Abstract
BackgroundNo studies, particularly quantitative analyses, have been conducted regarding the workload of village doctors in the National Essential Public Health Services (NEPHS) program and differences in service delivery by village doctors, according to region and services. In this study, we developed a quantitative analysis approach to measure the workload of NEPHS provided by village doctors in six provinces of China in 2016. We aimed to identify areas and services of the NEPHS needing improvement, so as to implement targeted measures to ensure adequate delivery of NEPHSs in rural remote underserved areas.MethodsBased on survey data from 300 town hospital centers (THCs) located in 60 counties in the six selected provinces, we calculated village doctors’ share of workload under the NEPHS using the equivalent value (EV) model. To define the workload and corresponding EV of each NEPHS, a series of five meetings was held with THC managers, public health workers, family physicians, nurses and village doctors. Field observations were conducted to verify the workload and EV of each service.ResultsVillage doctors’ share of the workload under the NEPHS program was 43.71% across the 300 sampled THCs in six provinces. The village doctors’ workload shares for different NEPHS ranged from 17.14 to 57.00%. The percentage workload undertaken by village doctors under the NEPHS program varied across different provinces, with the highest proportion 63.4% and the lowest 28.5%.ConclusionsThe total NEPHS workload assigned to village doctors by THCs in the six sampled provinces exceeded the Chinese government’s requirement of 40%, but the workload proportion in some provinces was less than 40%. In addition, the percentage workload for some NEPHS undertaken by village doctors was lower than others. We suggest conducting district-level analysis of the workload among village doctors under the NEPHS program using the EV method, to identify areas and services needing improvement, to implement targeted measures to expand and promote health service provision in China’s rural underserved areas.
Highlights
No studies, quantitative analyses, have been conducted regarding the workload of village doctors in the National Essential Public Health Services (NEPHS) program and differences in service delivery by village doctors, according to region and services
Workload for different NEPHS provided by village doctors The total workload of NEPHS was 42.32 million equivalent value (EV) across 300 sample Township Hospital Centers (THC) from six provinces; village
This study showed that differences exist in the percentage of the NEPHS workload taken on by village doctors according to different provinces and different services, with the percentage workload in some provinces lower than 40%
Summary
Quantitative analyses, have been conducted regarding the workload of village doctors in the National Essential Public Health Services (NEPHS) program and differences in service delivery by village doctors, according to region and services. Recent decades have witnessed rapid improvement in China’s public health system, with average life expectancy up from 71.4 to 74.8 years between 2000 and 2010 [1, 2], the maternal mortality rate down from 53.0 to 30.0 per 100,000 population and the infant mortality rate dropping from32.2 to 13.1 per 1000 live births between 2000 and 2010 [3,4,5] Despite this progress, diseases including hypertension, obesity, diabetes and other noncommunicable diseases still pose challenges to China’s public health [6, 7]. The NEPHSs are the most essential public health services provided free of charge to all residents, focusing on children, pregnant women, the elderly and patients with chronic diseases, aiming at the main health problems of urban and rural residents. The program focuses on essential primary care (maternal, infant and older adult health) accessible for all people, rather than regulatory and monitoring tasks
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