| ObjectivesThrough the analysis of rural health human resource status by comparison between Yunnan province of China and Songkhla Province of Thailand during 2011-2015,which including health service system and human resources,medical education and personnel training mode,general medicine and community clinical practice separately,compared the differences of the two parties,the advantages and disadvantages of each other,explored successful experiences,in order to learn from Thailand and improve the health human resources policy in Yunnan Province,and promote the status of health service in rural area of Yunnan Province.Research objectives1.To compare the training mode,human resource policy and general medical personnel between Yunnan province of China and Songkhla of Thailand,learn how to make a real,attracted into,to retain and use well from education,training,development and systematic on-job training,then put forward available experience on the basis of Yunnan province.2.To discuss and perfect the training mode of rural order oriented medicine free general medical students in Yunnan province.Methods:During the whole process of the project implementation,qualitative research was the main method,supplemented by the overall quantitative analysis and questionnaire survey of township hospitals.The qualitative research method was used for the comparison of Yunnan province and southern Thailand in the social and economic conditions and policy environment,resource ownership,management skills,and the number of rural health personnel ability,health service cost,community participation and support,as well as the difference of rural undergraduate medical education.The whole research framework learned from the WHO(World Health Organization,WHO)in the framework of human resources for health action part,and focused on 4 dimensions which including training from the policies and laws and regulations,government intervention,participation,education.Results1.The overall comparison results.China:imperfect supporting policies.Government investment was insufficient.The current medical education model was not suitable for the actual needs of rural areas.Rural health manpower was shortage and low quality.Treatment of rural medical was poor and uneven,less development opportunities,Rural health team was unstable,and unwilling to come and stay.Thailand:Positive policy guidance.Government investment was large.There were many ways to cultivate general medical talents in rural areas.Rural grassroots medical staffs had better treatment,and strong willingness to serve.The health volunteer system played an important role in the human resources of rural primary health care.2.Comparison of human resource and health service system.China:Undergraduate degree in the county hospital accounted for 42%,township hospitals undergraduate education accounted for 12%.The number of Doctors,nurses,pharmacists and dentists is serious shortage.Only 29%of the staff participated in all kinds of levels training.Only 14%of the staff was satisfied with the current work incentive mechanism.Wage income was low.Continuing education was very difficult.Thailand:Undergraduate degree among county hospital and township health center staff accounted for 100%.Need more doctors,pharmacists and dentists.Each one has training opportunity at least once per year.All staffs were satisfied with the incentive present mechanism.Income was higher than the similar personnel of city.Comparison of aware of knowledge about insurance between China and Thailand was lower than P<0.01,which meant significant differences.3.Comparison of training models.China:The subject oriented curriculum made it clear,and there was no necessary link among different subjects,such as the basic medicine and the clinical medicine.The students learnt passively.There were no special courses in the common diseases and frequently occurred diseases in rural areas,and the opportunity of case discussion and students' active participation was relatively lack,so it was difficult to adapt to the requirements of primary health work.Teaching facilities could not meet the teaching needs.The intership time was not enough.Most of the teaching methods were centered on the classroom,teachers as the center,ignoring the interaction between teaching and learning,the lack of active participation of students.Thailand:The courses were mainly based on the organ system,interaction between disciplines,achieves the unity of knowledge,training students in the logic and structure of the contact.Network teaching method was more than China.There were community medical curriculums from 2 year to 5 year.Community clinical practice targeted from the beginning.4.Comparison of community clinical practice.China:The lack of basic health personnel,and some of the equipments were not available,there was no phenomenon of technical personnel equipment.Rural doctors were mostly local farmers,cultural level was low,the medical professional skills were not standardized training,no practice certificate.Rural doctor treatment was low,only 450 yuan each month,and could get it by the end of the year after the assessment.Thailand:Government granted priority of township's staff wages,housing construction and equipment costs.National policy on the grassroots tilt,there were incentives to stabilize the grassroots health personnel to provide protection.According to the different needs of township and village preventive medical care for health personnel training,according to the need to set up a reasonable allocation of human resources,labor costs.The system of health promotion volunteers had given full play to the role of the bridge between the primary health personnel and residents,and strengthened the function of health education and health promotion.5.Comparison of General Practitioner.China:Most of the teachers were specialist doctors,lack of understanding of community and grassroots services,to complete the need to adapt to the training of general practitioners have a certain gap.Teachers'professionalism,teaching philosophy,teaching methods were difficult to meet the needs of general practitioners training.The evaluation of general practitioners training was still single,and could not really reflect the comprehensive ability.Thailand:Scientific and rational policy system(the national training plan could meet local needs),curriculum,practice training and highlight the community needs of patients,medical institutions and grass-roots hospital training base form the benign mutual convergence,teaching methods,teaching the concept of advanced scientific teaching activities,training quality guarantee,scientific evaluation,feedback and improvement.Conclusions and suggestions1.To perfect the top-level design,and consolidate the basic service capabilities.2.To strengthen the training system for general practitioners and cultivate high-level,appropriate rural health talents.3.To improve the construction of training bases for general practitioners and encourage graduates to work at the grass-roots level.4.To innovate teaching philosophy,optimize the teaching staff and promote the reform of curriculum system.5.To increase government's health input and improve the economic income level of rural general practitioners.6.To adjust the health resources rationally,and attract the targeted general medical graduates. |
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