China Center for Health Development Studies, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China.
Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China.
Hum Resour Health. 2019 Nov 12;17(1):83. doi: 10.1186/s12960-019-0420-2.
China's TB control system has been transforming its service delivery model from CDC (Centers for Disease Control and Prevention)-led model to the designated hospital-led model to combat the high disease burden of TB. The implications of the new service model on TB health workforce development remained unclear. This study aims to identify implications of the new service model on TB health workforce development and to analyze whether the new service model has been well equipped with appropriate health workforce.
The study applied mixed methods in Zhejiang, Jilin, and Ningxia provinces of China. Institutional survey on designated hospitals and CDC was conducted to measure the number of TB health workers. Individual questionnaire survey was conducted to measure the composition, income, and knowledge of health workers. Key informant interviews and focus group discussions were organized to explore policies in terms of recruitment, training, and motivation.
Zhejiang, Jilin, and Ningxia provinces had 0.33, 0.95, and 0.47 TB health professionals per 10 000 population respectively. They met the national staffing standard at the provincial level but with great variety at the county level. County-designated hospitals recruited TB health professionals from other departments of the same hospital, existing TB health professionals who used to work in CDC, and from township health centers. County-designated hospitals recruited new TB health professionals from three different sources: other departments of the same hospital, CDC, and township health centers. Most newly recruited professionals had limited competence and put on fixed posts to only provide outpatient services. TB doctors got 67/100 scores from a TB knowledge test, while public health doctors got 77/100. TB professionals had an average monthly income of 4587 RMB (667 USD). Although the designated hospital had special financial incentives to support, they still had lower income than other health professionals due to their limited capacity to generate revenue through service provision.
The financing mechanism in designated hospitals and the job design need to be improved to provide sufficient incentive to attract qualified health professionals and motivate them to provide high-quality TB services.
中国的结核病控制体系已将其服务提供模式从以疾控中心（CDC）为主导的模式转变为以指定医院为主导的模式，以应对结核病的高疾病负担。新服务模式对结核病卫生人力发展的影响尚不清楚。本研究旨在确定新服务模式对结核病卫生人力发展的影响，并分析新服务模式是否配备了适当的卫生人力。
本研究在中国浙江省、吉林省和宁夏回族自治区采用混合方法。对指定医院和疾控中心进行机构调查，以衡量结核病卫生工作者的数量。对个人进行问卷调查，以衡量卫生工作者的构成、收入和知识。组织了关键知情人访谈和焦点小组讨论，以探讨招聘、培训和激励方面的政策。
浙江省、吉林省和宁夏回族自治区每 10 000 人口分别有 0.33、0.95 和 0.47 名结核病卫生专业人员。他们在省级层面达到了国家人员配备标准，但在县级层面差异很大。县级指定医院从同一医院的其他部门、曾经在疾控中心工作的现有结核病卫生专业人员以及乡镇卫生院招聘结核病卫生专业人员。县级指定医院从三个不同来源招聘新的结核病卫生专业人员：同一医院的其他部门、疾控中心和乡镇卫生院。大多数新招聘的专业人员能力有限，只能固定岗位提供门诊服务。结核病医生在结核病知识测试中获得了 67/100 的分数，而公共卫生医生获得了 77/100。结核病专业人员的月平均收入为 4587 元人民币（667 美元）。尽管指定医院有特殊的财政激励措施来支持，但由于其通过服务提供产生收入的能力有限，他们的收入仍然低于其他卫生专业人员。
需要改进指定医院的融资机制和工作设计，以提供足够的激励措施，吸引合格的卫生专业人员，并激励他们提供高质量的结核病服务。
