Study On The Development Of Community Health Institutions In Shandong Province And Its Countermeasures

BackgroundCommunity-level health institutions both in rural and urban areas are most close to the general residents and provide most of the basic medical and public health services to the residents, and they are the main health services providers in our country. For a long time, these community-level health institutions have made a positive contribution to ensure the health of the people.Along with the development of new health system reform, the functions and the scope of business will be further expanded and their importance in the health service system will be further improved. Thus, it is much valuable to carry out a systematic research on the current situation of grassroots health institutions to provide basic information for health policy-making.ObjectivesThe aim of this study is to analyze the construction and development situation of community-level health institutions from 2010 to 1013 in Shandong province, find out Existing problems and put forward relative suggestions. The specific objectives include:● To learn about the basic framework of community-level health institutions in Shandong province;● To analyze the current situation of health resources allocation at the grassroots health institutions;● To analyze the situation of health services provision of community-level health institutions;● To find out problems existing in the development of community-level health institutions, and probe relative strategies and measures to promote the development of community-level health institutions.Methods1.Literature review:Collected and reviewed all the relative literatures and files about the development of national economic, society and health system throughout the country and in Shandong province.2.Resource of quantitative data:China Statistical Yearbook, Statistical Yearbook of Shandong Province and Health Statistics Annual of Shandong Province were used to collect relative information and data about the development of economy, society and health system.3.Collecting of qualitative data:Focus group interview method was used to collect relative information about the construction and development of community-level health institutions.Descriptive method was mainly used in the study such as growth rate and proportion were analyzed to describe the trend and status of health resources allocation and the health services provision in community-level health institutions.Main results1.Quantity of community-level health institutions was insufficient and the distribution was unbalanced. By the end of 2013, there were more than 20% administrative villages having no clinics, and larger differences existed in number of community-level health institutions among different cities.2.Dstribution of grassroots health staffs were unbalanced among different cities. The number of medical(or assistant) practitioner, nurse practitioner, village doctors and health workers per 1000 people had larger differences among different cities.3.The quantity of grassroots health staffs was relatively insufficient. There were 2.02 health professionals including 0.92 medical(or assistant) practitioners and 0.62 nurse practitioners per 1000 residents which was in a much low level.4.High-level health professionals was insufficient in community-level health institutions.51.92% health professionals had a academic background under junior college in township hospitals and this percentage was 39.48% in urban community health institutions in 2013. As to the village doctors, medical (or assistant) practitioner and nurse practitioner only made up a percentage of 14.97% and 6.02% respectively of the total.5.Business building was inadequate in community-level health institutions. Up to 2013, the rented building accounted for 26.42% of the total in urban community health institutions and 0.70% in township hospitals. There were 239.6 thousands square meters of dilapidated building in community-level health institutions which accounted for 3.84% of the total buildings.6.There was less allocation of large-scale instruments and equipments in community-level health institutions. The number of community-level health institutions made up a percentage of 95.53% of total health institutions in Shandong province, but the value of large-scale instruments and equipments in community-level health institutions only accounted for 3.22% of the total value and 12.06% in number.7. Service capacity of providing basic medical and health services was relatively low in community-level health institutions. Although the number of outpatients, inpatients and physical examinations in community-level institiutions showed out an increasing trend in the recent years, but the propotion decreased compaired to the total amount of health services provision in Shandong province.Suggustions:1.Establishing a sustainable government financial input mechanism, and incrasing finacial inputs to the community-level institutions.2. Formulating and implementing a scientific and reasonable regional health planning to promote the balancing development of grassroots medical and health service systems.3.Adopting multiple forms of education to accelrate the cultivation of grassroots health professionals.4.Implementing comprehensive incentive policies aiming to the grassroots health professionals in order to ensure the stability of healh staffs in community-level health institutions.5.Redistributing the functions of different level of health services institutions and highlighting the role of community-level health institutions.