Department of Paediatrics, the Second Affiliated Hospital of Kunming Medical University, Yunnan, PR China.
BMC Public Health. 2012 Aug 7;12:620. doi: 10.1186/1471-2458-12-620.
Under-5-years child mortality remains high in rural China. Integrated management of childhood illness (IMCI) was introduced to China in 1998, but only a few rural areas have been included. This study aimed at assessing the current situation of the health system of rural health care and evaluating the clinical competency of village doctors in management of childhood illnesses prior to implementing IMCI programme in remote border rural areas.
The study was carried out in the border areas of Puer prefecture of Yunnan province. There were 182 village doctors in the list of the health bureau in these border areas. Of these, 154 (84.6%) were recruited into the study. The local health system components were investigated using a qualitative approach and analyzed with triangulation of information from different sources. The clinical component was assessed objectively and quantitatively presented using descriptive statistics.
The study found that the New Rural Cooperative Medical Scheme (NRCMS) coordinated the health insurance system and the provider service through 3 tiers: village doctor, township and county hospitals. The 30 RMB per person per year premium did not cover the referral cost, and thereby decreased the number of referrals. In contrast to available treatment facilities and drug supply, the level of basic medical education of village doctors and township doctors was low. Discontent among village doctors was common, especially concerning low rates of return from the service, exceptions being procedures such as injections, which in fact may create moral hazards to the patients. Direct observation on the assessment and management of paediatric patients by village doctors revealed inadequate history taking and physical examination, inability to detect potentially serious complications, overprescription of injection and antibiotics, and underprescription of oral rehydration salts and poor quality of counseling.
There is a need to improve health finance and clinical competency of the village doctors in the study area.
中国农村地区的 5 岁以下儿童死亡率仍然很高。综合儿童疾病管理（IMCI）于 1998 年引入中国，但仅在少数农村地区实施。本研究旨在评估农村卫生保健系统的现状，并在偏远边境农村地区实施 IMCI 计划之前评估乡村医生管理儿童疾病的临床能力。
本研究在云南省普洱市边境地区进行。这些边境地区的卫生局名单中有 182 名乡村医生。其中，有 154 名（84.6%）被招募参加了这项研究。采用定性方法调查当地卫生系统组成部分，并通过来自不同来源的信息三角分析进行分析。临床部分通过客观评估和使用描述性统计进行定量呈现。
研究发现，新型农村合作医疗制度（NRCMS）通过三个层次协调了医疗保险制度和服务提供：乡村医生、乡镇和县级医院。每人每年 30 元的保费不包括转诊费用，从而减少了转诊人数。与现有治疗设施和药品供应相比，乡村医生和乡镇医生的基本医学教育水平较低。乡村医生普遍不满，特别是对服务回报低感到不满，但例外的是注射等程序，实际上可能给患者带来道德风险。对乡村医生评估和管理儿科患者的直接观察发现，他们病史采集和体检不足，无法发现潜在的严重并发症，过度开具注射和抗生素处方，口服补液盐和咨询质量差。
需要改善研究地区的卫生财务状况和乡村医生的临床能力。
