| 1. Research objective and SignificanceRural doctors emerged in the 1960s in our country. To solve the problem of lacking doctors and medicine in rural areas at that time, the government decided to actively raise (short-term medical knowledge training) the primary rural sanitation personnel at half-time farm and half-time medical work, who were called as "barefoot doctors". In 1975, the total number of barefoot doctors reached 1,560,000 and every thousand farmers had 2.5 barefoot doctors in average. In 1985, the Ministry of Health unified stipulated that all village medical personnel must participate in a test, and awarded rural doctor certificates to the passers. Those taking the test unqualified or having not participated in the test were called as the health workers. In 1986, the number of rural sanitation personnel was 1,290,000, including 640,000 people with rural doctor certificates and 650,000 health workers, which reduced half approximately compared with 2,400,000 people in 1985. The data the Ministry of Health announced in 2003 demonstrated that there are 791856 rural doctors in our country and each village had 1.25 rural doctors or the health workers in average.Rural doctors in Zhenjiang were borne in the mid-1950s. To respond to the patriotic health campaign and the summon of "must eliminate snail fever" proposed by Chairman Mao vigorously and in view of the condition which lacked doctors and medicine in rural areas, each village elected a young people educated to accept a short-term training for one month in medical constitution in town. The young people, who learned basic medicine knowledge as well as the prevention and control methods of some simple common diseases, thus became initial rural doctors--the hygienic health care workers. In the early 1960’s, the Party and government proposed the policy to develop the medical and health work in the countryside. As a result, the urban medical and health team ran 6-8 month-long training classes in the countryside and consequently the rural doctors were developed into the "barefoot doctors" both worked as fanners and doctors. Up to the 1970’s, particularly after the party’s 11 Third Session, Zhenjiang Health school conducted one year off-job training classes to enhance the theoretical level of rural doctors. At least one rural doctor of each village accepted the training. In the early 1990’s, to carry out "10- year plan of rural doctor education" drawn up by the Ministry of Health, the training of the rural doctors in Zhenjiang was developed into the systematized and standardized secondary specialized medical education, bringing vitality and vigor for this team. No matter the development of national or Zhenjiang rural doctors, it has well solved the problem of lacking doctors and medicine in rural areas at that time.With the rapid development of social economy and the improvement of people’s living standards, service capacity of rural doctors has not been able to meet the increasingly growing demands for rural medical and health services. To adapt to the development of the times, the Ministry of Health and local department of health once carried on training and education programs to rural doctors. However, there was a great gap between the service capacity of rural doctors and the actual demands in rural areas. How does the team of rural doctors develop? Whether can their abilities meet the rural medical and health requirements? Several researchers and practitioners proposed that the staff of township health center could completely substitute for rural doctors in order to administer the integrated management between villages and towns. Also some people suggested to remain the team of rural doctors under integrated management. If the staff of village health posts were insufficient, township health centers could assign doctors. Nowadays, the focus is on which way the rural doctors will follow.The research aims to answer these questions:(1) what is the present situation of rural doctors in Zhenjiang? (2) How does the compensation mechanism affect the development of rural doctors? (3) What are the policies and supportive system to enlarge the team of rural doctors and meet the demands of rural residents? The research could provide a basis for the reform of rural doctors’service in Zhenjiang.2. Materials and MethodsThis research investigated the number, constitution, distribution, service capacity and administrative compensation policy of rural doctors in Zhenjiang from 2009 by standard-disparity analytic method and inventory survey method, as well as the intention of the development regarding of rural doctors proposed by the rural health service organizers and providers. Furthermore, it may offer a scientific mirror on the enlargement of rural doctors.The data source and methods included the literature canonical parse method, survey on the team of rural doctors, rural doctors’ work diary and so on.Sample survey method of the research was as follows:Taking samples from four counties in Zhenjiang including Danyang, Jurong, Yangzhong and Dantu, according to the lamination entire group random sampling’s principle. Sample towns were divided into three levels on the basis of average per person GDP (statistical caliber). Then, one town in each level and every three towns in each county were selected randomly. Likewise, Sample villages were divided into three levels in light of average per person GDP. Then, two villages in each level were collected in random. The study investigated 72 villages distributed in 12 towns of 4 counties including 360 rural residents and 290 health service organizers or providers. These health service organizers or providers comprised of 6 directors or vice-directors of health bureaus, 12 mayors or vice-mayors of towns,16 administrators in public health, personnel and financial sections,18 director or vice-directors of township health centers,72 mayors of villages and 166 rural doctors.3. ResultThe number of rural doctors is insufficient and their age is relatively old, also the degree of their academic qualifications and professional titles are low.Firstly, the number of staff was insufficient in 50% village health posts. Secondly, the degree and profession title of rural doctors was low, only 60.7% people achieved secondary specialized degrees,34.7% people had doctors or assistant doctors’ qualifications. Thirdly, the average age of rural doctors has been reached 52.1 years old,57.2% people were over 50 years old and 18.5% people were even over 60 years old.Labor intensity of rural doctors is hard, and along with enlargement of public health work load, the labor intensity increasesThe main daily work of rural doctors included basic medical services consisting of diagnosing, treating and infusing patients in the morning, and basic public health services including establishing healthy files, carrying out healthy education, administrating of the diabetes, olds and hypertensive patients, as well as health visiting of parturient and neonate in the afternoon. However, with the transmission of the work mode, the demand and intensity of basic public health services became more and more high. Since healthy file contracts were sighed in 2011, rural doctors needed to do the jobs after working or taking the time of weekends.The income of rural doctors is low and their old-age security problem has not been solved.Main source of rural doctors’income consisted of two parts. One was medical income including registration fee, diagnosis fee and treatment costs, the other was medicine income. However, drugs had been sold at zero mark-up since the national system of essential drugs was put into effect from February 2010. In 2011 rural doctors in Zhenjiang earned 21,000 Yuan in average.85.2% of the rural health service organizers and managers believed that the income was low, not matching the rural doctors’high strengthen work. Meanwhile, since the rural doctors’after-retire security problem has not been solved, the source of their income after retirement could not be guaranteed.Subsidies for rural doctors in the way of purchasing services are insufficient.Rural doctors got subsidies from township health centers on basis of the work of the basic public health services which were loaded by. However, they got little subsidies because they could not undertake much public health work due to their limited working capacity. Government failed to fulfill the promise to village health posts after the national system of essential drugs, and only 50% profits of drugs were compensated for them.4. SuggestionAuthority is suggested to optimize the constitution of rural doctors by means of improvement on education and recruitment for more staff.Local health authority should improve rural doctors’education through the method of professional trainings and performances, and also enhance their abilities on public health services, prevention and diagnosis of common diseases. The outstanding doctors of township health centers should be assigned to village health posts to direct rural doctors. Meanwhile, rural doctors should be organized to study in advanced areas.Government should increase the financial investment on village health posts and the income of rural doctors.Local authority should increase the subsidies of basic public health services offered by rural doctors and improve the assessed system. The diverse constitution of rural doctors’ income should be established which are departed from the income of. The primary work of village health posts should be transmitted into public health services completely. It is also suggested government increases investment or put the rural doctors into personnel administration of township health centers.It is suggested to integrated manage village health posts and township health centers in order to transmit the administrated mode of village health posts.The integrated management on village health posts includes integrated personnel management, integrated business management, integrated drugs and medical instruments management, integrated financial management and integrated performance appraisal. The outstanding doctors of township health centers should be assigned to village health posts to direct rural doctors. Rural doctors are encouraged to participate in compensatory education and Medical Qualification Examination, and the passers take priority to public management.4. Main discussion and insufficiency· Main discussionA. The research was a utility exploration research which included investigation of rural doctors’current situation, survey and analysis on the intention of managers, organizers and providers. The study discussed the present development and compensation mechanism of rural doctors in Zhenjiang comprehensively which was more systematic, comprehensive and thorough in domestic similar researches. At the same time, the investigation had both qualitative and quantitative analysis which might provide a scientific basis for the development of rural doctors in Zhenjiang.B. The research investigated the present development and compensation mechanism of rural doctors in Zhenjiang and estimated the number of rural doctors which could meet the demand of present medical and public health services, as well as the responsibility and input which the government should take.· Research insufficiencyA. The research was limited in Zhenjiang, so the data only provided a scientific basis for the development of rural doctors in Zhenjiang which just only refer to other areas in our country on view of the limited time and accessible resources. Further studies were needed to understand the situation of other areas.B. According to the developing mode of rural doctors which were agreed by the rural health served organizers and providers in Zhenjiang, the data could provided a basis for the following reform of development and compensation mechanism of rural doctors. Certainly, there are other measuring methods such as prediction in light of influencing factor’s change. Meanwhile, we hope that the study can attract more researchers to focus on the development of rural doctors and make a contribution for the rural sanitation development in our country. |
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