Longitudinal study of rural health workforce in five counties in China: research design and baseline description

Abstract

BackgroundThe village doctors have served rural residents for many decades in China, and their role in rural health system has been highly praised in the world; unfortunately, less attention has been paid to the health workforce during the ambitious healthcare reform in recent years. Therefore, we conducted a longitudinal study to explore the current situation and track the future evolution of the rural healthcare workforce.MethodsThe self-administered structured Village Clinic Questionnaire and Village Doctor Questionnaire, which were modified from the official questionnaires of the Ministry of Health, were constructed after three focus groups, in-depth interviews in Hebei Province, and a pilot survey in Sichuan Province. Using a stratified multistage cluster sampling process, we gathered baseline data for a longitudinal survey of village doctors, village clinics from Changshu County, Liyang County, Yongchuan District, Mianzhu County, and Jingning County in China in 2011. Well-trained interviewers and strict procedures were employed to ensure the quality of this survey. Descriptive and correlation analyses were performed with Stata 12.0.ResultsAfter four months of surveying, 1,982 Village Doctor Questionnaires were collected, and the response rate was 88.1%. There were 1,507 (76.0%) male and 475 (24.0%) female doctors, with an average age of 51.3 years. The majority of village doctors (58.5%) practiced both western medicine and Traditional Chinese Medicine, and 91.2% of the doctors received their education below college level. Their practice methods were not correlated with education level (P = 0.43), but closely related to the way they obtained their highest degree (that is, prior to starting work or as on-the-job training) (P < 0.01). The mean income of the village doctors was 1,817 (95% CI 1,733 to 1,900) RMB per month in 2011; only 757 (41.3%) doctors had pensions, and the self-reported expected pension was 1,965 RMB per month.ConclusionsVillage doctors in rural China are facing critical challenges, including aging, gender imbalance, low education, and a lack of social protection. This study may be beneficial for making better policies for the development of the health workforce and China’s healthcare reform.

Developing challenges in the urbanisation of village doctors in economically developed regions: A survey of 844 village doctors in Changzhou, China

“…13 Studies have shown that recruitment is influenced by both financial and nonfinancial incentives. 14,15 In our study, results about the unattractiveness of the job as a village doctor leading to a decreased amount of village doctors are consistent with the findings from studies in central and western China. [16][17][18] The study attempted to understand how urbanisation influences the development of village doctors in eastern China and the challenges they face (Fig.…”

“…Less than 10% of the village doctors had heard that young people in their same villages wanted to become village doctors, and more than 90% of village doctors did not want their children to follow their path to become village doctors. 14 (1.7%) 40 (4.8%) 0 (0.0%) 95 (11.3%) 6 (0.8%) 75 (9.0%) 21 (2.5%) †Indicates number of responses in the category, and percentages represent portion of actual number of responses. ①, too old and no energy to do other career; ②, being a doctor as a kind of responsibility; ③, lack of new staff; ④, lack of other skills; ⑤, high income; ⑥, main economic source; ⑦, have social pension insurance; ⑧, hometown feelings; ⑨, be respected by local residents.…”

Population impact of a high cardiovascular risk management program delivered by village doctors in rural China: design and rationale of a large, cluster-randomized controlled trial

“…Existing policies apply mainly to the provision of curative services by village doctors and do not extend to preventive care [31]. We therefore designed a performance-based feedback and financial incentive payment, which serves to address this gap.…”

Aging village doctors in five counties in rural China: situation and implications

“…The self-administered structured Village Doctor Questionnaire, modified from the official questionnaire from the MOH after three focus groups, in-depth interviews in Hebei Province, and a pilot survey in Sichuan Province, was the tool to investigate the village doctors in this study [16]. …”

“…All of those variables were consistent with the official statistics, and had been used in the previous study [16]. …”