Training primary healthcare workers in China\u2019s township hospitals: a mixed methods study

Xuan Zhao,Haipeng Wang,Beibei Yuan,Juan Li

doi:10.1186/s12875-020-01333-4

Abstract

BackgroundPrimary health care (PHC) was a keystone toward achieving universal health coverage and Sustainable Development Goals (SDGs). China has made efforts to strengthen its PHC institutions. As part of such efforts, regular in-service training is crucial for primary healthcare workers (PHWs) to strengthen their knowledge and keep their skills up to date.ObjectiveTo investigate if and how the existing training arrangements influenced the competence and job satisfaction of PHWs in township hospitals (THs).MethodsA mixed method approach was employed. We analyzed the associations between in-service training and competence, as well as between in-service training and job satisfaction of PHWs using logistic regression. Interviews were recorded, transcribed, and analyzed using NVivo12 to better understand the trainings and the impacts on PHWs.ResultsThe study found that training was associated with competence for all the types of PHWs except nurses. The odds of higher competence for physicians who received long-term training were 3.60 (p < 0.01) and that of those who received both types of training was 2.40 (p < 0.01). PHWs who received short-term training had odds of higher competence significantly (OR = 1.710, p < 0.05). PHWs who received training were more satisfied than their untrained colleagues in general (OR = 1.638, p < 0.01). Specifically, physicians who received short-term training (OR = 1.916, p < 0.01) and who received both types of training (OR = 1.941, p < 0.05) had greater odds of general job satisfaction. The odds ratios (ORs) of general job satisfaction for nurses who received short-term training was 2.697 (p < 0.01), but this association was not significant for public health workers. The interview data supported these results, and revealed how training influenced competence and satisfaction.ConclusionsConsidering existing evidence that competence and satisfaction serve as two major determinants of health workers’ performance, to further improve PHWs’ performance, it is necessary to provide sufficient training opportunities and improve the quality of training.

Highlights

Primary health care (PHC) was a keystone toward achieving universal health coverage and Sustainable Development Goals (SDGs)
The study found that training was associated with competence for all the types of primary healthcare workers (PHWs) except nurses
The odds of higher competence for physicians who received long-term training were 3.60 (p < 0.01) and that of those who received both types of training was 2.40 (p < 0.01)

Summary

Introduction

Primary health care (PHC) was a keystone toward achieving universal health coverage and Sustainable Development Goals (SDGs). In China, THs constitute a critical part of the PHC delivery system by providing services ranging from basic public health services (such as preventive and health management care) to clinical outpatient and inpatient care for common diseases. They take responsibility in supervising and providing technical guidance for the village clinics [4], the grassroots and first contact health care providers in rural China. As a result of the reforms aimed at strengthening the PHC system, the PHWs in THs who play a crucial role in improving the availability and quality of primary health services [5] have changed their role and increased their work responsibilities. Improving work motivation does not necessarily mean more money input and in many cases, development can be realized through non-financial incentives such as opportunities for education or training to build skills [17,18,19,20,21]

Results

Discussion

Conclusion