| In 2002, "The Decision on Further Strengthening Rural Health Work made by CPC Central Committee and State Council" called for that, "by 2010 China will establish health service system and cooperative medical care system in the rural areas adapting to the request of the socialist market economic system and the rural economic and social development". In the three-tier network of rural health service, the rural township health centers play a decisive role as the hub, and it is not only the main body to provide basic health services in rural areas, but also has major responsibility to achieve integrated management of health services in rural areas. Their functions related to the raise of people's health level and steady development of the rural health services. Therefore, to define and improve the primary health service functions of township health centers in China is the theoretical and practical issues which need to be study.Research Objectives:This study aims to analyze the situation of the primary health services of township health centers in China, and put forward some policy suggestions to strengthen their health service functions. Specific research objectives include:1) Investigate and analyze the situation of the primary health service functions of township health centers;2) To compare the gap of primary health service functions between the rural township health centers and urban community health service centers;3) Analyse the main factors which can affect health service functions of township health centers;4) Put forward a set of policy recommendations to strengthen their primary health service functions. Data Resources:The sources of information come from the data in the 4th National Health Service Survey, and the special topic on the functions and human resources in the primary health institutions. The 4th National Health Service Survey investigated a total of 1225 institutions in 31 provinces (municipalities and autonomous regions). A total number of rural township health centers are 348, of which 117 in the eastern area,97 in the central area, and 134 in the western area; Sample areas in special topic are three counties and one city in Shandong Province, also two counties and one city in Hubei and Chongqing respectively. In this article, the status quo analysis of the rural township health center functions mainly adapts the surface data from the township health centers in the 4th National Health Service Survey and related analysis of interviews from the specific topic. The influencing factors of their functions and a few functions such as the information management function and coordination function, adopted data from the special topic due to lack of data in the national survey.The Main Results:1) In this study, the primary health services are divided into three levels according to the economic and social development, health service capacity of primary health institutions, the major health problems of urban and rural residents, and the priority level of primary health services during different periods and in different conditions; 2) With regard to the items, the township health centers only conducted 50% of the overall 142 service items, and the items in the eastern area are more than 11.5 than the central area,18.3 more than the western area. The central area conducts more than 6.8 than the western area; 3) With regard to the priorities, the township health centers has already carried out 66.8% of the total items in level 1,41.4% in level 2, and less than 30% in level 3. These three levels have significant difference among different regions, and the difference is the largest in level 2. No matter consider nationally or in different regions, the proportions of the items carried out by township health centers reduce significantly with the reduction of their priority levels; 4) With regard to the functions, the total 57 items of basic medical function include 21 laboratory examination items,31 common diseases clinic items,5 family clinic and referral items. The township health centers carry out 28 items on average, of which,12.2 laboratory examination items,13.3 common diseases clinic items,2.4 family clinic and referral items; The 45 total items of preventive care function include 21 vaccination,12 chronic disease management, and 12 health education services, and township health centers conducted an average of 23.4, of which,14.4 vaccination,2.6 screening and management of chronic diseases,6.4 health education; Health management function has 3 items in total with the average of 0.7 conducted by township health centers. Function of specific group health care has a total items of 26 with an average of 11.5 conducted by township health centers; Function of public health and infectious diseases monitor and control has a total of 11 items, with an average 7.2 conducted by township health centers; 5) The primary health service functions of rural township health centers are still less than that of urban community health service centers:In term of priority, these three levels of primary health services have significant difference between rural township health centers and urban community health service centers. And with the reduction of their priority levels, the gap between the proportions of items carried out by these two institutions has gradually expanded to 15.9% in level 3. In term of function, the proportion of other service function items carried out by rural township health centers is lower than that of urban community health service centers except the function of infectious diseases control; 6) The key factors which can affect the functions of township health centers are insufficient number of personnel, lack of staff capacity, equipment, financial support, less demand and so on. Among them, the most important reasons are inadequate staff numbers, low staff capacity, and the funding and equipment shortage.Suggestions:Assess the functions of township health centers at different levels and areas accurately and objectively, analyze their affecting factors, and make sure the necessary resources and mechanisms to township health center functions; Plan work for improving the functions of township health centers, and develop periodic goals as well as corresponding measures to ensure the goals aiming at the major problems in construction of township health center functions at different areas and of different types; The construction of township health center functions should be incorporated into the overall framework of health reform in China. Increase motivation and pressure to their function improvements by the means of patient distribution and using the opportunity of the constructions of Medical Insurance Systems such as the New Rural Cooperative Medical System, Medical Aid System, and so on. Strengthen their public health service functions using the opportunity of the public health system construction; The fundamental solution to their function development is the capacity-building of their health personnel as the core. |
PDF Full Text Request