Transcript Community Health Center 社区卫生服务中心

“The (Re)Emergence of Primary
Health Care in Urban China”
Mark A. Strand, PhD
CCIH Conference
May 2008
Learning Objectives:
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Grasp China’s development and challenges in
providing primary health care
Understand the balancing roles of big
government and small communities in
implementing primary health care.
See the role of the Christian NGO to enhance
this process
History of China’s primary health
service system
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1949 to 1980:
80 % of urban residents covered by work units
90% of rural residents were covered by cooperative
health plans
1985 to 2002:
The health system was turned over to the market
and became dependent on fee-for-service.
“看病难，看病贵”
China’s Challenges
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Hypertension rate of 28.2% age 50-60 and
42.4% over age 60.
Urban diabetes rates for over age 20 rose from
4.6% in 1996 to 6.4% in 2006.
Public health uncoordinated and passive
With a service pop’n for our CHS of 25,000 in
one week our catchment area will have 1915
disease events (2003).
Tertiary hospitals expensive and relatively
impersonal
China’s Challenges
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No medical records for out-patient care
Frequent use of ancillary tests and sales of
meds
Rapidly growing urban population, with a goal of
50% urban by 2020, meaning the move of 275
million people into urban areas over the next 12
years
Urbanization resulted in loss of “community” and
social dislocation
Need to stretch limited health resources
Current Policy of China’s Primary
Health Service System
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2003 to now
Rural: The New Rural Health cooperative
began. 80% of farmers are covered now.
“农村合作医疗”
Urban: Community health system was started
in 2006 in major cities and all cities should have
the system in place by 2010.
“城市社区卫生服务”
Spring 2007 Jinzhong Gets
Going
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6 in 1 CHS
Train nurses and doctors
Set up clinics
10 yuan per person for each served
CHS Components 六为一体
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2.
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Health Education
Disease Prevention
Health Maintenance
Medical Treatment
Rehabilitation
Family Planning
健康教育
预防
保健
医疗
康复
计生指导
The Community
治疗
（注射，
输液，
观察）
Rehab
中西药房
Welcome Lobby
(咨询、接待、挂号、收费）
全科诊室
（慢病管
理）
中医诊室
医技诊室
（放射，超
声，检验）
Clinical Services
Health Records
Health Ed.
Prevention
（慢病管理）
H. Main.
F.P.
Rehab
Public Health Services
Urban Community Health (CHS) System
城市医疗卫生服务体系框
综合
医院
疾 控 妇幼保 卫 生 监
中心 健中心 督中心
专科
医院
Hospitals & Specialized Hospitals
Consulting
training
and
CDC
MCH Management Center
Two-way
referral
Clinics
诊所
Nursing
homes
护理院
Community Health
Center
社区卫生服务中心
Civil Affairs
Reports
CHS Station
社区卫生服务
站
Other
1. Health Education 健康教育
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Cooperated with local CHS center
Started with a HTN screening
Organized by community leaders
Did 3 years’ group health education
Focus on chronic diseases: HTN, DM,
Coronary Heart disease etc.
Serving church as a community member
Health Records 健康档案
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CHS training
First step in CHS
development
Help to understand
situation of the
families and their
service needs
Started in April 2007
Health education
opened the door
Visited 2741 families
served 7035 people
2. Disease Prevention 预防
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Infectious: TB prevention
Chronic: HTN, DM
management
3. Health Maintenance 保健
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Well Baby Project in urban nursery schools
Could address many areas
4. Medical Treatment 医疗
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Family Medicine work at CHS
Trained and empowered Social Workers
5. Rehabilitation 康复
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No work in this area yet
6. Family Planning 计生指导
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Still functioning tightly under the Family
Planning Commission
Health Systems
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Significant gap
Little accountability
What are some example nations?
Large NGO Systems
Weak
Government
System
Health Systems
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Large gap, limited communication
NGOs struggle for space
NGOs serve a small population
Limited NGO impact
Big Government
Small and
weak NGO
Health Systems
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Government is strong, and responsible
NGOs are small but effective
For responsibility and sustained impact
NGOs in strong overlap with government
Large, Responsible
Government
Small but
strong NGO
Serving population
Impacting the
system
Engaging the Government System
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Regularly visits with government bureaus
Look at newspapers, TV news, internet to
understand changes and opportunities
Talk with partners to understand opportunities
and to find someone with a vision and passion
for the work you are interested in
Have your local staff participate in local
government training opportunities.
Do research in the community about local health
issues important to the people and the
government.
Challenges
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Transitioning from a medical to a CH perspective
Clinical work with weak connection to community health
outreach
Govt motivated, so it has support, but under compulsion
Community participation is limited, but the argument is
made that urgency precludes community involvement.
Will this threaten the sustainability and depth of the
model in the years to come?
China’s ability to openly embrace a daunting challenge is
impressive.
Through political will, and the talents of 1000s of flexible
Chinese medical workers, it is coming to pass.
Has to happen overnight, compromising quality
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No community council yet
It is a privilege to be involved at this level, as a
public witness for Christ. But it is not easy to
bring the church into community service.
We prioritize both skills and the spirit of PHC,
which flows from a Christian spirit of love and
sacrifice
“Christian Community and Wholeness”
CCIH conference theme.
Recent home visit outing, mother with TB
Conclusions
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Political will is essential. ICDP was difficult.
While now our work is smooth.
Implementation of the Community Health
Service Model may avert a primary health
care disaster in China.
This development has the potential of
(re)establishing China as a global leader in
cost-effective primary health care delivery
for developing nations.