Village Clinics Research Articles

The attitude of farmers to the New Rural Cooperative Medical Scheme in Northwest China one year after its introduction: a cross-sectional study

The implementation of the Chinese New Rural Cooperative Medical Scheme (NRCMS) spread fast since a county pilot trial in 2003. The purpose of this survey is to guide policy-makers on how to improve the current national NRCMS policy. Cross-sectional survey of 1,978 farmers in 50 villages in Huxian Shaanxi Province on their attitudes towards the NRCMS administered door-to-door in 2005. Most farmers hold a positive attitude towards the NRCMS. However, they do not trust the scheme management. Farmers place more trust in village doctors rather than village cadres for fund collection. More than two thirds of farmers seek care in county hospitals directly, bypassing village clinics and township hospitals. Not all hospitals and doctors fully comply with the NRCMS rules, and supplier-induced demand is still widespread. More than half of farmers worry that the NRCMS is not sustainable. Importantly, the survey showed a high enrolment rate of 92% (95% CI, 91; 93) in a voluntary insurance scheme. A number of remedial actions in health financing, planning and management to counteract the identified issues are proposed.

Mental health system in China: history, recent service reform and future challenges

This paper summarizes the history of the development of Chinese mental health system; the current situation in the mental health field that China has to face in its effort to reform the system, including mental health burden, workforce and resources, as well as structural issues; the process of national mental health service reform, including how it was included into the national public health program, how it began as a training program and then became a treatment and intervention program, its unique training and capacity building model, and its outcomes and impacts; the barriers and challenges of the reform process; future suggestions for policy; and Chinese experiences as response to the international advocacy for the development of mental health.

Job satisfaction and relevant factors among village health personnel in Puan county

Objective To explore the level of job satisfaction among village health personnel(VHP)and to analyze relevant factors of job satisfaction at Puan county,Guizhou province. Methods A cross-sectional survey was conducted with a self-administered questionnaire among 149 VHP in January 2010 at Puan county,Qianxi'nan autonomous prefecture of Buyi and Miao minorities,Guizhou province. Results The score of general job satisfaction was 3.44±0.62.The score of welfare and income,working condition,and job characteristics was 2.76±0.76,2.92±0.80,and 3.32±0.70,respectively, which were lower than the score of general job satisfaction(P<0.01).The general job satisfaction could be predicted by working load,training chance,position promotion,medical service compensation criterion,VHP medical insurance,village clinic medicine,and working performance,with the crude coefficients of 0.16,0.21,0.19,0.12,0.12,0.08,and 0.09 (P<0.01),respectively.Training chance,supervisor reward,social security,job fulfillment,income,and gender had obvious effects on the general job satisfaction,with the odds ratios of 32.48,31.70,8.20,5.72,5.55,and 4.32,respectively.The Cox and Snell R2 was 0.53 and the modelχ2 was 112.26(P<0.01). Conclusion The level of general job satisfaction is low for VHP.The general job satisfaction is influenced by training chance,supervisor reward,social security,job fulfillment, income,and gender.

Comparing federal and state healthcare provider performance in villages targeted by the conditional cash transfer programme of Mexico

This study investigates household out-of-pocket healthcare expenditures (OPH) and preventive care utilization (PHU) to compare federal and state healthcare provider performance in villages targeted by conditional cash transfer (CCT) programmes in poor rural areas of Mexico. Lower OPH and higher PHU are indicative of better performance in the study setting. Log-linear and probit regression models were used to compare outcomes in households from treatment and control villages reached by federal and state healthcare providers. In treatment villages, eligible households receive cash grants from the CCT programme. In control villages, eligible households do not receive cash grants from the CCT programme at the time of the survey. Families who live in treatment villages reported lower OPH (-52.5% for federal and -46.2% for state clinics) and higher PHU (21% for federal and 20% for state clinics) regardless of clinic setting. As the reduction in OPH is higher in areas reached by the federal clinics, it implies better performance from this healthcare delivery system. Additionally, federal clinic outcomes were also more homogeneous because OPH are not significantly different between treatment and control villages. Alternative measures such as drug and physician expenditures, diabetes and hypertension tests and nutritional-supplement receipt confirmed these findings. Mexico has two healthcare delivery systems that cater to identical rural populations. The better-funded and more centralized federal system is more effective at providing health care in poor rural villages of Mexico regardless of CCT participation. State clinics in villages targeted by the CCT programme, however, perform significantly better.

The practice of humanitarianism: A village birthing clinic in Palestine

Discourses and practices surrounding humanitarian organisations have changed over time. This is certainly the case for Palestinian non-governmental organisations, which have followed the structural and ideological transformations observed in local, regional and international contexts. There have been three successive but interlocking generations of groups active in health in Palestine: charitable societies, popular committees, and donor-based entities. Against this background, a village clinic in the West Bank is seen to have gone through various incarnations in the context of an emerging neo-liberal economic, administrative and political environment. Despite the critiques justifiably addressed towards them, non-governmental organisations may in some cases be functionally fluid. Communities and people continue to use them strategically in their relations with states, political groups, individuals and receivers of aid, making them potential networking sites in the context of an ongoing occupation.

COMPARISON OF MONOTHERAPY VS COMBINATION THERAPY ON BLOOD PRESSURE CONTROL

1Istanbul University Cerrahpasa Medical Faculty, Istanbul-Turkey, 2Turkish Republic Ministry of Health Sefakoy Village Clinic, Kucukcekmece, Istanbul-Turkey, 3Selcuk University Medical Faculty, Konya-Turkey

Research on country doctors' training in frontier and poor counties of Pu'er City of Yunnan Province

To discuss the situation of country doctors' training in Honghe State of Yunnan Province and to search the more useful training methods, the 171 trainees were surveyed by self-designed questionnaire. It appeared that most students improved knowledge and clinical skills obviously and they wanted more knowledge and case analysis and training of clinic skills. Key words: Country doctor; Training; Village clinic

Abstract LB-405: Modulation of the metabolism of air-borne pollutants by broccoli sprout beverages: Results of a short term, cross-over clinical trial in Qidong, People's Republic of China

Abstract Epidemiological evidence has suggested that consumption of a diet rich in cruciferous vegetables reduces the risk of several types of cancers and chronic degenerative diseases. In particular, broccoli sprouts are a convenient and rich source of the glucosinolate, glucoraphanin (GR) which can release the chemopreventive agent, sulforaphane (SF), an inducer of glutathione transferases. Two broccoli sprout-derived beverages, one glucoraphanin-rich (GRR) and the other sulforaphane-rich (SFR), were evaluated for SF bioavailability, tolerability and pharmacodynamic action. The GRR beverage relied on the conversion of GR to SF in the gut microflora whereas the SFR beverage was prepared by conversion of GR to SF with myrosinase from daikon sprouts prior to consumption. Study participants were recruited from the farming community of He Zuo Township, Qidong, People's Republic of China, previously documented to have a high incidence of hepatocellular carcinoma and more recently, exposures to substantive levels of air-borne pollutants including phenanthrene, acrolein, crotonaldehyde, benzene and ethylene oxide. Two hundred five individuals were screened at village clinics and 50 willing, healthy participants were randomized into two treatment arms. The study protocol was as follows: a 5-day run-in period, a 7-day administration of beverages, a 5-day washout period, and a 7-day administration of the opposite beverage. Bioavailability of SF, as indicated by excretion of GR, SF and SF-thiol conjugates in urine collected daily 12 hours after dosing, was measured by isotope dilution mass spectrometry. The urinary excretions of SF and its thiols were substantially greater in individuals receiving a SFR beverage compared to a GRR beverage. Determination of possible pharmacodynamic action of the SFR and GRR beverages has been assessed through measures of the urinary excretion of the mercapturic acids of acrolein, crotonaldehyde, ethylene oxide, benzene and 1,3-butadiene using liquid and gas chromatography coupled to mass spectrometry. Statistically significant increases in the levels of excretion of glutathione-derived conjugates of acrolein, crotonaldehyde, and benzene were seen in individuals receiving SFR, GRR or both compared to their pre-intervention baseline values. Increases provoked by SFR were greater than for GRR, but the differences were not significantly different. Thus, chemopreventive intervention may attenuate risks to health associated with exposures to air-borne pollutants in addition to possible effects on aflatoxin exposures in this region. Supported by NIEHS grant P01 ES006052. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr LB-405. doi:10.1158/1538-7445.AM2011-LB-405

Doctor's injection prescribing and its correlates in village health clinics across 10 Provinces of Western China

Unsafe use and overuse of injection play an important role in transmission of very serious blood-borne infections. No studies have been conducted to investigate the levels and determinants of injection utilization in rural Western China. A total of 20 125 prescriptions were collected from 680 village clinics across 10 provinces of Western China. A generalized estimating equation logistic regression model was employed to examine the determinants of injection utilization. The proportion of prescriptions with injection was 22.93%. Village doctors who had full-time medical education prescribed less injections than those without full-time education (OR = 0.65; 95% CI: 0.52, 0.80). The injection proportion was higher among children less than 3 years old in comparison with adults aged 18-44 years (OR = 1.72; 95% CI: 1.43, 2.08). The number of drugs in a prescription was also a significant predictor of injection (OR = 1.91; 95% CI: 1.77, 2.06). Injection prescribing proportion in rural Western China was higher than that in India and lower than that in Cambodia. Injection prescribing was associated with the education of village doctor, patient age and diagnoses of diseases. The findings have important policy implications for recommendations on injection utilization in China.

Implementation of "without added profit to sale drug" policy at village clinics in Shanghai

This study investigated nine village clinics in Wanxiang county of Shanghai Nanhui area through interview and questionnaire survey method, based on which the research analyzed the implementation effect and existing problems of without added profit to sale drugpolicy. We concluded that the basic policy reached it expectation, but therewere still room for improvement,so relevant departments and suburban county grassroot community health service agencies should take active measures to further improve this policy. Key words: Without added profit to sale drug policy; Village clinics; Effect analysis

Drug prescribing indicators in village health clinics across 10 provinces of Western China

The irrational use of drugs was a global problem, especially in developing countries. However, there are no studies available on irrational use of drugs in rural Western China. To assess the drug prescribing patterns using World Health Organization Drug Use Indicators at village health clinics in rural areas of Western China. A total of 20 125 prescriptions were collected from 680 primary health clinics in villages from 40 counties in 10 provinces of Western China. Five measurements were used to assess the irrational drug use: percentage of encounters with an antibiotic prescribed, average number of drugs per encounter, percentage of encounters with an injection prescribed, percentage of drugs prescribed by generic name and percentage of drugs prescribed from National Essential Medicines List or Formulary. Index of Rational Drug Prescribing (IRDP) was used as an indicator of rational drug use. The percentage of prescriptions containing antibiotics was 48.43%, while the average number of drugs per prescription was 2.36, and the percentage of injection prescriptions was 22.93%. The percentage of drugs prescribed by generic name was 64.12%, and the percentage of drugs prescribed from the National Essential Drug List was 67.70%. The IRDP of the present study was 3.32 with the optimal level of 5. There are also some regional variations in these measurements. The study provides some evidence of irrational use of drugs to a great extent in rural areas of Western China. Overuse of injection and overuse of antibiotics were the most prominent manifestations of such irrational drug prescribing.

Analysis on the diarrhea mortality rate, pre-death diagnosis and treatment of children under-5 in China, 1996-2006

To understand the trends of diarrhea mortality rate, pre-death diagnosis and treatment of children under-5 in China, from 1996 to 2006. We used data obtained from the 1996 to 2006 national child mortality surveillance network, including 116 counties (cities) throughout China, to evaluate the under 5 mortality rate (U5MR) due to diarrhea in different geographical areas, and related factors of under 5 children mortality due to diarrhea. Data from the national U5MR due to diarrhea fell from 249.8 in 1996 to 75.6 per 100 000 live births, in 2006. The U5MR due to diarrhea in urban reduces from 11.6 in 1996 to 6.1 per 100 000 live births in 2006, with a reduction of 47.4%. The U5MR due to diarrhea in rural decreased from 304.7 in 1996 to 94.3 per 100 000 live births in 2006, with a reduction of 69.1%. The U5MR due to diarrhea in coastal, inland and remote areas fell from 48.9, 178.9 and 566.9 in 1996 to 6.2, 30.4 and 199.2 per 100 000 live births in 2006, with a reduction of 87.3%, 83.0% and 64.9%, respectively. Among the rural children died of diarrhea, about 37.9% were diagnosed in a village clinic, 15.1% never received any diagnostic procedure. Nearly 20% of the patients had not been treated, with 50% - 60% of them had only been treated in an outpatient department. During 1996 - 2006, the U5MR due to diarrhea showed a substantially downward trend in China but the disparities between urban and rural, remote and coastal, areas were increasing.

Cooperative Medical Insurance and the Cost of Care in Shandong, PR China

This research was conducted to identify the cost of care associated with utilization of village clinics and membership of the New Cooperative Medical Scheme (NCMS) in 2 counties of Shandong province, PR China. A total of 397 community members and 297 patients who used the village clinics were interviewed. The average cost for primary care treatment of 1 episode of illness was about 55 yuan (about US$8). Although more than 50% of people had NCMS membership, many consider the monetary reimbursements as insufficient. The low insurance reimbursement rates and inability to pay out-of-pocket expenses compromise access to care. Delays can cause more serious illnesses with potential to overburden the secondary care at the township and county hospitals. Those rural people who have not yet enjoyed the benefits of China's economic development may not benefit from recent health care reform and finance mechanisms unless schemes such as the NCMS provide more substantial subsidies.

Synthetic evaluation of the effect of health promotion: Impact of a UNICEF project in 40 poor western counties of China

To synthetically evaluate the effects of a health promotion project launched by the Ministry of Health of China and the United Nations Children's Fund (UNICEF) in 40 poor western counties of China. The two surveys were cross-sectional studies. Stratified multistage random sampling was used to recruit subjects. Data were collected through two surveys conducted in the 40 'UNICEF project counties' in 1999 and 2000. After categorizing the 27 evaluation indicators into four aspects, a hybrid of the Analytic Hierarchy Process, the Technique for Order Preference by Similarity to Ideal Solution, and linear weighting were used to analyse the changes. The 40 counties were classified into three different levels according to differences in the synthetic indicator derived. Comparing the synthetic evaluation indicators of these two surveys, issues for implementation of the project were identified and discussed. The values of the synthetic indicators were significantly higher in 2000 than in 1999 (P=0.02); this indicated that the projects were effective. Among the 40 counties, 11 counties were at a higher level in 2000, 10 counties were at a lower level, and others were in the middle level. Comparative analysis showed that 36% of village clinics were not licensed to practice medicine, nearly 50% of village clinics had no records of medicine purchases, nearly 20% of village clinics had no pressure cooker for disinfection, and 20% of pregnant women did not receive any prenatal care. The health promotion projects in the 40 counties were effective. Health management, medical treatment conditions, maternal health and child health care have improved to some extent. However, much remains to be done to improve health care in these 40 poor counties. The findings of this study can help decision makers to improve the implementation of such improvements.

Use of Health Services by Women with Gynecological Symptoms in Rural China

To examine the relation between demographic factors and symptom type in the use of gynecological health services in rural China. Married women aged 19 to 45 years from three rural communities in Anhui province, central China, were invited to participate in a structured interview in the summer of 2006. They provided information on gynecological symptoms, healthcare-seeking behaviour and socio-demographic characteristics. Risk factors were analyzed using logistic regression. 860/1221(70.4%) reported at least one gynecological symptom during the previous year, with 485 (39.7%) reporting three or more. Of the women with symptoms, 36.7% sought treatment during the previous year. Younger women and those with multiple symptoms were more likely than others to seek treatment. Women with abnormal vaginal bleeding or discharge were more likely to delay seeking treatment. Years of education were strongly related to seeking treatment. More highly educated women and women with a higher household income were more likely than others to seek treatment at the highest level (county or city hospital) of the tertiary healthcare system rather than at a village clinic or township hospital. Women who did not seek treatment were more likely to report that they saw no need than to say that they could not afford care. There may be a misperception of the need for, and utility of, treatment for gynecological symptoms, particularly in more disadvantaged women. Interventions should both address women's negative perceptions and reinforce the capacity of the local health facilities to ensure effective care.

Assessment of Private Health Sector in China

With the reform and development of the health service system, China now is Facing a shortage of medical services. A policy that permitted qualified medical professionals to engage in private practice was issued by the state government in 1980, and reconfirmed and detailed in later years. Public-private partnerships become the new target for Chinese government and researching institutes. Private Health Sectors have there competition advantage in a certain aspect, according to the features of their ownership system. Although the development of private practice was already a fact, debates related to whether government should ban privatization and limit the scale of private practice have never stopped. Arguments in favors of private practices were that the development of the private health sector could improve access to health services, and that efficiency and quality could be improved by introducing competition into the health care market. The way of assessment private sector is the key for study on Public-private partnerships in China. There is no uniform methodology for measuring quality of health care. The method commonly used is to measure respectively three quality dimensions: structure, process and outcome. Four indicators that are observable and measurable were selected for measuring clinic quality. These indicators are quality of health workers, amount of medical equipment, working conditions, and clinic supervisors’ evaluation. Since village clinics are very small health units with one to two health workers and limited medical technology and equipment, to a large extent the quality of the health workers will determine the quality of the services provided. The four indicators were measured for each type of clinic and then compared between clinic groups. This paper is mainly study on the assessment means of Private Health Sectors. Building information systems around Private Health Sectors was the hardest work for assessment research. This paper tries to make a point on how to avoid this problem, and do well assessment work.

Predictors of Virologic Failure in HIV‐1–Infected Adults Receiving First‐Line Antiretroviral Therapy in 8 Provinces in China

Despite poor primary health care systems, free antiretroviral therapy (ART) has been available in China for >5 years. Virologic outcomes in Chinese patients receiving ART have not been described on a national level. A multistage cluster design was used in 8 provinces to randomly select patients who had been receiving first-line ART for at least 6 months, who were stratified into 3 treatment-duration groups. Viral load testing and patient interviews were conducted, and data were linked with national treatment database information. Collected data were analyzed for association with viral suppression by means of multivariate modeling. Adequate viral suppression was defined as a viral load of <400 copies/mL. Of 5256 patients receiving ART, 3894 met the eligibility criteria, among whom 1153 were analyzed. Overall, 72% demonstrated viral suppression, and 82%, 73%, and 67% of the participants receiving ART for 6-11, 12-23, and > or = 24 months, respectively, experienced viral suppression (P < .001). In a multivariate model, treatment given at locations other than county-level hospitals was less likely to achieve viral suppression, with greater odds for inadequate virologic response found at village clinics (odds ratio [OR], 5.4; 95% confidence interval [CI], 2.9-10.1), township health centers (OR, 3.1; 95% CI, 1.7-5.6), and public health clinics (OR, 3.1; 95% CI, 1.7-5.6). Patients receiving didanosine-based regimens were more likely to experience an inadequate virologic response than were those receiving lamivudine-based regimens (OR, 3.9; 95% CI, 2.7-5.7). China's national ART program is largely successful at suppressing viral load. Care received outside of hospitals and regimens containing didanosine were associated with less favorable virologic outcomes.

New evidence on the impact of China’s New Rural Cooperative Medical Scheme and its implications for rural primary healthcare: multivariate difference-in-difference analysis

Objectives To determine whether China’s New Rural Cooperative Medical Scheme (NCMS), which aims to provide health insurance to 800 million rural citizens and to correct distortions in rural primary care,...

Provision capacity research of primary healthcare services in rural China

Objective Studying the status quo and constraints for rural healthcare service in grassroot rural healthcare units,for policy recommendations.Methods Using data from the fourth healthcare service investigation,by means of quantitative interview and qualitative interview,for an investigative interview of 348 township hospitals and 251 village clinics in 31 provinces in China.Results Deployment percentage of primary heahhcare services at township hospitals level is 49.1% (28.0/57),and that for village clinics is 60.6%(5.4/9).Conclusions The key to upgrading rural healthcare service system at grassroots level is to deploy better diagnostic equipments,upgrade the diagnostic competence of grassroots healthcare personnel and build a continuous service system for primary healthcare service. Key words: Rural; Grassroots heahhcare units; Primary heahhcare service; Provision

Individual attitudes and perceived social norms: Reports on HIV/AIDS‐related stigma among service providers in China

This study examined HIV/AIDS-related stigma among Chinese service providers by comparing their personal attitudes toward people living with HIV/AIDS with their perception of social norms related to people living with HIV/AIDS. We randomly selected three provincial hospitals, four city/prefecture hospitals, 10 county hospitals,18 township health clinics, and 54 village clinics from Yunnan, China. Doctors and nurses were randomly sampled proportionally to the doctor–nurse ratio of each hospital or clinic. Lab technicians were over-sampled in order to include an adequate representation in the analysis. A total of 1,101 service providers participated in a voluntary,anonymous survey where demographic characteristics, individual attitude and perceived social norms toward people living with HIV/AIDS, discrimination intent at work, general prejudicial attitude and knowledge on HIV/AIDS were measured. A majority of the sample demonstrated a similarity between their personal views and what they thought most people in society believe. Multiple logistic regressions revealed that participants who were younger or reported personal contact with people living with HIV/AIDS were significantly more likely to report personal attitudes toward the population that were more liberal than their perceived social norms. Holding a more liberal personal attitude toward people living with HIV/AIDS than perceived social norms was significantly and negatively related to the level of discrimination intent at work, perceived discrimination at interpersonal level and the level of general prejudicial attitude toward people living with HIV/AIDS. Results underscored the importance of understanding social norms and personal attitudes in studying HIV-related stigma and called for the incorporation of existing human capital into future HIV stigma reduction programs.