Background: Village doctors, as gatekeepers for the health of rural residents in China, are confronted with adversity in providing the basic public health services (BPHS), which has significantly impeded them from providing high quality BPHS. This study aimed to explore the obstacles and difficulties faced by village doctors in order to improve the quality and efficiency of BPHS provision and increase the health level of the population. Methods: In-depth interviews were employed to conduct this qualitative study. A total of 51 village doctors in four cities of Shandong Province were interviewed. The interviews were transcribed, anonymized, and imported into NVivo11.0 to facilitate management. Thematic framework analysis employing the constant comparison method was applied to the data analysis. Results: The main challenges faced by village doctors comprised the shortage, gender imbalance, and poor education of village doctors; older village doctors in some villages; low income; lack of social security; inappropriate performance assessment; inadequate professional BPHS training; heavy workload; and insufficient cooperation from rural residents, which have exacerbated the quality, efficiency, and accessibility of BPHS to some extent. Conclusions: Village doctors, as the important BPHS providers in rural Shandong, are facing a wide range of challenges. It is urgent for government officials and policy makers to consider these challenges and concentrate on improving the quality of BPHS provision by developing relevant and practical strategies.
Objective: This study aimed to assess the quantitative effects of short-term exposure of ambient nitrogen dioxide (NO2) on respiratory disease (RD) mortality and RD hospital admission in China through systematic review and meta-analysis. Methods: A total of 29 publications were finally selected from searches in PubMed, Web of Science, CNKI and Wanfang databases. Generic inverse variance method was used to pool effect estimates. Pooled estimates were used to represent the increased risk of RD mortality and RD hospital admission per 10 μg/m3 increase in NO2 concentration. Results: Positive correlations were found between short-term NO2 exposure and RD in China. RD mortality and RD hospital admission respectively increased by 1.4% (95% CI: 1.1%, 1.7%) and 1.0% (95% CI: 0.5%, 1.5%) per 10 μg/m3 increase in NO2 concentration. Differences were observed across geographic regions of China. The risk of RD mortality due to NO2 was higher in the southern region (1.7%) than in the north (0.7%). Conclusions: Evidence was found that short-term exposure to NO2 was associated with an increased risk of RD mortality and RD hospital admission in China and these risks were more pronounced in the southern regions of the country, due in part to a larger proportion of elderly persons with increased susceptibility to NO2 in the population compared with the north.
Background: General practitioners (GPs) play a vital role in primary health care services and promoting the health equity of residents, but there is a paucity of evidence on equity in the allocation of GP resources in mainland China. This study explores equity in the allocation of GP resources from 2012 to 2019 in mainland China. Methods: We used GP data from 31 provinces, autonomous regions, and municipalities in mainland China. Lorenz curves, Gini coefficients, Theil indices, and agglomeration degree were used to analyze the data. Results: The total number of GPs in China was 365,082 in 2019, which corresponded to 2.61 GPs per 10,000 residents and accounted for 9.44% of the total number of practicing doctors in 2019. From 2012 to 2019, the Gini coefficient of GP allocation based on population decreased from 0.3123 to 0.1872. However, the Gini coefficient based on geographical area was maintained at 0.7108–0.7424. The Theil index of GP allocation based on population decreased from 0.0742 to 0.0270, but GP allocation based on geographical area was maintained at 0.5765–0.6898. The intra-regional contribution rates were higher than the inter-regional rates. The agglomeration degree based on geographical area and population decreased in the eastern region but increased in the central and western regions. Conclusions: The number of Chinese GPs has increased rapidly in recent years, but the distribution of GPs across China is uneven. In the western and middle regions, there is a relative shortage. Equity in the allocation of GP resources based on population was far greater than that based on geographical area. In the future, the tough issue of inequitable GP resource allocation should be resolved by comprehensive measures from a multidisciplinary perspective.
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