Human resource staffing and service functions of community health services organizations in China

Abstract

Purpose: We report a study on the developmental status of human resource staffing and service functions of community health services (CHS) in China and offer recommendations for improving the CHS in the future.

Methods: A study questionnaire was completed by 712 CHS organizations distributed in 52 cities and districts in all areas of China using a multilevel stratified randomized sampling method. Data were collected on the backgrounds, human resources, and service functions of CHS organizations.

Results: We found that 68.2% of doctors and 86.5% of nurses employed in CHS centers have low-level medical training. The doctor-nurse ratio in CHS centers is 1.2 to 1 and in CHS stations is 1.3 to 1. More than 50% of CHS organizations have developed on-the-job training programs, causing cost trends for staff training to increase. Although the delivery of basic clinical services and public health services is steadily increasing, 58.6% of stations are open less than 12 hours per day. Health records are established in a high proportion of CHS organizations. Two kinds of health education--general public health education, and personal education for specific problems--have been adopted by more than 92% of CHS centers and 90% of CHS stations.

Conclusions: Desired functions for CHS organizations have been partially achieved. Training for doctors and nurses engaged in CHS should be promoted and improved as quickly as possible. Training in basic clinical services and management of noncommunicable chronic diseases should be strongly promoted. Changes in government policies should be pursued to promote effective support for the development of CHS.

Figure 1.

Sampling flow of community health services centers and stations in 2003 in China. ^a Five cities specifically designated in the state plan (this city is similar in size to a provincial capital) include Xiamen, Ningbo, Qingdao, Shenzhen, and Dalian, which are controlled by provincial governments politically and managed by the central government economically. ^b Four municipalities (a municipality is roughly equivalent to a province) are directly under the jurisdiction of the central government, including Beijing, Shanghai, Tianjin, and Chongqing. ^c Considering level of local economic as a stratification factor, 27 provinces were stratified into 7 strata. Every stratum includes 4 provinces with similar economic levels, except 3 provinces in the last stratum. Each province was selected from every stratum by simple random sampling. ^d Seven capitals of selected provinces were selected in terms of economical and political characteristics.