Research On The Current Situation Of National Essential Public Health Services And Manpower Cost Estimation In Jiangsu Province

Objectives: The National Essential Public Health Service(NEPHS)is a public health intervention strategy aiming to solve main public health-related problems and to improve the health level of residents in China.In 2009,the government of China published the ―Opinions on Deepening the Reform of Medical and Health System” and proposed the NEPHS to provide services for urban and rural residents in disease control and prevention,maternal and child health care,health education and other areas.In recent years,the NEPHS program has been rapidly developed and improved together with the primary medical service system.With the increase of service items and the steady improvement of subsidy standards,the equalization of essential public health services has been guaranteed.However,at the same time,it also brings great challenges to primary health care institutions.Taking Jiangsu as the research site,this study combines qualitative and quantitative design to describe the current situation of NEPHS,analyze the main problems existing in the implementation process,estimate the manpower cost of NEPHS and provide information for improving the organization,management and compensation mechanism of essential public health services.Methods: This study adopted a mixed design of qualitative research and quantitative research.By using a stratified multi-stage sampling method,we recruited 36 primary health care institutions from the southern,middle and north part of Jiangsu province as study settings.The field investigation was performed during August and September 2017.We collected basic information about the number of permanent residents,the number of on-the-job employees,personnel-related expenditure and so on.For qualitative research,we used the focus group discussion to interview institution managers and NEPHS providers separately.The open-ended questions for the interview were designed according to the role respondents with aims to explore the current situation of services implementation,difficulties they were facing and suggestions to solve problems.The interviews were audio-taped,transcribed and then analyzed by using the thematic content analysis.For quantitative research,we subdivided NEPHS items and developed a questionnaire to estimate the human cost according to the method of Time-Driven Activity-Based Costing(TDABC).Service providers were selected by cluster sampling method.After inform consent,they were invited to fill in the questionnaire.The questionnaire collected the basic characteristics of study subjects,the unit time to complete the sub-items of NEPHS and the number of services they have provided in 2016.The method of TDABC was used to estimate the manpower cost for each service item.Results: We divided Jiangsu into three regions: southern region,central region,and northern region.In each region,we randomly selected two cities.In each city,we randomly selected two districts(counties).Three community health service centers or township health centers were randomly selected from each district(county).In total,we selected 36 primary health institutions as the study settings.The average number of residents served by each institution was 55 thousand.The average number of on-the-job staffs was 84 in each sampled health institution.For the qualitative study,we interviewed 206 managers and 327 NEPHS providers.Findings from the focus group discussion showed that there was a common phenomenon that one person was responsible for multiple posts in primary health institutions.Both managers and providers pointed out that the implementation of NEPHS was facing with problems such as shortage of human resources,lagging in information construction,inadequate project service capabilities,lack of project assessment and incentive mechanism,low public awareness and lack of interdepartmental coordination.In the quantitative study,the NEPHS package was divided into 105 sub-items according to the content and process of service delivery.A total of 1089 health providers participated in this survey.The average cost of NEPHS was estimated to be 98 yuan per capita.To provide NEPHS for 10,000 residents,in theory,8.68 health service providers were needed.There existed differences of cost-driver rate and per capital service cost of NEPHS among the southern,middle and north regions of Jiangsu.The shortage of human resources and inadequate funding were common problems in study settings.Conclusion: Further improvement of management,operation,and compensation mechanism is essential to promote the NEPHS in Jiangsu province from wide coverage to high quality.The government should take effective measures to improve the primary health care system,reasonably allocate the NEPHS personnel,focus on both the quantity and quality of talents,improve service efficiency,increase government funding,clearly define the incentive mechanism,promote the process of informatization,build a dynamic cost estimation system and promote propaganda and department cooperation.