Counterpart Technical Support between Urban Tertiary Hospitals and Rural Hospitals in China
Author: Ministry of Health, China
China has the largest population in the world, with more than 1.3 billion people, 70% of whom are living in the rural areas. However, less than 20% of the total health resources are allocated to the rural population. Even though China’s economy has been improving dramatically over the past three decades, there has been an imbalance in development between the western and eastern parts of the country, the interior and coastal regions, and rural and urban areas. This has resulted in imbalances in healthcare delivery across the country, which has become a concern for the Chinese government.
In recent years, a variety of national health policies have been implemented in order to reduce the gap in the quality of health services between rural and urban areas. An important area of intervention has been that of facilitating cooperation and knowledge transfer from the large well-resourced hospitals to those in marginalized areas.
In 2005 the ‘Ten Thousand Physicians to Support Rural Healthcare Project’ was put in place to improve the standard of health service in rural areas. From January 2005 to the end of 2008, more than 10,000 physicians from urban tertiary hospitals were assigned to work at county-level hospitals and township health centers. Designated physicians were required to work for 1 year in rural health facilities and were given financial incentives (an additional allowance during their year at the facility), as well as non-financial incentives (with future promotion contingent upon adequate performance during their 1 year placement) to encourage effective participation in the project. Along with fulfilling their regular duties as physicians whilst working in these facilities, they were also required to provide technical support and training for health workers in recipient health facilities.
This cooperation aimed to develop human resources for health in rural areas. This in turn was expected to enhance service capacity in marginalized health facilities, reduce the incidence and mortality rates of common diseases and make quality health services more accessible and cheaper for those living in rural areas.
To ensure sustainability of the project, the Chinese government then issued the ‘Measures for the Administration of Counterpart Support between Urban and Rural Hospitals (2009-2012)’ initiative. This initiative builds on the ’10,000 physicians’ project by encouraging tertiary hospitals to continue providing counterpart support to at least 3 county hospitals.
As of the end of 2008, 600 county hospitals and 3,644 township health centers in 665 marginalized counties have benefited from the counterpart technical support policy. The recipient hospitals have significantly improved their hospital management capability, technical skills, and service quality. Medical costs have been reduced and patient satisfaction has increased.
The project has been very successful in building the capacity of human resources for health in rural and marginalized areas, helping improve health care services in these areas. The high level of priority that the Government has assigned to the task as well as the proactive incentive-based approach taken in addressing the imbalances have both contributed to this success. The Government’s approach of encouraging continued cooperation between institutions should ensure that these capacity gains are sustainable over the longer term.