Study On Present Situation Of Performance Evaluation Of Disease Control Position In Township Health Centers

ObjectiveThis study aims to learn about the positions established for disease control and the performance appraisal of disease control staff at some township health centers in the provinces of Guangdong, Jiangxi and Gansu, summarize the experience and lessons, explore into the solutions for the challenges, and inform decision-making and policy-making on performance appraisal of staff at township health centers.MethodsData were collected via literature review, questionnaire survey, in-depth interviews and expert consultation and some other study methods. A database was created by using the software EpiData3.0on the basis of data collected via questionnaire survey. Statistical analysis was conducted by using the statistical software SPSS13.0. The rates or percentages of the three project provinces were compared via chi-square test. Rank sum test was conducted with single ordered data. The significance level is a=0.05. Descriptive analysis and interpretive analysis of qualitative data were conducted with thematic framework method.Results1. Positions and staffingAll the surveyed township health centers have established offices of epidemic prevention and health care which have set up the positions for vaccination, infectious disease reporting, health education and some other conventional disease control functions, as well as chronic disease management and the prevention and control of mental disorders, occupational disease, etc. Each township health center has an average of56in-service staff members, including6staff members for epidemic prevention and health care (accounting for10.0%of the staff of the center),70.9%of whom are full-time, officially employed staff members. Most disease control staff members at the township health centers are aged30-40and hold an educational degree of junior college. Only34.4%of the disease control staff members have an education background of preventive medicine, and32.0%have an education background of clinical medicine.2. Current practices of performance appraisal of disease control staff88.8%of the township health centers have initiated the performance appraisal of disease control staff. Governments, disease control institutions and township health centers jointly arrange for and participate in the performance appraisal of disease control staff at township health centers. The performance appraisal is primarily carried out on a quarterly and annual basis (both accounting for43.8%), followed by annual and monthly performance appraisal. The performance appraisal mainly covers the amount of work done, the quality of work, the working capacity, client satisfaction, medical ethics and practices, and compliance with labor discipline. The performance appraisal is primarily carried out via interviews with internal staff and the clients (accounting for100.0%), followed by field visits, literature review, and questionnaire survey. The results of performance appraisal are linked to the salaries of disease control staff, bonus and other material incentives as well as career development, training and other non-material incentives. The performance appraisal has effectively driven the implementation of disease control activities at rural grassroots level.3. Comments of disease control staff about their performance appraisalThe survey subjects generally offered objective comments with regard to the disease control staffing at the township health centers and the performance appraisal.96.9%of the disease control staff believe that they thoroughly or well understand their roles and responsibilities;82.5%believe that the positions established are very reasonable or generally reasonable;54.6%feel very satisfied or generally satisfied about the performance appraisal of disease control staff. Nevertheless, only46.1%and53.0%of the disease control staff respectively believe that the current indicators used in the performance appraisal of disease control staff can accurately or largely reflect their amount and quality of work done; and53.2%believe that the workload is too heavy or heavy.ConclusionsThe first conclusion is that the current disease control positions and staffing are still unable to meet the actual demands; the performance appraisal of disease control staff generally has no sound basis; the positions established can hardly meet the demands for disease control work and the actual work load. The second conclusion is that the limited professional capacities of the disease control staff have constrained the effectiveness of disease control at township health centers; the disease control staff generally have a suboptimal educational background; few have a professional background of preventive medicine, and therefore the levels of knowledge and skills in disease control are yet to be enhanced. The third conclusion is that the key practices of performance appraisal of disease control staff at the township health centers are still not well targeted and designed, which has affected the effectiveness of performance appraisal; the approaches to and frequency, scope, methods and subjects of performance appraisal as well as the utilization of the performance appraisal results should be appropriate for the nature of the positions and the actual local situations; formalism should be avoided to achieve desirable outcomes.Policy recommendations:1) Strengthen the development of township health centers and lay a solid foundation for grassroots disease control work;2) Employ more staff members for disease control staff at township health centers, and ensure appropriate disease control staff structure;3) Refine the practices of performance appraisal of disease control staff at local level and within township health centers; and4) Improve the protocol for the performance appraisal of disease control staff, and establish scientifically sound indicators for the performance appraisal.