Research On Evaluation For Appropriate Health Technology Program In Rural China

Rural health care is the emphasis of the health sector in China. Transferring appropriate health technologies to hospitals and clinics in rural area is a strategical measure to develop rural health care. Appropriate Health Technology Program in Rural China, which covered 20 counties in 10 provinces, was implemented as a major project of the Ministry of Science and Technology and the Ministry of Health from 2004 to 2006. By now, the program has been carried out for more than two years. Most of the stakeholders want to know clearly about the process, lessons learned and outcome of the program. It is necessary and significant to develop scientific evaluation for the program.Basing on experience gained from literature review and information from program stakeholders, the author designed evaluating indicators. Most of the indicators were collected through questionnaire and interview during field work in August 2006. Others were acquired through recorded database of the program.The major findings of the research are as follows:(1) Organizations were established in 10 provinces and 10 counties to manage the program. The total outlay of the program was 26.03 millions yuan, 20 millions from cental government, 6.03 millions from local governments. Some local program managers and hospital functionaries reported that the outlay they got was scarce.(2) 99.1% of the medical staffs thought they had "urgent demand" or "demand" for technologies they had been trained, 65.9% of them wanted to be trained again. 65.7% of the medical staffs been investigated showed that they knew much about technologies they had been trained, and 77.9% of the technologies had been utilized in clinical practice. (3) 167 health technologies and 11,887 medical staffs had been trained in 10 provinces during the program period. 68,965 patients had benefited from the program by August 2006. 93.5% of the interviewed patients prefered the new technology to others they had utilized before for better efficiency. Expenditure of numerous diseases was reduced in contrast with that in 2003.(4) Factors that influence the effect of appropriate health technology transfer include: positivity and capability of the program managers; total amount and allocation of program outlay; propriety of technologies, such as conveniency, price of service, prevalence of target disease, etc; willingness of patent holders to transfer or share their technologies; hospital facility and staff ability; income level and health care utilization of rural residents, etc.Conclusions: The program received a warm welcome from hospitals and medical staffs in rural areas. Local governments of the 10 provinces attached much importance to the program. Most of them invested in the program in proportion to central government' outlay. Organizations at two levels—province and county were established to manage the program. Thanks to the program, capabilities of rural hosipitals and rural doctors to diagnose and treat diseases have been improved significantly. In addition, expenditures of several diseases have been reduced. Otherwise, several problems were discovered to be resolved. For example, the outlay for appropriate health technology transfer is limited, especially in western provinces; There are few appropriate technologies that can be selected to meet demands of rural hospitals; The training was in such a hurry that quite a lot medical staffs could not master the technology. Lack of necessary facilities was reported by several hospitalsas an obstacle to technology utilization.Suggestions: (1) Both central government and local governments should increase budget for appropriate health technology transfer, and western depressed areas have the priority to obtain invest from central government. (2) Facilitate a faster transition from research to clinical practice. More attention should be payed to Health Technology Assessment and the selection of appropriate health technology, so that rural hosipitals and clinics will have more choices. Evidence shows that technology demands of different hospitals are diverse. They prefer techonologies that adapt to their own situation. (3) Enhance the quality of technology training. Time of learning should be prolonged, especially for doctors from township hospitals and village clinics. Envidence also shows that retraining is necessary for the majority of doctors. Besides, quite a few doctors expressed that they need multimedia teaching material to learn the technology by themselves after training. (4) Appropriate health technology transfer needs policy supports such as market admittance of new technologies, setting up the price of technology service, etc. Hospitals and doctors that provide appropriate health service to rural residents should be encouraged and granted with bonus.