the reimbursement rate should be further ranged, and physicians should be incentivized appropriately. The administrators, policy makers, and medical staff of THs should be aware of these findings owing to the potential benefits for the capacity building of the rural healthcare system.
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Affiliation(s)
- Zhong Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No 13 Hangkong Road, Qiaokou District Wuhan, Hubei, 430030 China
| | - Jian Yang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No 13 Hangkong Road, Qiaokou District Wuhan, Hubei, 430030 China
- Department of Medical Affairs, Guangdong General Hospital, Guangzhou, 510080 Guangdong China
| | - Yue Wu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No 13 Hangkong Road, Qiaokou District Wuhan, Hubei, 430030 China
| | - Zijin Pan
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No 13 Hangkong Road, Qiaokou District Wuhan, Hubei, 430030 China
| | - Xiaoqun He
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No 13 Hangkong Road, Qiaokou District Wuhan, Hubei, 430030 China
| | - Boyang Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No 13 Hangkong Road, Qiaokou District Wuhan, Hubei, 430030 China
| | - Liang Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No 13 Hangkong Road, Qiaokou District Wuhan, Hubei, 430030 China
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Satisfaction of village doctors with the township and village health services integration policy in the western minority-inhabited areas of China. ACTA ACUST UNITED AC 2017; 37:11-19. [PMID: 28224422 DOI: 10.1007/s11596-017-1687-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 12/14/2016] [Indexed: 12/31/2022]
Abstract
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.
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