Who will protect the health of rural residents in China if village doctors run out?

2019 ◽  
Vol 25 (2) ◽  
pp. 99 ◽  
Author(s):  
Le Yang ◽  
Hongman Wang
Keyword(s):  
Health System ◽  
Rural Areas ◽  
Low Cost ◽  
Current Status ◽  
Chinese Government ◽  
Rural Residents ◽  
Village Doctors ◽  
Primary Health ◽  
The Village ◽  
Improve Access

This paper discusses the current situation of Chinese village doctors and highlights the importance of increasing the number of village doctors for better health service and a stronger health system. This study reviewed relevant health policies and data from the Chinese Statistic Year Book 2016 to assess the current status of Chinese village doctors and clinics. The Chinese government has launched a set of healthcare reforms to strengthen primary health care (PHC), especially in rural areas. However, the recruitment and retention of village doctors has not been successful. The analysis of available data suggests that fewer doctors or graduated medical students want to work in village clinics and provide services for rural residents. It is widely recognised in China and other countries that a good PHC system protects the population’s health at low cost. To achieve a better health system, the Chinese government should strengthen PHC, expanding the village clinics’ coverage to improve access to PHC and basic public health, and introduce more sustainable policies to attract more PHC practitioners to Chinese villages.

scholarly journals Thoughts on the Construction of Beautiful Villages with Poverty Alleviation in the Perspective

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Yanxue Li ◽  
Zhu Shu ◽  
Dawei Xu
Keyword(s):  
Sustainable Development ◽  
Rural Area ◽  
Rural Areas ◽  
Poverty Alleviation ◽  
Chinese Government ◽  
Government Institutions ◽  
Rural Revitalization ◽  
National Congress ◽  
The Village ◽  
The Relationship

 Accurate poverty alleviation has become an important task in implementing the rural revitalization strategy. Since the 19th CPC National Congress, Chinese government institutions have been striving to take measures to lift poor rural areas out of poverty. This essay takes Tailai district as the blueprint to start the research on precision poverty alleviation, explores and discusses the construction of beautiful villages, proposes strategies for sustainable development, makes people change concepts to coordinate the relationship between interests and concepts. It also points out the target that using the industry as a guide, using technology to alleviate poverty and make the village vibrant. Therefore, the endogenous power will be derived from the roots, and the agriculture, farmer and rural area will be fed back, in order to provide a reference for the Construction of Beautiful Villages in Heilongjiang.

scholarly journals Community Empowerment in Health: An Exploratory Study in Rural Community of a District of West Bengal

2020 ◽  
pp. 11-19
Author(s):  
Dipta Kanti Mukhopadhyay ◽  
Sujishnu Mukhopadhyay ◽  
Nivedita Das ◽  
Tarun Kumar Sarkar ◽  
Fasihul Akbar ◽  
...  
Keyword(s):  
Health Services ◽  
Health System ◽  
National Health ◽  
Rural Areas ◽  
West Bengal ◽  
Health Workers ◽  
Community Empowerment ◽  
Current Status ◽  
Health Staff ◽  
Key Informants

Background: Community empowerment is the process and outcome where community itself is able to identify, prioritize health problems and address them. It has been considered as the key strategy for scalability and sustainability of health services. Objectives: To explore the status of community empowerment in health in rural areas in West Bengal, India and the interplay of different stakeholders. Methods: A cross-sectional, qualitative study was conducted in 2017 – 2018 among the people residing in rural areas of Birbhum district in West Bengal, India who utilized the public health system (lay informants), formal and informal leaders of the community, community level health workers and peripheral health staff (key informants). Three community blocks, two sub-centers from each block and one village from each sub-center were selected randomly. In-depth interviews were conducted among 36 lay and 36 key informants using Laverack’s nine dimension model of community empowerment. Framework analysis was done to summarize data. Results: Participation of people was restricted to awareness and utilization of existing health services. Unmet aspiration for greater participation was noted among a small section of the community. They were mostly fitted to the role of beneficiaries. Functioning of village level organization to promote communitization as envisaged in national health programmes was largely deficient. The community health workers acted as the most peripheral appendages of formal health system rather than the health activists to empower community regarding community’s health. Conclusion: Although, every national health programme advocated community empowerment, the current status and the process of empowerment in health is in nascent stage.

scholarly journals Sustainability of Micro Hydropower Generation in a Traditional Community of Indonesia

2021 ◽  
pp. 105-117
Author(s):  
Tatsuro Sato ◽  
Jun’ichiro Ide
Keyword(s):  
Rural Areas ◽  
Research Agenda ◽  
Lessons Learned ◽  
Current Status ◽  
Sustainable Operations ◽  
Model Simulations ◽  
History Of ◽  
The Village ◽  
Local Materials ◽  
Large Floods

AbstractOver 3 years, we undertook a micro hydropower (MHP) project in the Ciptagelar village, West Java, to improve the understanding and implementation of sustainable operations and management of MHP generation in remote rural areas, where the primary industry is farming and thus monetary incomes are low. First, we describe in this paper the history of setting up the research agenda to be tackled with the cooperation of governmental and nongovernmental stakeholders. Second, we report the current status of MHP plants and the related issues obtained through fieldwork and model simulations, in the context of culture, traditions, and society in the village. Finally, we propose guidelines to solve the issues and present the lessons learned and things scientists should pay attention to when proceeding with transdisciplinary research projects in remote rural areas. Through fieldwork and model simulations, we revealed issues related to budgeting and techniques for maintaining and operating MHP plants. We found that the village had difficulty in securing funds for repairing broken intake weirs, though it had funds to cover the general maintenance of the MHP plants. We also found that the intake weirs were vulnerable to large floods and that no accomplished technicians were available to operate MHP plants in the village properly. To solve these issues, we need to find ways to reinforce the intake weirs using local materials and increase monetary incomes by creating new industries based on the MHP generation while considering the cultural and traditional backgrounds of the remote rural areas.

scholarly journals The Impact of COVID-19 on Primary Health Care and Antibiotic Prescribing in Rural China: Qualitative Study

2021 ◽  
Author(s):  
Tingting Zhang ◽  
Xingrong Shen ◽  
Rong Liu ◽  
Linhai Zhao ◽  
Debin Wang ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Primary Health Care ◽  
Rural Areas ◽  
Rural China ◽  
Antibiotic Prescribing ◽  
Epidemic Control ◽  
Primary Health ◽  
Tract Infections ◽  
The Village

Abstract Background: Primary health care (PHC) system is designated to be responsible for epidemic control and prevention during the outbreak of COVID-19 in China, while COVID-19 suspected cases in PHC are required to be transferred to specialist fever clinics at higher level hospitals. This study aims to understand to impact of COVID-19 on PHC delivery and antibiotic prescribing at community level in the rural areas of central China.Methods: Qualitative semi-structured interviews were conducted with 18 PHC practitioners and seven patients recruited from two township health centres and nine village clinics in two rural residential areas of Anhui province. Interviews were transcribed verbatim and thematically analysed.Results: Practitioners’ and patients’ views and perspectives on COVID-19 impacts on PHC services and antibiotic prescribing are organised into four broad themes. PHC practitioners took on a key public health role of tracing, screening and educating in rural areas, while their original role in seeing and treating patients was reduced since government required patients to be diverted. The additional work, risk, and financial pressure that PHC practitioners faced placed considerable strain on them, particularly those working in the village clinics. PHC largely diminished that related to the difficulty of PHC workforce with limited medical training and the high number of elderly patients in rural areas, and as a result of epidemic, rural patients found it more difficult to access health care. Antibiotic prescribing practices for non-COVID-19 respiratory tract infections remained unchanged and were not seen as relevant to practitioners’ knowledge of COVID-19, although overall antibiotic treatments were reduced because fewer patients were attending rural PHC clinics. Conclusions: Our study identified the considerable impact of COVID-19 epidemic on PHC in rural China. Since COVID-19 epidemic control work has been designated as a long-term task in China, rural PHC clinics now face the challenge of how to balance their principal clinical and prevention and public health roles and, in the case of the village clinics, remain financially viable.

scholarly journals Primary health care among rural pregnant women in China: achievements and challenges in maternal mortality ratio

2019 ◽  
Vol 20 ◽  
Author(s):  
Le Yang ◽  
Hongman Wang
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Maternal Mortality ◽  
Pregnant Women ◽  
Rural Areas ◽  
Maternal Mortality Ratio ◽  
Chinese Government ◽  
Primary Health ◽  
Mortality Ratio ◽  
The Government

Abstract Background: The maternal mortality ratio (MMR) is not only an important indicator of maternal and infant safety, but also a sign of the development of economy, education, and medical care in a country. In the last 60 years, the Chinese government has implemented various strategies and policies to reduce the MMR, especially in the rural areas. Aim: This study aimed to discuss the strategies developed by the Chinese government, showing the successful experience of Chinese intervention programs and highlighting the challenges to the government in the context of current economic and social status. Method: This study probed into the Chinese government’s efforts and achievements in the MMR reducing by reviewing the relevant health policies, extracting the data from China Health Statistics Yearbook of 2015, analyzing the reduction of maternal death in rural areas and the major causes from 1991 to 2015, comparing the MMR trend in urban and rural areas, and discussing the changes of the situation in China. Finding: Although it seems that Chinese government’s efforts have brought evangel to the rural pregnant women and significantly reduced rural maternal mortality, the government still needs to develop more equitable and flexible primary health care policies to narrow the imbalance in health resource allocation and pay more attention to the health care for the rural-to-urban migration in China.

scholarly journals The Influence of Job satisfaction, Resilience and Work engagement on Turnover Intention among Village Doctor in China:a cross-sectional study

2019 ◽  
Author(s):  
Xuewen Zhang ◽  
Liyan Bian ◽  
Xue Bai ◽  
Dezhong Kong ◽  
Li Liu ◽  
...  
Keyword(s):  
Job Satisfaction ◽  
Work Engagement ◽  
Turnover Intention ◽  
Village Doctor ◽  
Mediating Effect ◽  
Equation Modeling ◽  
Rural Residents ◽  
Village Doctors ◽  
Negative Effect ◽  
The Village

Abstract Background As the gatekeepers of rural residents ‘health, the team of village doctors plays a vital role in improving the health level of rural residents. However, a large number of village doctor’s turnover, or even dozens of them turnover collectively, threatening the stability of the village medical team. This research evaluated the influence of job satisfaction, resilience, work engagement on turnover intention of village doctor and explored the mediating role of resilience and work engagement between job satisfaction and turnover intention among village doctor in China.Methods A quantitative study using a self-administered questionnaire containing mostly structured items was conducted among the village doctors with a sample size of 2693 from 1345 rural hospitals or clinics of Shandong province, China, during May and June 2019. All variables including demographic characteristics, job satisfaction, resilience, work engagement and turnover intention were based on literature and measured on 5- or 6-point Likert scale. Such statistical methods as one-way ANOVA, bivariate correlation, exploratory factor analysis (EFA) and Structural Equation Modeling (SEM) were used.Results As high as 46.9% of the participants had a high turnover intention and no less than 26.3% of the participants had a medium turnover intention. Job satisfaction not only has a direct negative effect on turnover intention(β=-0.37, p < 0.001), but also has an indirect effect on it through work engagement(β= -0.04, p < 0.001), work engagement has a direct negative impact on turnover intention(β= -0.13, p < 0.002), and resilience had an indirect negative effect on turnover intention through the mediating effect of work engagement(β= -0.09, p < 0.001). The results of this study strongly verified that job satisfaction, resilience, work engagement were early, powerful predicators of turnover intention.Conclusion According to the results, reasonable and fair income, effective promotion mechanism, fair social old-age security, reasonable workload, strong psychological coping mechanism for work stress, should be taken seriously to improve job satisfaction. The turnover intention of village doctors could be reduced through improving job satisfaction, resilience and work engagement.

scholarly journals Bypassing primary care facilities: health-seeking behavior of middle age and older adults in China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Changle Li ◽  
Zhuo Chen ◽  
M. Mahmud Khan
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Health System ◽  
Rural Areas ◽  
Urban Areas ◽  
Chinese Patients ◽  
Care Needs ◽  
Healthcare Facilities ◽  
Primary Health ◽  
Care Facilities

Abstract Background With economic development, aging of the population, improved insurance coverage, and the absence of a formal referral system, bypassing primary healthcare facilities appear to have become more common. Chinese patients tend to visit the secondary or tertiary healthcare facilities directly leading to overcrowding at the higher-level facilities. This study attempts to analyze the factors associated with bypassing primary care facilities among patients of age 45 years or older in China. Methods Random effects logistic models were used to examine bypassing of primary health facilities among rural-urban patients. Data from 2011 to 2015 waves of the China Health and Retirement Longitudinal Study were used. Results Two in five older patients in China bypass primary health centers (PHC) to access care from higher-tier facilities. Urban patients were nearly twice as likely as rural patients to bypass PHC. Regardless of rural-urban residence, our analysis found that a longer travel time to primary facilities compared to higher-tier facilities increases the likelihood of bypassing. Patients with higher educational attainment were more likely to bypass PHCs. In rural areas, patients who reported their health as poor or those who experienced a recent hospitalization had a higher probability of bypassing PHC. In urban areas, older adults (age 65 years or older) were more likely to bypass PHC than the younger group. Patients with chronic conditions like diabetes also had a higher probability of bypassing. Conclusions The findings indicate the importance of strengthening the PHCs in China to improve the efficiency and effectiveness of the health system. Significantly lower out-of-pocket costs at the PHC compared to costs at the higher tiers had little or no impact on increasing the likelihood of utilizing the PHCs. Improving service quality, providing comprehensive person-centered care, focusing on family health care needs, and providing critical preventive services will help increase utilization of PHCs as well as the effectiveness and efficiency of the health system.

Rationale and Design of a Cluster Randomized Trial of a Village Doctor-Led Intervention on Hypertension Control in China

2021 ◽  
Author(s):  
Yingxian Sun ◽  
Zhao Li ◽  
Xiaofan Guo ◽  
Ying Zhou ◽  
Nanxiang Ouyang ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Cluster Randomized Trial ◽  
Village Doctor ◽  
Health Coaching ◽  
Multifaceted Intervention ◽  
Hypertension Control ◽  
Rural Residents ◽  
Village Doctors ◽  
Cluster Randomized ◽  
The Village

Abstract Background In China, hypertension prevalence is high and increasing while the control rate is low, especially in rural areas. Traditionally, village doctors play an important role in infectious disease control and delivering essential health services to rural residents. We aim to test the effectiveness of a village doctor-led multifaceted intervention compared to usual care on blood pressure (BP) control and cardiovascular disease (CVD) among rural residents with hypertension in China. Methods In the China Rural Hypertension Control Project (CRHCP), a cluster randomized trial, 163 villages were randomly assigned to the village doctor-led intervention and 163 villages to control. A total of 33,995 individuals aged ≥40 years with an untreated BP ≥140/90 mmHg or treated BP ≥130/80 mmHg or with an untreated BP ≥130/80 mmHg and a history of clinical CVD were recruited into the study. The village doctor-led multifaceted intervention is designed to overcome barriers at the healthcare system, provider, patient, and community levels. Village doctors receive training on standard BP measurement, protocol-based hypertension treatment, and health coaching. They also receive technical support and supervision from hypertension specialists/primary care physicians and performance-based financial incentives. Study participants receive health coaching on home BP monitoring, lifestyle changes, and adherence to medications. The primary outcome is BP control (&lt;130/80 mmHg) at 18 months in phase 1 and CVD events over 36 months in phase 2. Conclusions The CRHCP will provide critically important data on the effectiveness, implementation, and sustainability of a hypertension control strategy in rural China for reducing the BP-related CVD burden. Clinical trials registration ClinicalTrials.gov identifier NCT03527719

scholarly journals Study on Rural Residents’ Satisfaction with the Clean Energy Heating Program in Northern China—A Case Study of Shandong Province

2021 ◽  
Vol 13 (20) ◽  
pp. 11412
Author(s):  
Xingmin Liu ◽  
Beibei Qin ◽  
Yong Wu ◽  
Ran Zou ◽  
Qing Ye
Keyword(s):  
Rural Areas ◽  
Evaluation System ◽  
Policy Design ◽  
Implementation Process ◽  
Clean Energy ◽  
Northern China ◽  
Shandong Province ◽  
Chinese Government ◽  
Entropy Weight ◽  
Rural Residents

The Chinese government announced the Clean Energy Heating Program in northern China in 2017, promoting clean energy for residents’ winter heating. The key difficulty of implementing this policy initiative lies in rural areas. This research hence focuses on evaluating the implementation of this policy in rural areas. Rural residents who directly benefit from, and are integrally involved in, the implementation process in Shandong Province were surveyed to evaluate their satisfaction with this policy. In order to identify their satisfaction indicators and obstacle factors, a TOPSIS obstacle model adjusted by entropy weight was developed. An evaluation system of the indicators of residents’ satisfaction with the policy was developed and converted into a questionnaire. The designed questionnaire was distributed to 341 rural residents in Jinan, Zibo and Heze in Shandong province. Data analysis suggests that, at the fiscal subsidies level, supporting infrastructure, technical supports and support organizations are four important factors affecting rural residents’ satisfaction. The key obstacle factors identified include technical support, supporting infrastructure, the operation subsidies level, heating cost, period of subsidies and achieved temperature. Corresponding suggestions for further clean energy heating policy design and implementation in rural areas in northern China are provided.

Barriers to Nursing Home Care for Nonelderly Rural Residents

2017 ◽  
Vol 38 (12) ◽  
pp. 1708-1727
Author(s):  
Carrie Henning-Smith ◽  
Katy Kozhimannil ◽  
Shailendra Prasad
Keyword(s):  
Nursing Home ◽  
Home Care ◽  
Rural Areas ◽  
Nursing Home Residents ◽  
Nursing Home Care ◽  
Rural Residents ◽  
Semistructured Interviews ◽  
Medical Complexity ◽  
Specific Barriers ◽  
Improve Access

Rural residents experience higher disability, mortality, and poverty rates than their urban counterparts; they also have more barriers to accessing care, including nursing home care. Meanwhile, the proportion of nonelderly adult nursing home residents (<65 years old) is growing, yet little is known about this population and barriers they face trying to access care, especially in rural areas. This qualitative study uses data from 23 semistructured interviews with rural hospital discharge planners in five states to identify specific barriers to finding nursing home care for nonelderly rural residents. We grouped those barriers into three primary themes—payment status, fit, and medical complexity—as well as two minor themes—caregivers and bureaucratic processes—and discuss each in the article, along with potential policy and programmatic interventions to improve access to nursing home care for nonelderly rural residents.

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