Research On The Core Competence Building Of Basic Public Health Service Workers In Primary Health Care Sectors In Western China

Background China authority has launched the project of implementation of a national basic public health service(BPHS)that covers the entire national population in March 2009.Furthermore the promotion of the gradual equalization of basic public health services is the key task of deepening the reform of the medical and health care system.Over the past 10 years,Chinese basic public health services have made remarkable progress and effectiveness,play an important role in improving the health status of local residents,and greatly improved the fairness and accessibility of public health.However,the lack of competent primary health workers is the bottleneck that affecting the quality of basic public health services.Therefore training of primary health workers in primary health care sectors(PHCS)has been widely carried out across the country since 2010.However,a series of studies demonstrate that the current primary health worker training is still not effective,showing the problems of poor service personnel and service ability,especially in the western region in the country,remaining to be solved.The main reason behind the relatively poor service in the remote regions of China is that it is unclear what the standard of the core competence of these primary health workers should possess,which is reflected by insufficient training of theoretical knowledge for core ability.The United States of America and Canada and other Western countries have successively established their own core models of public health professionals.The capacity building of public health professionals is largely driven by the core competency-oriented model.At present,it remains to be explored that the systematic investigation about the theoretical knowledge training of the core competence model for the basic public health service personnel.Aims The current study was evaluated systematically the requirement of the current capacity building and training of primary health workers in primary health care sectors in Chongqing.Primary health workers in primary health care sectors in China have been developed,based on the establishment of a functional framework for basic public health services in China.The core competence model provides a theoretical basis for the capacity building(training project design)of primary health workers in primary health care sectors,as well as,proposes countermeasures and suggestions for capacity building.Method1.Selection of investigation regions: Based on the geographic location and 2016 GDP situation,the current study selected 8 main urban areas and 18 districts/counties in Chongqing,and it was used a multi-stage stratified random sampling method to select 91 primary health care sectors(including 43 community health centers and 48 township health centers)as research sites.2.Quantitative research: A continuous sampling method was used to select 1275 primary health workers(including service agency leaders and front-line staff)as the research object.Self-made questionnaires to investigate the current status of the primary health workers' capabilities and training needs at the research site.The survey items included sex,age,education level,profession,professional title,qualification category,job position,work experience,training times,training needs(including 9 dimensions of professional knowledge,professional skills,basic public health service contents,communication skills,epidemiological investigation,needs assessment,intervention formulation,satisfaction surveys or evaluation of project implementation effects,and teaching skills).The database was established using Epidata 3.02 software,and the data was statistically processed using SPSS 21.0 software.Descriptive analysis of the general situation of primary health workers,the current status of personnel capabilities,and training needs;Chi-square test was used to analyze the differences of the primary health workers' gender,age,education,professional title and other aspects;Chi-square test was used to screen the relevant factors for training needs,and the binary classification logistic regression method was used to analyze the relevant factors that were screened out.All statistical tests were two-sided tests with P <0.05 as the difference was statistically significant.3.Qualitative research: Purpose sampling method was used to select leaders in charge of basic public health service project management and primary health workers(considering each project)from primary health care sectors of the selected research sites for personal in-depth interview.Used the information saturation principle to determine the final sample size.The personal in-depth interviews were conducted according to a semi-structured interview questionnaire developed in advance.The content of the interview questionnaires for the leaders mainly includes information about the human resources status of basic public health services(that is,the number,quality,and stability of health workers in the sector),current training status,problems with current training programs and training needs.The interview outline of front-line health workers includes their self-assessment of their service capabilities,their participation in training,their views on current training,and training needs.All interviews were conducted in a quiet office or conference room selected by the health sector where the interviewees were located.Each interview lasted approximately ~60 minutes.All interviews were recorded with a voice recorder with the informed consent of the interviewees.Finally,the main frame analysis method is used to analyze all interview data.4.Delphi Method: In this study,17 basic public health experts in different regions of eastern,western,northern and southern China were selected to participate for two rounds of Delphi consultations.Prior to Delphi consultation,a basic public health service functional framework,a preliminary draft of the core competence model for basic public health services,and a consultation questionnaire were initially constructed through literature research,expert meetings,job analysis,expert meetings and other research methods.Then,the functional framework of basic public health services in China and the core competence model of primary health workers were constructed,after two rounds of Delphi consultations.Results1.General situation of the respondents: In the questionnaire survey,a total of 1275 respondents were surveyed,of which 1244 were valid questionnaires,with an effective rate of97.6%.Among the respondents,57.9% came from urban community health centers.The24-34 age group account for 38.7%,and the majority(82.6%)were women.The education background is mainly college(62.3%),93.1% of the respondents have received medical school education,40.8% are nursing in majors,and more than half(54.6%)are primary title.36.7% have worked for more than 5 years,72.6% are qualification licensed,and 56.9% are nurse practitioner.Most of them(83.7%)have no previous public health related work experience,and 40.4% have nursing practice experience.A total of 10 leaders from 35 primary health care sectors and 35 front-line primary health workers conduct personal in-depth interviews.Of the 10 leaders,more than half(6/10)are women;more than half(6/10)of the leaders are between 30 and 40 years old;and most leaders(8/10)have worked for more than three years.More than half(21/35)of front-line workers are from community health centers,and more than three-quarters(27/35)are women.The majority of front-line workers(32/35)are ?40 years of age,and most(21/35)have working years less than 3.2.Status of the capacity of primary health workers: With regard to the number of human resources for health,the leaders of all primary health care sectors believe that the staffing of basic public health services and the number of existing workers is seriously inadequate,especially for general practitioners and public health professionals.In terms of human resource capabilities,both front-line workers and leaders believe that the existing primary health workers have low academic qualifications(primarily with a college degree or below)and low professional titles(primary titles).In general,78.5% of the academic qualifications are college education or below;in the professional composition,the proportion of health workers with public health and clinical medical background is low,and more than 41% are from nursing majors,especially in cities and main urban areas.Of the primary health care sectors,nurses account for nearly 50%.Only 5.9% of the staff have a background in public health;in terms of professional title composition,80% of the staff have primary titles or non titles,while only 3% have deputy senior titles.Most front-line workers believe that they lack the ability to perform their jobs,especially in services that require high professional knowledge and skills(such as health education,child health management,maternal health management,management of patients with severe mental disorders,and health of TB patients management,communicable disease and public health emergency reporting and handling)less than half of the staffs are fully qualified,and most are relatively incompetent because of lack of knowledge and skills.3.Status of capacity building of primary health workers: more than 85% of staffs have received at least one training in half a year.However,most of the leaders of primary health care sectors believe that the current training is less effective,and that training has not fundamentally improved capabilities.The main reasons are: 1)The primary health care sectors are unable to arrange personnel to participate in the training,due to the shortage of personnel;2)The current training is not well organized,which is overlying or duplicating training contents,in addition to highly specialized training(such as severe mental illness and chronic disease management)is not undertaken by professional institutions;3)The current training usually focuses on policies and service specifications related to basic public health services,but covers much less or none on core public health capabilities.Moreover some training projects do not provide the actual needs of health workers,because of lacking assessment for the training;4)the current training format is single mode,usually only through lectures or conferences,mainly for the transfer of theoretical knowledge,but lack of operational training;5)the most of the training duration is too short and/or fragmented,and the knowledge and ability cannot be systematically improved;6)the training teachers are not fixed and the teaching ability needs to be improved,and meanwhile,the training materials are not uniform which is difficult to ensure training homogeneity.4.Assessment of training needs of primary health workers: Among the nine dimensions of training needs for primary health workers,professional knowledge accounts for 91.3%,professional skills account for 84.6%,basic public health service specification content is78.8%,communication ability is 64.3%,and formulating interventions is 41.6%.Needs assessment accounts for 33.2%,epidemiological investigation accounts for 32.5%,satisfaction investigation or project development effect evaluation accounts for 27.9%,and teaching skills accounts for 26.7%.Through the analysis of the two categories of logistic regression to analyze the influencing factors of the above training needs,it is found that the training needs of primary health workers are affected by various factors,such as professional background,education,job title,qualification category.Job position is especially the main influencing factor among 9 job dimensional training needs.5.Establishment of functional framework for basic public health services: After two rounds of Delphi consultation,a functional framework for basic public health services in China established.The framework consists of one general function(promoting equalization of basic public health services and maintaining public health),and eight sub-functions("Resident Health Literacy Improvement","Resident Health Information Management","Community Health Monitoring and Needs Assessment","Maintenance of Life Cycle Health", "Disease Prevention and Control","Community Health Emergency Management","Multi-sector Collaboration","Policy,Planning and Evaluation").6.Construction of core competence model for primary health workers: Through two rounds of Delphi consultation,a core competence model for primary health workers in primary health care sectors in China has been constructed.The core competency model consists of 3 primary indicators(including professional knowledge,practical skills,attitude and values),19 secondary indicators(including public health and preventive medical knowledge,community health monitoring capabilities,community health needs assessment capabilities,policies,and intervention development and implementation and evaluation capabilities,health management capabilities,infectious disease and public health emergency reporting and emergency response capabilities,information technology application capabilities,communication and communication capabilities,management and leadership capabilities,basic scientific research capabilities,and professionalism,etc.),60 three-level indicators(including epidemiology and medical statistics,knowledge of traditional Chinese medicine health management,ability to monitor residents' health status and disease risk factors,ability to participate in policy formulation,implementation and evaluation,health promotion and health education skills,chronic diseases health management ability,epidemiological investigation ability,public health emergency response ability,social mobilization skills,working partnership establishment,project management ability,basic research design and implementation ability,career planning ability and dedication,etc.)and129 specific capacity definition groups.Conclusion There is still room for improvement that primary health care sectors in Chongqing,such as shortage of human resources for basic public health services,less competent personnel,and poor training effectiveness.At the same time,the training needs of primary health workers are diversified,and the training needs of different health workers have different focuses.The core competence model of primary health workers established in the current study lays the foundation for primary health care sectors to train primary health workers based on core competence.Furthermore,our study provides a theoretical basis for the health administrative department to further improve the design of training programs,as well as,enhances the relevance of training programs,improving the effectiveness of training,and improving the service capabilities of primary health workers in primary health care sectors.We proposed the following policy recommendations,based on the current status of capacity building of primary health workers in Chongqing,1.It is necessary to pay greater attention to capacity building of human resources for basic public health services.2.The state provide strong support for the capacity building of primary health worker at the policy level.3.Based on the core competence,adjust and reform the medical education curriculum system of public health related majors in medical colleges and improve the post competence of students.4.Development of a capacity training program is based on the core competence model of health workers in primary health care sectors.Performing the training based on the core competence model to improve the capacity building effect of health workers in primary health care sectors.