The development of rural primary health care in China’s health system reform

Abstract

China started its national health system reform in 2009, with the focus on primary health care (PHC). This study aimed to investigate the progress of PHC in rural China during the health system reform, with a special focus on human resources for health (HRH). It used data from health statistical yearbooks as well as a questionnaire survey and qualitative interviews in three provinces. The study found that central and local governments increased their financial subsidies to township health centres. Medical education and training activities were organized to improve HRH development. Health professionals’ monthly income increased as a result of the implementation of a performance-based payment system. The number and quality of health professionals at township health centres had a steady increase, but health managers reported serious HRH crises in terms of attraction and retention of qualified health professionals. The amount of medical and public health services provided by township health centres had a significant increase. The study recommended the control of uncoordinated expansion of public hospitals, strengthening of medical education, and improving health professionals’ income in order to promote HRH development and quality of rural PHC services.