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BackgroundIn order to address several health challenges, the Chinese government issued the National Essential Public Health Services Package (NEPHSP) in 2009. In China’s large cities, the lack of funding for community health centers and consequent lack of comprehensive services and high quality care has become a major challenge. However, no study has been carried out to estimate the cost of delivering the services in the package. This project was to develop a cost estimation approach appropriate to the context and use it to calculate the cost of the NEPHSP in Beijing in 2011.MethodsBy adjusting models of cost analysis of primary health care and workload indicators of staffing need developed by the World Health Organization, a model was developed to estimate the cost of the services in the package through an intensive interactive process. A total of 17 community health centers from eight administrative districts in Beijing were selected. Their service volume and expenditure data in 2010 were used to evaluate the costs of providing the NEPHSP in Beijing based on the applied model.ResultsThe total workload of all types of primary health care in 17 sample centers was equivalent to the workload requirement for 14,056,402 standard clinic visits. The total expenditure of the 17 sample centers was 26,329,357.62 USD in 2010. The cost of the workload requirement of one standard clinic visit was 1.87 USD. The workload of the NEPHSP was equivalent to 5,514,777 standard clinic visits (39.23 % of the total workload). The model suggests that the cost of the package in Beijing was 7.95 USD per capita in 2010. The cost of the NEPHSP in urban areas was lower than suburban areas: 7.31 and 8.65 USD respectively.ConclusionsThe average investment of 3.97 USD per capita in NEPHSP was lower than the amount needed to meet its running costs. NEPHSP in Beijing is therefore underfunded. Additional investment is needed, and a dynamic cost estimate mechanism should be introduced to ensure services remain adequately funded.

BackgroundAntibiotic resistance is one of the world’s biggest public health issues, and the situation in China is particularly grave. The objective of this study is to investigate the antibiotics usage pattern among Chinese children and provide further insight in developing strategies for promoting public health education.MethodsThis is a cross-sectional study, in the study, participants are from 53,665 guardians of children aged 0–6 years, who were recruited with multistage stratified random cluster sampling in 2013/2014 from 46 community health centers in 14 provinces across China Mainland. Children’s guardians completed surveys on their previous experience on using antibiotics in treating diarrhea of their children without a prescription from any pediatrician. Odds ratios (ORs) and 95% confidential intervals (CIs) for the association between antibiotic use and its predictors were estimated using multilevel logistic regression models, with antibiotic rational use group as a reference group.ResultsThe prevalence of antibiotic misuse among children with diarrhea in the eastern, middle and western areas of China and associations between antibiotic misuse and its predictors were studied. The average rate of antibiotic misuse is 35.12%. Multilevel logistic regression revealed that living in urban areas (OR = 0.79 (0.76, 0.83)), female children (OR = 0.92 (0.88, 0.96)), guardians having higher education (OR = 0.60 (0.55, 0.66)), being raised by parents (OR = 0.90 (0.85, 0.94)), guardians having basic health knowledge (OR = 0.82 (0.79, 0.86)) are protective factors and children’s age (1–3 years OR = 1.62 (1.54, 1.71)); 4–6 years OR = 1.90 (1.77, 2.03)) is a risk factor of antibiotic misuse among children aged 0–6 years with diarrhea in China.ConclusionsOur findings confirmed that there has been a high rate of antibiotic misuse without a prescription in children with diarrhea in China, which requires considerable attention. Suitable regulations and interventions are needed to solve this problem.

The objective of this study was to examine the association between patient satisfaction with community health service (CHS) and self-management behaviors in patients with type 2 diabetes mellitus (T2DM). In all, 1691 patients with T2DM from 8 community health centers in 5 provinces in China participated in the present study. The dependent variables included 4 measures of self-management behaviors: regular self-monitoring of blood glucose (SMBG), prescribed medication adherence, recommended dietary changes, and regular exercise. The independent variable was patient satisfaction with CHS. Multivariable logistic regression models were performed to examine the association between patient satisfaction with CHS and self-management behaviors. The mean satisfaction score in the participants was 3.14 (out of a maximum of 5). After adjusting for covariates including demographic factors, health status, health knowledge, and socioeconomic status (SES), diabetic patients with high CHS satisfaction had better medication adherence (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.02–1.55), increased exercise management (OR 1.19, 95% CI 1.06–1.35), and more SMBG (OR 1.16, 95% CI 1.03–1.32); all these associations varied across SES groups. The association between satisfaction and medication adherence was significant among participants younger than 65 years with lower education (OR 2.15, 95% CI 1.37–3.37), income (OR 1.62, 95% CI 1.13–2.32), and lower-status occupations (OR 1.69, 95% CI 1.16–2.47). Among participants younger than 65 years and had lower education attainment, the association between satisfaction and diet management was observed. There were positive associations between satisfaction and regular exercise among subgroups of participants younger than 65 years, except for lower education group. A significant association between satisfaction and SMBG among participants ≥65 years old, who also had lower SES and higher-status occupations, was also observed. The study findings suggested that T2DM patient satisfaction with CHS was moderate. High satisfaction with CHS indicated better medication adherence, exercise management, and SMBG, and these associations varied by SES.

This study aims to evaluate the prevalence and sociodemographic factors of anemia in children <36 months old in China. In this study, data of 24 235 children were investigated from 32 primary health care (PHC) facilities in 11 province-level regions. Pearson χ-test and logistic regression model were used to estimate potential risk factors associated with anemia. The overall prevalence of anemia was 24.4%, and 32.8% children from rural areas were anemic, but no statistically significant difference was observed between male and female. Predictors of anemia are different regions of China, cesarean delivery, premature birth and neonatal asphyxia. We also found that education level and income of children's parents are important determinants of childhood anemia. In additional, feeding practice would affect anemia among children aged 6-12 months. Our results could provide some insights for prevention and control of childhood anemia in PHC facilities.

BackgroundChina has had no effective and systematic information system to provide guidance for strengthening PHC (Primary Health Care) or account to citizens on progress. We report on the development of the China results-based Logic Model for Community Health Facilities and Stations (CHS) and a set of relevant PHC indicators intended to measure CHS priorities.MethodsWe adapted the PHC Results Based Logic Model developed in Canada and current work conducted in the community health system in China to create the China CHS Logic Model framework. We used a staged approach by first constructing the framework and indicators and then validating their content through an interactive process involving policy analysis, critical review of relevant literature and multiple stakeholder consultation.ResultsThe China CHS Logic Model includes inputs, activities, outputs and outcomes with a total of 287 detailed performance indicators. In these indicators, 31 indicators measure inputs, 64 measure activities, 105 measure outputs, and 87 measure immediate (n = 65), intermediate (n = 15), or final (n = 7) outcomes.ConclusionA Logic Model framework can be useful in planning, implementation, analysis and evaluation of PHC at a system and service level. The development and content validation of the China CHS Logic Model and subsequent indicators provides a means for stronger accountability and a clearer sense of overall direction and purpose needed to renew and strengthen the PHC system in China. Moreover, this work will be useful in moving towards developing a PHC information system and performance measurement across districts in urban China, and guiding the pursuit of quality in PHC.

BackgroundA shortage of community health professionals has been a crucial issue hindering the development of CHS. Various methods have been established to calculate health workforce requirements. This study aimed to use an economic-research-based approach to calculate the number of community health professionals required to provide community health services in the Xicheng District of Beijing and then assess current staffing levels against this ideal.MethodsUsing questionnaires, we collected relevant data from 14 community health centers in the Xicheng District, including resident population, number of different health services provided, and service volumes. Through 36 interviews with family doctors, nurses, and public health workers, and six focus groups, we were able to calculate the person-time (equivalent value) required for each community health service. Field observations were conducted to verify the duration.ResultsIn the 14 community health centers in Xicheng District, 1752 health workers were found in our four categories, serving a population of 1.278 million. Total demand for the community health service outstripped supply for doctors, nurses, and public health workers, but not other professionals. The method suggested that to properly serve the study population an additional 64 family doctors, 40 nurses, and 753 public health workers would be required.ConclusionsOur calculations indicate that significant numbers of new health professionals are required to deliver community health services. We established time standards in minutes (equivalent value) for each community health service activity, which could be applied elsewhere in China by government planners and civil society advocates.

Aim: This study aimed to evaluate the effectiveness of hypertension management and analyse the factors associated with blood pressure reduction within China’s primary healthcare system. Background: Hypertension is one of the leading risk factors for global disease burden and is strongly associated with cardiovascular diseases. In China, hypertension is a serious public health problem, but few studies have evaluated the effectiveness of hypertension management in China’s primary healthcare system. Methods: The study sites were 24 primary healthcare institutions, selected using multistage stratified random sampling method. In each institution, hypertension patients aged at least 35 years who agreed to participate and had no disabilities or mental health problems were enrolled for hypertension management. Participants received comprehensive interventions in the primary healthcare system via a team. After a one-year intervention, data from 6575 hypertension patients were analysed to check the effectiveness of hypertension management and examined factors associated with hypertension control. Findings: There was an overall mean reduction of 4.5 mmHg in systolic blood pressure (SBP) and 1.9 mmHg in diastolic blood pressure (DBP). The blood pressure reduction after one year was greater in rural patients than in urban patients, 6.6 mmHg versus 3.4 mmHg for SBP and 2.6 mmHg versus 1.6 mmHg for DBP, respectively. The hypertension control rate also increased more in rural areas (22.1%) than in urban areas (10.6%) after the one-year intervention. Age, body mass index, region and being in an urban area had a significant negative association with the reduction of SBP (P < 0.05). Education level and baseline SBP showed a significant positive association (P < 0.05). Conclusions: Community-based hypertension management by general practitioners was feasible and effective. The effectiveness of hypertension management in rural areas was greater than in urban areas. Intervention strategies should pay more attention to patients in rural areas and western China.