| Health human resources are the most important component of health resources. The quality and quantity of health manpower is a key determinant to the development of the primary health care facilities. Human resources management plays an important role in health facilities administration. Through the planning and management activities of obtaining, developing, maintaining and utilizing of human resources, it can mobilize the hospital staff’s enthusiasm, improve their work efficiency, achieve the development objectives and gain competitive advantages.For recent some decades, the key issue in the development of health human resources is insufficiency of quantity, uneven distribution and imbalance of structure, and these problems exist all over the world. In the past ten years, the tendency of health manpower urbanization of geographical distribution is still a serious problem in many countries, particularly in developing countries. There is a serious deficit of health manpower in primary health care facilities and in rural areas. According to statistics, for most developing countries, more than80percent health manpower who have received systematic training of medical knowledge health personnel are concentrated in large and medium-sized cities, and serve only20percent of population. In most developing countries in Asia and Africa, the majority of primary health facilities are still lack of health personnel with formal discipline. The inefficient allocation of health human resources has long been a cause of serious waste of health resources in large and medium-sized urban health facilities. Meanwhile, there is a lack of health resources in primary health care facilities and in rural areas. As a result, there is a relative surplus of human resources in large and medium-sized cities, but a grave deficit of medical experts in township and communality health care system..As for human resources management, under planned economy, health facilities in China implemented a personnel management system. This system was inherited after the reform and opening up. While health facilities increasingly participated in market competition, this conventional system could not be adapted to the development of health system and meet the requirements of society development. Therefore, in the year2000, the Central Organizational Ministry and Ministry of Health jointly Published The implement deliverance of deepening health institutions’personnel system reform, indicating that a new health personnel system full of vigor and vitality will be established.In recent years, although the hospital personnel system reform has made progress, some deep-rooted problems such as staff turnover and compensation can not be solved and hinder the deepening of the reform. Due to the imperfections of supporting measures, coupled with not talking full account of the special conditions of primary health facilities, there is a serious lag of the construction of primary health manpower. Lower quality, un-reasonable structure and distribution, irrational administration system and mechanism, these all widely exist in primary health system and hinder the primary health reform. Therefore, it is urgently necessary to adopt effective measures to speed up the building of primary health manpower, in both urban and rural areas.Researches of human resources management in primary health facilities in China mainly focus on theoretical discussion of certain facility and most of them only based on institute investigation. The nationwide primary health facilities study is seldom found, and study from the view of staff is rather inadequate, let alone in-depth interviews with key informants. To study the staff’s cognition to human resources management and the information from deep interviews can reflect the status and possible problems of human resources management from another point of view can greatly help to study the status quo and development of human resources management in primary health facilities. Utilizing all the above information comprehensively, we can well understand the status quo and the existing problems, and provide suggestions to the development of primary health human resources management.The main objective of this study is to describe and analyze the status quo of human resources management in township health centers and urban community health facilities, to provide suggestions to the policy-making, and to contribute to establish a effective human resource management system and employment mechanism.Stratifies sampling is used to select samples in this study. According to the economic development levels and geographic distribution, we selected Shanghai City, in eastern China, Sichuan Province in western China. Overall,19township hospitals include it’s159township health stations and5community health care centers which have29health care stations were selected. In this study, information were gathered from institution and staff questionnaires, combined with in-depth interviews. One-way and multi-way statistical methods are used in the analysis and comparison of the status quo of primary health facilities. Finally some appropriate policy recommendations were proposed according to the study.The major findings of this study are as follows:1) The understaffed problem is rather prominent in primary health care facilities. Which means that, for township hospitals and community health care centers, in average, there are9.6percent and15.7percent staff without authorized strength respectively. Primary health facilities have a widespread shortage of health professionals. And they cannot supplement the needs of the candidates in time, because of the constraints of recruitment rights, authorized strength and finance. Health professionals account for83.4percent of all the staff in primary agencies. The Proportion of doctors to nurses is rather unreasonable, that is1doctor with only0.59nurse in township hospitals and1doctor with0.81nurse in community health care centers. Only very few of them have bachelor degree, and many of them have no medical specialty degree. And more than half of the staffs only have primary professional title.2)Around80percent of the staff answered that their agencies had implemented employment system, the situation of the middle area is poorer than that of the eastern and western area. Most staff is mainly evaluated with knowledge and skills tests and interviews. Staff have a higher degree of satisfaction on the way of employ, and about17percent showed general and2percent showed unsatisfied.3) The staff had less opportunity of training, mainly internal and short-term training. Employees were not very satisfied with the training. And there was a bigger difference between the actually accepted and staff’s expectations. There were few people taking part in resident standardized training, health management cadre training and the training of general practitioners. And in the implementation of continuing medical education, there are still some problems. The training cost of each primary health care facility in Sichuan province is only about620Yuan, but in Shanghai, is39975Yuan.4) Income was the most important incentive in primary health facilities. The main indicators to assess staff were the quality and quantity of their work. The staff were mainly encouraged according to their completion of work and punished according to work accidents. Staff were not very satisfied with the procedures and results of the evaluation, and relatively unsatisfied with the income and bonus distribution system.5) From the year2006to2009, the number of the inflow and outflow staff both tended to upgrade. A zero growth or even negative growth existed in township health centers. There was a run off of high-educated and high-title professionals to a certain degree in primary health facilities. Redeployment was the main reason of outflow in addition to redeployment, and the number of redeployment staff tended to rise. At the same time, the wanted staff can’t be obtained and the unwanted can’t be drawn out was a predominant phenomenon in primary health facilities.6) Based on the results of multi-factor analysis, age, education level, workload saturation, training contents satisfaction, evaluation results satisfaction and income satisfaction can evidently influence staff’s outflow tendency in township health centers. While in community health facilities, it was influenced by region, age, cognition of the requirements of important posts, manager’s attitude to staff’s observations and recommendations, situation of job descriptions settings, workload saturation, evaluation procedures satisfaction and income satisfaction.Policy recommendations include:1) To adjust the quantity of health manpower, optimize the structure and improve the quality. Primary health facilities should identify their emphasis and adjust the proportion of doctors to nurses. Meanwhile, relative policy must be made to support primary facilities.2) To improve the staff recruitment system and enhancing the fairness of the use of qualified personnel. The employment evaluating system and standard should be improved. Allowing for the presents status, more autonomy should be given and flexible management should be strengthened to allow primary facilities to hire the required health personnel.3) To strengthen health staff’s capacity, set up a good developing environment. In-service training should be emphasized and training opportunities and times be increased. Requirements analysis should be made before making training plan. At the same time, more financial support should be given by the government.4) To reform the personnel incentive mechanisms, and enhance their enthusiasm, primary facilities should play a creative role in the expansion of incentives, building a scientific and flexible management system.5) To lead to rational flow of personnel, and improve the structure of Primary health facilities. To resolve the problem of staff’s run-off from primary facilities and poorer areas, especially those professionals, the fundamental solution is to encourage the implementation of the current privilege policy. On the one hand, employment-oriented policy should be established to promote medical personnel to primary health facilities. On the other hand, better environment should be created, such as the environment, development, human care and treatment circumstances, to allow the professionals to enter and retain. |
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