Looking forward to the future, --Primary Health Care Reform in Qingdao, China
Background
Primary Health Care Reform (PHCR) was initiated in Qingdao in 1999. Before 1999, hardly any regulated or formalPrimary Health Care (PHC)facilitiesexisted in the city. From 1999 to 2002, led by State Development and Planning Committee of China and Ministry of Health, Welfare and Sports of the Netherlands, under the umbrella of a Memorandum of Understanding signed by the representatives of both sides, the Sino-Dutch Qingdao PHCR Project was carried out. The final aim of the reform was to realize the vision of “hospitals treat serious illness, PHC facilities treat commonly-seen illness”.
The main goalsof the projects are as follows:to share the Dutch ideas and service model of PHC as a top priority, by comparing and analyzing the Chinese and Dutch urban health service systems. The aim is thatall of the stakeholdershave amutual understanding of PHC. The second important aim is sharing the experiences in constructing PHCfacilities.
With technical support from the Dutch partners,Qingdao Municipal Health Bureau(QMHB) prepared the Qingdao PHC Experimental Working Plan. Then, a leading group was established in Qingdao Municipal People’s Governmentand special staff wasin charge of this work. PHCR related managers,professionals and trainers were trained in the Netherlands and later on they ledor were involved in the project with advanced ideas, knowledge, attitude and skills. The project formally started in Sifang District and Shinan District in June 2000 and was well publicized, which helped to mainstream PHC ideasamong common people, professionals and health managers.
Till 2001, the primary framework of PHC system has been established. 96 GP's clinics, 2 community rehabilitation centers, 4 homecare centers and 8 nursing homes have been established.At the same time, in-service training of GP community nurses and full-time training of nurses for rehabilitation have started.Till the end of 2002, PHCR was popularized to all of the 4 inner city districts in Qingdao.There were 822 trained GPs working in the communities with practice qualification, 116 GP’s clinics, 4 community rehabilitation centers,12 home care centers, 16 nursing homes in the city. Till 2004, the number of GP’s clinic reached 169.
The current challenges and plan for future development
In Qingdao, after continuous efforts, a preliminary PHC system has been established. Judging from the number of the PHC facilities, of the PHC professionals, and from the fairly good PHC coverage rate of the population, a well-functioning PHC system could be expected. However, the system is seen not delivering to its full potential as PHC facilities are bypassed and hospitals are still the usual source of health care for the residents–The current utilization rate of PHC is 27% and the municipal goal is to reach 40% within 2 years. So questions like “what are the weaknesses hampering the reform? Why? How to tackle them?” are raised by the policy makers of the municipal government. In order to better guide the next stages of the reform, it is believed necessary to find out what efforts are required to amend the aspectswhich arenot working by a kind of forward-thinking.What’s more, the change of social context has driven the redesign of PHCR.Because the phenomenon of “too expensive health care and too difficult access to health care”is popularly regarded as a social problem and PHCis believed by the government as the main way for solving the problem.
QMHB has used two frameworks, one is PHC Result Framework Model for the City of Qingdao, adapted from Health and Family Planning Reform Framework, Office of Sustainable Development, Bureau for Africa, USAID, 1999.The other is the Analytic Framework for Primary Health Care recommended by European Observatory on Health Systems and Policies, and Focus Group Discussion to find out the problems in its PHCR. Based on stakeholder analysis SWOT analysis, study of PHC experiences in the Netherlandsand the updated suggestion from Chinese experts & WHO technical officer in China,the QMHB has developeda Logical Framework Matrix (LFM) for Qingdao PHC Project (2007-2012).
In the LFM, two overall objectives are identified.Objective 1:to improve population health through increase of utilization rateof PHC; Objective 2: to effectively alleviate the situation of “too expensive health care”by developinga cost effective PHC.The project purposes include 1: Annual increase in utilization rate of PHC;2: Establish and perfect the two direction referral mechanism and referral standard betweenPHC facilities and hospitals; 3.Develop a sustainable and replicable mechanism for the development of PHC.To achieve the objectives and purposes, six results are addressed:
1. All the stakeholders of the reform share the same vision of “Every resident enjoys a usual health care within their community”and reach an agreement on the necessary investment for the reform;
2. Improve the capability of planning, management, financing, coordinating and evaluating in PHC;
3. Improve the quality of PHC;
4. Strengthen the PHC Monitoring and Information System;
5. Rationalize the functions between PHC facilities, hospitals and public health care facilities and establish a mechanism for sharedcoordination;
6. Improve PHC related researches.
Joint researches are required with the topics of development of referral standard Essential Medical Package, performance assessment of the PHCR, human resources development and information management system development.
Qingdao Municipal Health Bureau is looking forward to a satisfactory PHC in the future which will benefit the Qingdao residents. To achieve that, we wish to cooperate with international organizations or colleagues with advanced experiences, skills and updated information in PHC and PHCR.If you wish to get in contact with us please see below the contact details:
Mrs. Yang Jing,
M.D., MPH
Department of Science, Education and Foreign Affairs,
Qingdao Municipal Health Bureau
Email: