Current status of rural grassroots health service provision in Beijing suburb
Authors: Jing Wang, Chen Wang, Xiaoyan Wang
Journal: BMJ (2018)

Objective
To survey the current status of the rural primary medical service supply in Beijing suburb, and to discuss the relationship between policy environment and rural primary medical service.


Methods
A purposeful sampling method was adopted to select Beijing Huairou District as the study site. In July to August 2016 a questionnaire survey was conducted among 260 village doctors from 260 village clinics in 14 townships; 21 village clinics were site visited; 21 village leaders, 21 village doctors, and 42 villagers were invited for in-depth interview. The impact of policy environment on the provision of basic health service at the village level was analyzed.


Results
The facilities of the 260 village clinics basically met the needs, but the service quality was still insufficient. The basic situation of village clinics: 174 villages (66.9%) were funded by the1 486project, 164 (63.1%) village clinics were located in the center of the village. In 173 village clinics (66.5%) the legal representatives were village leaders, but 11 (52.4%) village officials thought that rural doctors should be the legal persons. The mean age of 260 village doctors were (62.7±8.9) years. Among 260 village doctors, 168 (64.6%) were working more than 40 years, 149 (57.3%) had secondary medical education, 72 (27.7%) had no medical professional qualification; 247 (95%) held practice certificates of rural doctors and only 3 (1.2%) held medical license; 244 (93.8%) village doctors took subsidy from the government. The continuing education was organized monthly by the township health centers. The source of training teachers was township health centers (247, 95.0%). The teaching form was mainly audio-visual education (191, 73.5%); the content was based on general medicine (245, 94.2%). The top 5 basic medical service items provided by village clinics were the diagnosis and differential diagnosis of common diseases, family visits, measurement of blood pressure, respiratory and pulse rates, body weight, height and vision, and intramuscular injection. Most village doctors (199, 76.5%) provided night-time medical service. For the medical care needs, 22 (52.4%) villagers said they were basically satisfied. The most satisfying aspect was the service attitude, and the most unsatisfactory aspect was the equipment and facilities. The management function of village committee was mainly in personnel recruitment (231, 89.5%), daily supervision (218, 84.5%) and performance assessment (113, 43.8%). The assessment of service quality was conducted by the township health service centers, particularly in public health service.


Conclusions
The current status of rural primary medical service still cannot fully meet the needs of rural residents. In order to upgrade the quality of rural primary medical service to meet the health needs of villagers, it is necessary to improve the internal policy environment, such as villager autonomy, socio-economic development and so on.


Key words: 
Rural doctors; Policy environment; Basic medical services