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Development of village doctors in China: financial compensation and health system support

BACKGROUND: Since 1968, China has trained about 1.5 million barefoot doctors in a few years’ time to provide basic health services to 0.8 billion rural population. China’s Ministry of Health stopped using the term of barefoot doctor in 1985, and changed policy to develop village doctors. Since then,...

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Autores principales: Hu, Dan, Zhu, Weiming, Fu, Yaqun, Zhang, Minmin, Zhao, Yang, Hanson, Kara, Martinez-Alvarez, Melisa, Liu, Xiaoyun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5493879/
https://www.ncbi.nlm.nih.gov/pubmed/28666444
http://dx.doi.org/10.1186/s12939-016-0505-7
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author Hu, Dan
Zhu, Weiming
Fu, Yaqun
Zhang, Minmin
Zhao, Yang
Hanson, Kara
Martinez-Alvarez, Melisa
Liu, Xiaoyun
author_facet Hu, Dan
Zhu, Weiming
Fu, Yaqun
Zhang, Minmin
Zhao, Yang
Hanson, Kara
Martinez-Alvarez, Melisa
Liu, Xiaoyun
author_sort Hu, Dan
collection PubMed
description BACKGROUND: Since 1968, China has trained about 1.5 million barefoot doctors in a few years’ time to provide basic health services to 0.8 billion rural population. China’s Ministry of Health stopped using the term of barefoot doctor in 1985, and changed policy to develop village doctors. Since then, village doctors have kept on playing an irreplaceable role in China’s rural health, even though the number of village doctors has fluctuated over the years and they face serious challenges. United Nations declared Sustainable Development Goals in 2015 to achieve universal health coverage by 2030. Under this context, development of Community Health workers (CHWs) has become an emerging policy priority in many resource-poor developing countries. China’s experiences and lessons learnt in developing and maintaining village doctors may be useful for these developing countries. METHODS: This paper aims to synthesis lessons learnt from the Chinese CHW experiences. It summarizes China’s experiences in exploring and using strategic partnership between the community and the formal health system to develop CHWs in the two stages, the barefoot doctor stage (1968 –1985) and the village doctor stage (1985-now). Chinese and English literature were searched from PubMed, CNKI and Wanfang. The information extracted from the selected articles were synthesized according to the four partnership strategies for communities and health system to support CHW development, namely 1) joint ownership and design of CHW programmes; 2) collaborative supervision and constructive feedback; 3) a balanced package of incentives, both financial and non-financial; and 4) a practical monitoring system incorporating data from the health system and community. RESULTS: The study found that the townships and villages provided an institutional basis for barefoot doctor policy, while the formal health system, including urban hospitals, county health schools, township health centers, and mobile medical teams provided training to the barefoot doctors. But After 1985, the formal health system played a more dominant role in the CHW system including both selection and training of village doctors. China applied various mechanisms to compensate village doctors in different stages. During 1960s and 1970s, the main income source of barefoot doctors was from their villages’ collective economy. After 1985 when the rural collective economy collapsed and barefoot doctors were transformed to village doctors, they depended on user fees, especially from drug sale revenues. In the new century, especially after the new round of health system reform in 2009, government subsidy has become an increasing source of village doctors’ income. CONCLUSION: The barefoot doctor policy has played a significant role in providing basic human resources for health and basic health services to rural populations when rural area had great shortages of health resources. The key experiences for this great achievement are the intersection between the community and the formal health system, and sustained and stable financial compensation to the community health workers.
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spelling pubmed-54938792017-07-05 Development of village doctors in China: financial compensation and health system support Hu, Dan Zhu, Weiming Fu, Yaqun Zhang, Minmin Zhao, Yang Hanson, Kara Martinez-Alvarez, Melisa Liu, Xiaoyun Int J Equity Health Systematic Review BACKGROUND: Since 1968, China has trained about 1.5 million barefoot doctors in a few years’ time to provide basic health services to 0.8 billion rural population. China’s Ministry of Health stopped using the term of barefoot doctor in 1985, and changed policy to develop village doctors. Since then, village doctors have kept on playing an irreplaceable role in China’s rural health, even though the number of village doctors has fluctuated over the years and they face serious challenges. United Nations declared Sustainable Development Goals in 2015 to achieve universal health coverage by 2030. Under this context, development of Community Health workers (CHWs) has become an emerging policy priority in many resource-poor developing countries. China’s experiences and lessons learnt in developing and maintaining village doctors may be useful for these developing countries. METHODS: This paper aims to synthesis lessons learnt from the Chinese CHW experiences. It summarizes China’s experiences in exploring and using strategic partnership between the community and the formal health system to develop CHWs in the two stages, the barefoot doctor stage (1968 –1985) and the village doctor stage (1985-now). Chinese and English literature were searched from PubMed, CNKI and Wanfang. The information extracted from the selected articles were synthesized according to the four partnership strategies for communities and health system to support CHW development, namely 1) joint ownership and design of CHW programmes; 2) collaborative supervision and constructive feedback; 3) a balanced package of incentives, both financial and non-financial; and 4) a practical monitoring system incorporating data from the health system and community. RESULTS: The study found that the townships and villages provided an institutional basis for barefoot doctor policy, while the formal health system, including urban hospitals, county health schools, township health centers, and mobile medical teams provided training to the barefoot doctors. But After 1985, the formal health system played a more dominant role in the CHW system including both selection and training of village doctors. China applied various mechanisms to compensate village doctors in different stages. During 1960s and 1970s, the main income source of barefoot doctors was from their villages’ collective economy. After 1985 when the rural collective economy collapsed and barefoot doctors were transformed to village doctors, they depended on user fees, especially from drug sale revenues. In the new century, especially after the new round of health system reform in 2009, government subsidy has become an increasing source of village doctors’ income. CONCLUSION: The barefoot doctor policy has played a significant role in providing basic human resources for health and basic health services to rural populations when rural area had great shortages of health resources. The key experiences for this great achievement are the intersection between the community and the formal health system, and sustained and stable financial compensation to the community health workers. BioMed Central 2017-07-01 /pmc/articles/PMC5493879/ /pubmed/28666444 http://dx.doi.org/10.1186/s12939-016-0505-7 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Systematic Review
Hu, Dan
Zhu, Weiming
Fu, Yaqun
Zhang, Minmin
Zhao, Yang
Hanson, Kara
Martinez-Alvarez, Melisa
Liu, Xiaoyun
Development of village doctors in China: financial compensation and health system support
title Development of village doctors in China: financial compensation and health system support
title_full Development of village doctors in China: financial compensation and health system support
title_fullStr Development of village doctors in China: financial compensation and health system support
title_full_unstemmed Development of village doctors in China: financial compensation and health system support
title_short Development of village doctors in China: financial compensation and health system support
title_sort development of village doctors in china: financial compensation and health system support
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5493879/
https://www.ncbi.nlm.nih.gov/pubmed/28666444
http://dx.doi.org/10.1186/s12939-016-0505-7
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