Understanding the shortage of village doctors in China and solutions under the policy of basic public health service equalization: evidence from Changzhou

Abstract

As the most important public health service providers in rural China, village doctors are facing a new challenge of heavier workload resulting from the recent policy of public health service equalization. Studies on the shortage of village doctors, mainly based on the national statistics, have so far been very broad. This study conducted detailed field surveys to identify specific factors of and potential solutions to the shortage in village doctors. Eight hundred forty-four village doctors and 995 health decision makers and providers were surveyed through a questionnaire, and some of them were surveyed by in-depth face-to-face interviews and focus group interviews. Opinions on the shortage in village doctors and the potentially effective approaches to addressing the problem were sought. Some village doctors (51.3%) were at least 50 years old. Some village doctors (92.3%) did not want their children to become a village doctor, and the main reasons were "low salary" and "lack of social security". Village doctors felt that it was difficult to provide all the required public health services. Local residents indicated that they established good relationships with village doctors. Some health decision makers and providers (74.0%) thought that they needed more village doctors. The shortage in village doctors presents a major obstacle toward the realization of China's policy of public health service equalization. The aging of current village doctors exacerbates the problem. Policies and programs are needed to retain the current and attract new village doctors into the workforce. Separate measures are also needed to address disparities in socioeconomic circumstance from village to village.

Evaluation and mechanism for outcomes exploration of providing public health care in contract service in Rural China: a multiple-case study with complex adaptive systems design

“…The study in Changzhou County indicated that village doctors felt difficult to provide all the required items of public health services. Most village doctors (92.3%) complained about the "low salary" and "lack of social security" [20]. Our former study in five counties of China also [21] evinced that only 41.3% of the village doctors had pension, and the proportions varied from 2.3% to 83.3% among different counties because the pension were supported by local finance.…”

Determinants of village doctors’ job satisfaction under China’s health sector reform: a cross-sectional mixed methods study

“…As previous studies have suggested, a sufficient pension plan is critical for retention of village doctors in rural areas [34–38]. However, through various pilot programs [39, 40], NRPP has still not achieved the goal, mainly due to the low return rate [15]. As such, NRPP is limited to being a supplementary income for village doctors after retirement, rather than sufficient support [41].…”

Challenge of China’s rural health

“…According to one statistical report, the percentage of rural doctors aged over 60 years rose from 3.1% in 2002 to 13.6% in 2010. 4 The number of rural doctors decreased from 1.13 per 1000 rural residents in 2002 to 0.81 per 1000 rural residents in 2010 despite a population increase in these areas during the same period. The government must take urgent action to encourage more medical school graduates and other young health workers to work in rural areas, to expand medical insurance coverage, and to invest in better medical equipment and facilities in rural areas.…”