Supporting and retaining competent primary care workforce in low-resource settings: lessons learned from a prospective cohort study

Abstract

ObjectiveAssess whether local health facilities can adequately support the performance of general practitioners (GPs) trained by China’s national compulsory services programme (CSP).DesignProspective cohort study.SettingHealth facilities in middle and western rural areas in China, 2015–2022.ParticipantsCohorts of CSP graduates from 2015 to 2019 in four major medical universities.Main outcomesJob performance measured by a 12-item Job Performance Scale; productivity measured by outpatient volume per day; turnover measured by ever changing jobs within the past year.Results91.2%, 92.0% and 90.5% GPs working in township health centres reported inadequate medication, equipment and external assistance from higher level hospitals, while CSP graduates working in secondary or tertiary hospitals reported a lower rate of less than 60%. The top three tests reported as lacking were blood gases (67.7%), microbiology (61.6%) and cancer biomarkers (49.7%); the top three lacked procedures were CT scan (64.8%), MRI scan (58.1%) and ambulatory BP monitoring (55.8%); and the top three lacked drugs were drugs for cardiovascular diseases (23.3%), systematic hormonal preparations (17.7%) and traditional Chinese medicines (13.0%). Multivariable analysis showed that facility support was positively associated with job performance—adequate medication increased job performance by 2.2 points (95% CI 0.7 to 3.8), and adequate external assistance increased job performance by 3.3 points (95% CI 1.8 to 4.8). Facility support was also positively associated with productivity—adequate medication increased outpatients seen per day by 20% (95% CI 0.1 to 0.3), and adequate equipment increased outpatients seen per day by 12% (95% CI 0.0 to 0.2). Facility support did not have significant impact on turnover, but GPs who changed jobs in the past year were 1.9–2.3 times more likely to report adequate facility support.ConclusionGPs in township health centres experienced a high prevalence of shortage in facility support. The identification of a positive association between facility support and performance and productivity has implications for future research and resources deployment in primary healthcare.

Quality of primary health care for chronic diseases in low-resource settings: Evidence from a comprehensive study in rural China

“…To address this problem, China launched a national compulsory services program to train and provide qualified general practitioners with a five-year medical training program in these areas in 2010. The program has been implemented for more than 13 years and provides more than 5000 general practitioners each year [ 12 ]. China has also invested great efforts in improving comprehensiveness, notably the launch of a comprehensive national public health services program [ 27 ].…”

“…However, PHC in rural areas is often understaffed, placing healthcare workers under strain to deal with the growing disease burden [ 11 ]. Constrained resources and insufficient external support also undermine the job performance and productivity of healthcare workers [ 12 ]. PHC workers in rural areas often have low medical qualifications, which subsequently leads to low-quality services [ 13 , 14 ].…”