Additional evidence from China Recruiting Licensed Doctors for Township Health Centers in Remote & Rural Areas Guangpeng Zhang Health Human Resources Development Center, MOH, China WHO Collaborating Center for Human Resources for health
Background Severe shortage of licensed doctors in township hospitals in remote & rural areas -- In 4700 THs (11.8%), no licensed doctors The total of health workers in THs had appeared to be zero growth or negative growth during 2001-2005 -- The brain drain is severe Better remuneration package Career development
China s policies to address doctor maldistribution The MOH initiated a pilot program to recruit licensed doctors to work in township health centers
Objectives of the Project -- to address shortage of licensed doctors facing by THs in rural areas; -- to attract and encourage licensed doctors to work in rural areas; -- to explore a long-acting mechanism of attraction and retention for rural health institutions Specifically, -- from 2008, 10,000 licensed doctors be recruited in the next 5 years, -- which will allow each of the THs having the licensed doctors.
Management The central government will establish a special fund for the project. Every year each of those recruited licensed doctors will get 20,000RMB special compensation from that special fund. THs selection, be under 3 conditions: -- it must be located in the poverty-stricken areas -- there is not any licensed doctor in the center -- there are official vacant posts in the center Targeted recruitment: --doctors who have the licenses --willing to work in the rural area --Those who have already worked in THs & village clinics not be included
Pilot areas In 2008, the project has been conducted in 8 provinces: Hunan, Hubei, Jiangxi, Anhui, Gansu, Sichuan, Chongqing and Xinjiang. Totally 1,000 licensed doctors have been recruited In 2009, the number of provinces conducting project expended to 11: Hebei, Shanxi, Inner Mongolia, Chongqing, Jiangxi, Chongqing, Sichuan, Guizhou, Yunnan, Shaanxi, Gansu, and Qinghai. 500 more licensed doctors will be recruited
研究背景 Implementation plans of pilot provinces
Implementing & Organizing Each of pilot provinces will decide the type and number of the posts for the recruitment. Procedure of recruitment: information release (position and number to recruit ) - registration for candidates -qualification checking & test- signing the contact - pre-job training -registration for starting to work-evaluation
Results of recruitment(year 2008) 1,000 recruiters covering 8 pilot provinces, 190 pilot counties and 736 pilot township hospitals. Averagely, each pilot township hospital has recruited 1.3 licensed doctors Pilot provinces Number of all counties Number of impoverished counties Number of pilot counties Number of pilot township hospitals Number of recruiters Hu Bei 64 29 17 95 90 Chong Qin 40 18 4 32 56 Hu Nan 122 38 23 79 117 Xi Jiang 83 30 25 75 93 Gan Su 86 51 34 85 160 Jiang Xi 99 41 37 126 133 An Hui* / 19 16 / 90 Si Chuan 181 77 34 244 261 Total 675 303 190 736 1000
Primary influence With the help of project, the THs are able to recruit the licensed doctors without increasing their labor cost budget. The project is highly welcomed by the related organization at all levels. This policy attracted many licensed doctors, some of them even came from provincial or prefecture hospitals. The main reason of attraction is better payment and the willingness to support rural areas
Case licensed doctor Typical case: Dr.Huang Shigen Dr. Huang Shigen is recruited by Shacun township hospital. He was graduated from NanChang University Medical College, and was ever a temporary doctor of the Jiangxi Provincial People`s Hospital, dealing with cardiac and cerebrovascular diseases. When he saw the recruitment information, he made his mind to work in the township health center. Now, he has become the local famous doctor even though he has only worked for 3 months in the Shacun township hospital. The hospital dean has a high regard on him, and especially opened up examination for cardiac and cerebrovascular diseases in the hospital and bought some new medical devices which can not be mastered and used before in the hospital.
Experience Feasibility analysis licensed doctors at the grass-roots level were willing to work in THs conducted a study to identify the willingness and the factors determining the licensed doctors to work in township hospitals interviewing and surveying directors of health bureaus and township hospitals Salaries Continuing education Promotion Housing Working condition Husband and wife s work Others 0 200 Health Human 400 Resources Development 600 Center
Experience Dynamic information management A IT system is developed for the project in aiming to monitor and update the information timely. Through this system, we can find out the current status, suggestions and requirement of recruiters at any time. We can also know about the flow of recruiters which can help us adjust our strategies timely.
Dynamic information management We developed an information management system for recruited doctors, to dynamically manage the program (see to WWW. hhrdc.com.cn ). Through this system, we can find out the current status, suggestions and requirement of recruiters at any time. We can also know about the flow of recruiters which can help us adjust our strategies timely.
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province junior middle senior Hubei 52 25 13 Chongqing 56 0 0 Hunan 87 6 3 Xinjiang 60 26 2 Gansu 141 1 0 Anhui 87 2 0 Jiangxi 118 13 2 Sichuan Total 142 743 46 119 23 43
Experience Contemporary project evaluation Along with the project, we developed the framework and indicators and accesses the project on a contemporary basis. Through the evaluation of first year, many advanced experience and setbacks have been identified. The project could be adjust timely according to the result of evaluation.
Framework for program evaluation 3 parts 9 dimensions 20 indicators Organization and management Implementation Measures and policies Financial guarantee Inter-sector corporation supervision recruitment HR management Formulated implementation plan and assistant measures and policies for the pilot program Program funds have been timely put into operation Coordination and cooperation between health sectors and others Coverage rate of supervision and management Publicity of recruitment information Fairness of the recruitment process Ratio of recruiter and enrollment Management of information system Training Payment and social insurance Performance assessment Service provided Rate of Reasonable medication Diagnosis coincidence rate Evaluation Social benefits satisfaction Primary health care Public health care Teaching Satisfaction of patients and their family members Satisfaction of recruiters Satisfaction of township hospitals Satisfaction of local government
Challenges Equity between recruited doctors and other doctors. To take measures to prevent inequity between the recruited doctors and those who already worked in the THS. career development The recruited doctors will have the priority to have the continuing training and education. When their due service finish, they have the priority to be employed. motivation The requirement of recruited doctors will be easily known and recognized by the local government at all levels.
Case - management Typical case:one on One responsibility mechanism The Taihe county, Jian City, Jiangxi province issued Notify on Establishing Working Group of Recruiting Practicing Doctors Program in 2008, which initiated a One on One Responsibility mechanism between leadership of county health department and recruited doctors. Specifically speaking, each leadership of country health department will be responsible to keep in contact with one recruited doctor, to follow their work, living and thought. This measure can get information of recruiters timely and reflect the recruited doctors are valued and encouraged
Recommendation Public financing is necessary to create good jobs for such recruiters to be attracted to stay in rural areas Situate the training institution as close as feasible to the areas, so that the recruiters donot have to go off to the biggest cities Add both monetary and social incentives for rural service, e.g. pay, allowance, but also care regarding housing, schooling, transport for workers and their families
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