Job satisfaction and associated factors among health care staff in township health centers--a cross-sectional survey in rural Central China.

Township health centers play a cornerstone role in the primary healthcare in China while it's development is largely limited by the brain drain. Job satisfaction is closely related to brain drain, investigating the relevant factors of job satisfaction can provide strategies to reduce brain drain. This research was conducted in Huangpi, China. Convenience sampling methods and self-administereded questionnaires were used. We collected 1370 valid samples, with an effective rate of 97.72%. Descriptive statistics are used to describe sociodemographic information. The Pearson Chi-square statistical was used to test the binary association between job satisfaction and another categorical variable. All the sociodemographic information was applied to the binary logistic regression model using the stepwise selection method. The mean age was 36.98 (SD = 9.84), factors that affect job satisfaction include educational background (x2 = 7.99, p< 0.05), marital status (x2 = 8.96, p< 0.05, monthly income (x2 = 51.43, p< 0.01), hire form (x2 = 7.64, p< 0.05), hours worked per week (x2 = 33.48, p< 0.01), parent had a stable job (x2 = 10.65, p< 0.01). Government and management should consider the impact of current policies on job satisfaction. Increasing the welfare of healthcare staff and promoting equity are potential strategies for improving low levels of job satisfaction.

Spatial accessibility of primary health care in China: A case study in Sichuan Province.

Access to primary health care is considered a fundamental right and an important facilitator of overall population health. Township health centers (THCs) and Community health centers (CHCs) serve as central hubs of China's primary health care system and have been emphasized during recent health care reforms. Accessibility of these hubs is poorly understood and a better understanding of the current situation is essential for proper decision making. This study assesses spatial access to health care provided by primary health care institutions (THCs/CHCs) in Sichuan Province as a microcosm in China. The Nearest-Neighbor method, Enhanced Two-Step Floating Catchment Area (E2SFCA) method, and Gini Coefficient are utilized to represent travel impedance, spatial accessibility, and disparity of primary health care resources (hospital beds, doctors, and health professionals). Accessibilities and Gini Coefficients are correlated with social development indexes (GDP, ethnicity, etc.) to identify influencing factors. Spatial access to primary health care is better in southeastern Sichuan compared to northwestern Sichuan in terms of shorter travel time, higher spatial accessibility, and lower inequity. Social development indexes all showed significant correlation with county averaged spatial accessibilities/Gini Coefficients, with population density ranking top. The disparity of access to primary health care is also apparent between ethnic minority and non-minority regions. To improve spatial access to primary health care and narrow the inequity, more township health centers staffed by qualified health professionals are recommended for northwestern Sichuan. Improved road networks will also help. Among areas with insufficient primary health care, the specific counties where demographics are dominated by older people and children due to widespread rural-urban migration of the workforce, and by ethnic minorities, should be especially emphasized in future planning.

Unmet needs in health training among nurses in rural Chinese township health centers: a cross-sectional hospital-based study.

PURPOSE: Maintaining a sufficient and competent rural nursing workforce is an important goal of the Chinese health delivery system. However, few studies have investigated the health training status or conducted a needs assessment of rural Chinese nurses during this time of great transformations in health policy. This study was conducted to explore the current health training status of nurses working in rural Chinese township health centers (THCs) and to ascertain their perceived needs. METHODS: A cross-sectional survey using a self-administered structured questionnaire was conducted among 240 THC nurses in Guangxi Zhuang Autonomous Region, China from March 2014 to August 2014. The survey questionnaire was adapted from the Second Chinese Survey of Demographic Data and Training Demand for Health Professionals in THCs developed by the Ministry of Education. RESULTS: The nurses in THCs were young, with a low educational level. Their perceived needs for health training included further clinical studies at city-level hospitals to improve their skills and theoretical studies at medical universities in emergency medicine and general practice. Overall, 71.9% of the nurses with a secondary technical school background expected to pursue junior college studies, and 68.5% of the nurses with a junior college education expected to pursue a bachelor's degree. A decentralized program with theoretical studies at medical universities and practical studies at county hospitals was regarded as feasible by 66.9% of the respondents. CONCLUSION: Health-training programs for nurses in Chinese THCs must be improved in terms of coverage, delivery mode, and content. A decentralized degree-linked training program in which medical universities and city hospitals collaborate would be an appropriate mode of delivery.

Unmet needs in health training among nurses in rural Chinese township health centers: a cross-sectional hospital-based study / 보건의료교육평가

PURPOSE: Maintaining a sufficient and competent rural nursing workforce is an important goal of the Chinese health delivery system. However, few studies have investigated the health training status or conducted a needs assessment of rural Chinese nurses during this time of great transformations in health policy. This study was conducted to explore the current health training status of nurses working in rural Chinese township health centers (THCs) and to ascertain their perceived needs. METHODS: A cross-sectional survey using a self-administered structured questionnaire was conducted among 240 THC nurses in Guangxi Zhuang Autonomous Region, China from March 2014 to August 2014. The survey questionnaire was adapted from the Second Chinese Survey of Demographic Data and Training Demand for Health Professionals in THCs developed by the Ministry of Education. RESULTS: The nurses in THCs were young, with a low educational level. Their perceived needs for health training included further clinical studies at city-level hospitals to improve their skills and theoretical studies at medical universities in emergency medicine and general practice. Overall, 71.9% of the nurses with a secondary technical school background expected to pursue junior college studies, and 68.5% of the nurses with a junior college education expected to pursue a bachelor's degree. A decentralized program with theoretical studies at medical universities and practical studies at county hospitals was regarded as feasible by 66.9% of the respondents. CONCLUSION: Health-training programs for nurses in Chinese THCs must be improved in terms of coverage, delivery mode, and content. A decentralized degree-linked training program in which medical universities and city hospitals collaborate would be an appropriate mode of delivery.

Influencing Factors of the Post Competency of Health Professionals in Township Health Centers / 中国医科大学学报

Objective To understand the influencing factors of the post competency of health technical personnel in township hospitals in a prov-ince,so as to provide scientific reference for improving health professionals'post competency. Methods Using stratified cluster random sam-pling,1242 health professionals from township health centers and village clinics of 14 cities were extracted and then surveyed with questionnaire. Results The average score of the respondents'post competency was 3.43,which meant they could afford most of the work. Multiple linear re-gression analysis showed that the main influencing factors of the professionals'post competency included gender,age,specialty,and training. The female,senior,nursing and health-care professionals with training exhibited a better post competency. Conclusion To realize the further develop-ment of professionals'post competency,medical students should not only be early clinical and more clinical,but also actively participate in the training and continue the education after entering the clinic. On the other hand ,the government should define the function orientation of the town-ship healthy centers and explore human resource management mode based on the post competency.

Study on the professionalism of medical workers at township health centers in mountainous areas of Fujian province / 中华医院管理杂志

Objective To discuss the current professionalism of primary medical workers and its interconnections with their hometown identify and job performance. Methods Township health centers of Jianning county in Fujian province were surveyed. The classic Employee Engagement Assessment Tool Gallup Q12 survey was employed, to learn the current professionalism of medical workers at such centers, and the influencing factors as well. Results The average value of engagement of these medical workers is 47.33 points (86% of 55 points as full score). High professionalism is mostly supported by hometown identity and professional identity,but they don't have high momentum and passion in general.Conclusions It is imperative to improve the sense of accomplishment,sense of belongings,and professional well-being of these medical workers,broaden their career development horizons,and establish a reasonable salary system to strengthen their hometown identity and enhance their professional engagement.

Influencing factors on remuneration satisfaction of medical staffs in township health centers:Based on Hierarchical Linear Model / 中国卫生政策研究

Objective:To conduct a survey on the difference in medical staff remuneration level and satisfaction within the eastern, central and western township health centers, explore the influencing factors on remuneration satis-faction, and put forward some suggestions. Methods:909 medical staff and 104 township health centers from 9 coun-ties in the eastern, central and western regions were investigated. The Descriptive, ANOVA and Hierarchical Linear Model ( HLM) methods were used to analyze the survey results. Results:Average annual medical staff remuneration was 28 324 Yuan in 2011 and the remuneration satisfaction was 2. 77 in five-point scale. The difference between the remuneration level (F=140. 16,P<0. 001) and remuneration satisfaction (F=240. 84,P<0. 001) among three re-gions was statistically significant. The HLM analysis indicated that the working time, workload per day in individual level and whether by practicing the policy of separation between revenue and expenditure, the number of average monthly discharged patients and the fiscal appropriation income in the township health centers level affected the remu-neration satisfaction. Conclusions:The medical staff remuneration level and satisfaction in the township health centers were low, both having a great regional difference. Therefore, the improvement of the medical personnel remuneration satisfaction is obtained through improving the revenue and expenditure, and the performance-based pay system.

Impacts of essential medicine system on revenue structure:Evidence from township health cen-ter in Shanxi Province / 中国卫生政策研究

Objective:To analyze the effects of essential medicine system on revenue structures at primary med-ical institutions. Methods:Data on revenue status and structures from 58 township health centers in Shanxi Province was collected to analyze changes and trends. Results:Along with growing government investments in primary medical institutions, the essential medicine system has fundamentally realized full coverage. The percentage of essential medi-cine revenue to pharmaceutical revenue rose from 20 . 45% in 2009 to 97 . 03% in 2013 , though the percentage of pharmaceutical revenue to total revenue dropped by 18 . 43%. The percentage of fiscal subsidy revenue in total reve-nue rose from 25 . 77% in 2009 to 54 . 16% in 2013 , though the percentage of business revenue to total revenue dropped in general. Conclusions:The essential medicine system requires the government’s financial support. Essen-tial medicine lists and primary financial aid policies should be further improved;doctor reimbursement and incentive mechanisms should be improved as well and unreasonable doctor service pricing and reimbursement mechanisms should be reformed.

Practice and insight on the model of “County-level hospitals supervising township health centers”in Suichang / 中华医院管理杂志

Introduced and analyzed in the paper are a reform made in Suichang county of Zhejiang province,in which a general community health center is established as an affiliate to the county TCM hospital which oversees the medical personnel,financial and properties of primary health centers in the country.An analysis of the merits and setbacks of the practice,the authors hold that the reform to build vertical medical consortiums between county-level public hospitals and primary health centers should emphasize the principles of “Consolidating the primary level and benefiting the people”,keep the rights and obligations consistent,and emphasize functional integration and resources sharing in terms of patient flow,personnel,facilities,technology,information and management.

Cognition and evaluation of the essential drug system by doctors at township health centers of different ownership systems / 中华医院管理杂志

Objective To understand the comments for the essential drug system by doctors at township health centers in Nantong's six counties and to discuss the effect of implementing the essential drug system to different ownership systems.Methods The survey was made with stratified clusters random sampling method to select township health centers.Questionnaires were filled out by doctors,and leaders of the health bureau and township health centers were interviewed.Results After the implementation of the essential drug system,94.6％of the doctors found that the number of laboratory examinations increased in Rugao,Rudong and Haian.23.2％of the doctors in Tongzhou,Qidong and Haimen found that enthusiasm for work increased.Conclusion The compensation mechanism should be perfected and the financial subsidies should be paid in time.Supervision and management should be strengthened and the grassroots need for medicine be ensured.The skills training should be enhanced and the medical service ability be improved.

Dynamic efficiency analysis based on the DEA-Malmquist index for township health centers in Hunan / 中华医院管理杂志

Objective To analyze the dynamic efficiency of township health centers. Methods Based on the DEA-Malmquist indices model, this paper analyzed the total factor productivity change indices of 281 township health centers in Hunan province with panel data from 2000 to 2008. These include technological change indices, efficiency change indices, pure technical efficiency change indices and scale efficiency change indices. Results A growth trend is identified with all the input/output factors in all the 281 township health centers; the sample health centers are found with a growth in the total factor productivity, efficiency and pure technical efficiency; the center health centers are found with a growth in the total factor productivity, technology, efficiency and pure technical efficiency, with greater technical improvement than efficiency; health centers at large are found with improvement in total factor productivity, efficiency and pure technical efficiency. Conclusion During the study period, sample health centers were characteristic of improved efficiency in terms of all factor productivity; central health centers characteristic of improvement in technology, while health centers at large are characteristic of improved efficiency.