Progress of equalizing basic public health services in Southwest China--- health education delivery in primary healthcare sectors

Abstract

Background: Equalizing basic public health services (BPHS) for all has been one goal of the health system reform in China since 2009. At the end of the 12th five-year plan, we conducted a series of surveys to understand BPHS implementation in Southwest China, and firstly reported implementation of health education (HE) and explore the barriers to HE delivery.

Methods: Mixed research methods were used to investigate achievement in and barriers to HE in Southwest China. SPSS 22.0 was used for data analysis.

Results: Nine hundred and eighty-nine residents were surveyed by questionnaire. 16 health care workers (HCWs) and 16 directors from 16 PHC sectors were included in the in-depth interviews. Less than 50% of residents who knew or utilized some item of HE. Age, residence, region (Chongqing or Guizhou), marital status, education, occupation, type and quality of primary health care (PHC) sectors to deliver BPHS, self-reported health and status of chronic diseases were associated with knowledge or utilization of HE. Distance to PHC sectors was associated with the knowledge of HE, gender and health insurance were associated with utilization of HE. Age, marital status, occupation region and self-reported health were associated with satisfaction regarding HE. Barriers to HE delivery included defects in HE design, weak capacity in PHC sectors to provide HE, residents' poor cooperation, lack of multi-sector cooperation, poor equipment and weak health system.

Conclusions: Southwest China delivered HE in all PHC sectors. However, our study underlined many barriers to equalization of HE. To address those barriers and achieve HE quality improvement, comprehensive measures to improve capacity of PHC sectors, enhance multi-sector cooperation and strengthen health information systems are all urgent needs.

Keywords: Basic public health service; China; Health education; Mixed research methods.

Fig. 1

The Practical Robust Implementation and Sustainability Model (PRISM) for basic public health service. This figure presents the core domains of PRISM for basic public health service (BPHS). The interventions design is HE program design; the recipients include primary health care (PHC) sector and residents; the external environment is multi-sectors cooperation across related institutions; the organizational implementation and sustainability infrastructures include PHC sector’s infrastructure for HE and other essential infrastructures

Fig. 2

Knowledge and utilization of, and satisfaction to HE. This figure presents the percentage of residents had knowledge and utilization of the programs of health education (HE), the percentage of residents satisfied to the programs of health education (HE)