Competency building for lay health workers is an intangible force driving basic public health services in Southwest China

Shengxiang Liang,Li Li,John Ehiri,Xingneng Luo,Haoyue Deng,Yueying Xiang,Ying Li,Shili Liu,Jie Pu,Geng Wang,Mei Wang,Wei Xing

doi:10.1186/s12913-019-4433-2

Shengxiang Liang, Li Li + Show 10 more

Open Access

https://doi.org/10.1186/s12913-019-4433-2

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Abstract

BackgroundProviding 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.MethodsA 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.ResultsBoth 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.ConclusionsThe 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.

Highlights

Providing universal basic public health services (BPHS) for residents is the main goal of the new health reform in China
The Chinese government increased funding and infrastructure for primary health care (PHC), as human resources for health (HRH) in both quantity and quality are crucial to health services [10], and many trainings have been provided for Lay health workers (LHWs)
More than half of the leaders complained there was no needs assessment before trainings, which resulted in trainings that do not meet needs regarding the delivery of BPHS and so do not promote the competencies of LHWs to deliver BPHS

Summary

Introduction

Providing universal basic public health services (BPHS) for residents is the main goal of the new health reform in China. LHW in China refers to the health worker who works in PHC sectors They have formal professional (general practitioners and nurses) or paraprofessional tertiary education (such as college), whose roles include providing BPHS or basic clinical medicine to community residents, which are important services for improving health equity [7]. In 2012, the Department of Maternal and Child Health Care and Community Health of Ministry of Health of PRC issued the Notification of 2011 Major Special Training for Health Workers of Medical Reform [16] and Guidelines for implementation of capacity building of Community human resource [17], which provided guidelines for the training of LHWs in PHC sectors. LHW training is a traditional faceto-face training by trainers from hospitals, medical universities, specialized public health institutions (CDC, etc.) or PHC sectors and is organized by the Health and Family Planning Commission (HFPC) at all levels; the training mainly focuses on polices and service specifications for BPHS [17]

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