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Human Resources for Health
Published in: Human Resources for Health 1/2014

Open Access 01-12-2014 | Research

Aging village doctors in five counties in rural China: situation and implications

Authors: Huiwen Xu, Weijun Zhang, Linni Gu, Zhiyong Qu, Zhihong Sa, Xiulan Zhang, Donghua Tian

Published in: Human Resources for Health | Issue 1/2014

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Abstract

Background

The aging population, rapid urbanization, and epidemiology transition in China call for the improvement and adaptation of the health workforce, especially in underserved rural areas. The aging of village doctors (the former “barefoot doctors”) who have served the rural residents for many decades has become a warning signal for the human resources for health in China. This study aims to investigate the village doctors’ aging situation and its implications in rural China.

Methods

The data reviewed were obtained from the baseline survey of a longitudinal study of rural health workforce in five counties in rural China in 2011. Using a stratified multi-stage cluster sampling process, the baseline data was collected through the self-administered structured Village Doctor Questionnaire. Descriptive analyses, correlation analyses, and multivariate linear regression with interaction terms were conducted with the statistics software Stata 12.0.

Results

The average age of the 1,927 village doctors was 49.3 years (95% CI 48.8 to 49.9), 870 (45.2%) of whom were aging (50 years or older). Both the age and the recruitment time of the village doctors were demonstrated to have a bimodal distribution. A greater proportion of the male village doctors were aging. Furthermore, aging of the village doctors was significantly correlated to their education level, type of qualification, practicing methods, and their status as village clinic directors (P <0.05, respectively). As shown in the regression models, aging village doctors provided significantly more outpatient services to rural residents (P <0.01) but without an increase in income, and their expected pension was lower (P <0.01), compared with their non-aging counterparts.

Conclusions

Aging of village doctors is a serious and imperative issue in China, which has a complex and profound impact on the rural health system. Greater attention should be paid to the construction of the pension system and the replenishment of the village doctors with qualified medical graduates.
Appendix
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Literature
1.
Ezeh AC, Bongaarts J, Mberu B: Global population trends and policy options. Lancet. 2012, 380: 142-148.CrossRefPubMed
2.
Hesketh T, Lu L, Xing ZW: The effect of China’s one-child family policy after 25 years. N Engl J Med. 2005, 353: 1171-1176.CrossRefPubMed
3.
Nations U: World Population Prospects: The 2010 Revision. 2011, New York: United Nations
4.
5.
Anthony GOY, Jiang X, Kaizhi L: China’s Post-Reform Urbanization: Retrospect, Policies and Trends. 2011, New York: United Nations Population Fund (UNFPA) and International Institute for Environment and Development (IIED)
6.
Yi Z, Vaupel JW: The impact of urbanization and delayed childbearing on population growth and aging in China. Popul Dev Rev. 1989, 15: 425-445.CrossRef
7.
Chen J: Internal migration and health: re-examining the healthy migrant phenomenon in China. Soc Sci Med. 2011, 72: 1294-1301.CrossRefPubMed
8.
9.
Wang L, Kong L, Wu F, Bai Y, Burton R: Preventing chronic diseases in China. Lancet. 2005, 366: 1821-1824.CrossRefPubMed
10.
Yang G, Wang Y, Zeng Y, Gao GF, Liang X, Zhou M, Wan X, Yu S, Jiang Y, Naghavi M, Vos T, Wang H, Lopez AD, Murray CJ: Rapid health transition in China, 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet. 2013, 381: 1987-2015.CrossRefPubMed
11.
Gao Y, Chen G, Tian H, Lin L, Lu J, Weng J, Jia W, Ji L, Xiao J, Zhou Z, Ran X, Ren Y, Chen T, Yang W, China National Diabetes and Metabolic Disorders Study Group: Prevalence of hypertension in china: a cross-sectional study. PLoS One. 2013, 8: e65938-CrossRefPubMedPubMedCentral
12.
Xu Y, Wang L, He J, Bi Y, Li M, Wang T, Wang L, Jiang Y, Dai M, Lu J, Xu M, Li Y, Hu N, Li J, Mi S, Chen CS, Li G, Mu Y, Zhao J, Kong L, Chen J, Lai S, Wang W, Zhao W, Ning G, China Noncommunicable Disease Surveillance Group: Prevalence and control of diabetes in Chinese adults. JAMA. 2010, 2013 (310): 948-959.
13.
Ministry of Health of China: 2012 China Health Statistics Yearbook (In Chinese). 2012, Beijing: Beijing Union Medical University Press
14.
Cometto G, Witter S: Tackling health workforce challenges to universal health coverage: setting targets and measuring progress. Bull World Health Organ. 2013, 91: 881-885.CrossRefPubMedPubMedCentral
15.
16.
Xu H, Zhang W, Zhang X, Qu Z, Wang X, Sa Z, Li Y, Zhao S, Qi X, Tian D: Longitudinal study of rural health workforce in five counties in China: research design and baseline description. Hum Resour Health. 2013, 11: 17-CrossRefPubMedPubMedCentral
17.
Zhang D, Unschuld PU: China’s barefoot doctor: past, present, and future. Lancet. 2008, 372: 1865-1867.CrossRefPubMed
18.
19.
20.
Anand S, Fan VY, Zhang J, Zhang L, Ke Y, Dong Z, Chen LC: China’s human resources for health: quantity, quality, and distribution. Lancet. 2008, 372: 1774-1781.CrossRefPubMed
21.
22.
Sidel VW: The barefoot doctors of the People’s Republic of China. N Engl J Med. 1972, 286: 1292-1300.CrossRefPubMed
23.
Hsu RC: The barefoot doctors of the People’s Republic of China–some problems. N Engl J Med. 1974, 291: 124-127.CrossRefPubMed
24.
Daniels GL: China’s barefoot doctors. J Med Soc N J. 1974, 71: 486-487.PubMed
25.
26.
Langmuir S: Barefoot doctors and health care in China. J Allied Health. 1976, 5: 9-13.PubMed
27.
Mullan F, Bryant JH: Doctors--barefoot and otherwise. The World Health Organization, the United States, and global primary medical care. JAMA. 1984, 252: 3146-3148.CrossRefPubMed
28.
29.
Guo Q, Wang Z, Yan H: A survey and analysis on village doctors in 46 poor counties in Western China. China Public Health (In Chinese). 2003, 22: 51-52.
30.
Zhong Y, Wang Y, Cui X: Shanghai village doctors current situation investigation and analysis. Chinese Primary Health Care (In Chinese). 2009, 23: 7-10.
31.
Hua L, Ping X, Xiaoli Z, Jijun Y, Zuofu T, Shupao L, Jie C, Sheng W, Haizheng W: Guangxi village doctors' basic situation survey. Chinese Rural Health Service Administration (In Chinese). 2010, 30: 1013-1014.
32.
Huang Q, Jing S, Huang D, Hongzhao Y, Li Y, Lv X, Shang C: Basic situation of village doctors in China during “the eighty five-year project”. Practical Rural Doctors J (In Chinese). 1995, 6: 4-9.
33.
Li F, Gao L, Leng Y: 2009 Village doctor basic condition survey in Shandong province. Preventive Medicine Tribune (In Chinese). 2011, 17: 1084-1087.
34.
Wang J, Su J, Zuo H, Jia M, Zeng Z: What interventions do rural doctors think will increase recruitment in rural areas: a survey of 2778 health workers in Beijing. Hum Resour Health. 2013, 11: 40-CrossRefPubMedPubMedCentral
35.
Feng G, Zibiao W, Yuqi C: The report of current situation of village doctors in Liaoning Province. Guide China Medicine (In Chinese). 2011, 9: 156-158.
36.
37.
Maas CJ, Hox JJ: Sufficient sample sizes for multilevel modeling. Methodology. 2005, 1: 86-92.CrossRef
38.
Rosenthal MM, Greiner JR: The barefoot doctors of China: from political creation to professionalization. Hum Organ. 1982, 41: 330-341.CrossRefPubMed
39.
Ministry of Health of China: 2006 China Health Workforce Report. (In Chinese). 2007, Beijing: Chinese Peking Union Medical University Press
40.
Liu P, Zhao J: The difficulty and solution of village doctors in the new health reform. Health Economics Res (In Chinese). 2013, 9: 23-24.
41.
Mao Z, Gu X, Xiang G, Li T, Zhou X: The payment of China’s basic health institutes. Health Economics Res (In Chinese). 2012, 5: 50-52.
42.
Huang C: Change of education attainment between 1964 and 2005 in China: analysis based on the data from population census and 1% population sampling. Population J (In Chinese). 2011, 4: 3-13.
43.
National Bureau of Statistics of China: China Statistics Yearbook 2012. (In Chinese). 2012, Beijing: China Statistics Press
44.
Li X, Chongsuvivatwong V, Sangsupawanich P, Xia X: Evaluation of short term integrated management of childhood illness training on the clinical competency of village doctors in Yunnan, China. J Med Assoc Thai. 2012, 95: 890-894.PubMed
45.
Li X, Chongsuvivatwong V, Xia X, Sangsupawanich P, Zheng W, Ma K: Revisiting current “barefoot doctors” in border areas of China: system of services, financial issue and clinical practice prior to introducing integrated management of childhood illness (IMCI). BMC Public Health. 2012, 12: 620-CrossRefPubMedPubMedCentral
46.
Land T: China’s “barefoot doctors” to get medical training through new exchange program. Home Health J. 1984, 5: 19-PubMed
47.
Edward A, Kumar B, Niayesh H, Naeem AJ, Burnham G, Peters DH: The association of health workforce capacity and quality of pediatric care in Afghanistan. Int J Qual Health Care. 2012, 24: 578-586.CrossRefPubMed
48.
Ho CS, Gostin LO: The social face of economic growth: China’s health system in transition. JAMA. 2009, 301: 1809-1811.CrossRefPubMed
49.
Tang S, Meng Q, Chen L, Bekedam H, Evans T, Whitehead M: Tackling the challenges to health equity in China. Lancet. 2008, 372: 1493-1501.CrossRefPubMed
50.
Campbell J, Buchan J, Cometto G, David B, Dussault G, Fogstad H, Fronteira I, Lozano R, Nyonator F, Pablos-Mendez A, Quain EE, Starrs A, Tangcharoensathien V: Human resources for health and universal health coverage: fostering equity and effective coverage. Bull World Health Organ. 2013, 91: 853-863.CrossRefPubMedPubMedCentral
51.
Li X, Zhang W, Lin Y, Zhang X, Qu Z, Wang X, Zhang Y, Xu H, Zhao S, Li Y, Tian D: Pathways to psychiatric care of patients from rural regions: a general-hospital-based study. Int J Soc Psychiatry. 2014, 60: 280-289.CrossRefPubMed
52.
Meng Q, Xu L, Zhang Y, Qian J, Cai M, Xin Y, Gao J, Xu K, Boerma JT, Barber SL: Trends in access to health services and financial protection in China between 2003 and 2011: a cross-sectional study. Lancet. 2012, 379: 805-814.CrossRefPubMed
53.
54.
Liu Y: Reforming China’s health care: for the people, by the people?. Lancet. 2009, 373: 281-283.CrossRefPubMed
55.
56.
57.
Song K, Scott A, Sivey P, Meng Q: Improving Chinese primary care providers’ recruitment and retention: a discrete choice experiment. Health Policy Plan. 2013, [In press]
58.
59.
Lehmann U, Dieleman M, Martineau T: Staffing remote rural areas in middle- and low-income countries: a literature review of attraction and retention. BMC Health Serv Res. 2008, 8: 19-CrossRefPubMedPubMedCentral
60.
WHO: Increasing Access to Health Workers in Remote and Rural Areas Through Improved Retention. 2009, Geneva: WHO
61.
62.
63.
64.
Schofield D, Fletcher S, Callander E: Ageing medical workforce in Australia - where will the medical educators come from?. Hum Resour Health. 2009, 7: 82-CrossRefPubMedPubMedCentral
65.
Wolpert Barraza E: Physician retirement from clinical practice: how and when. Gac Med Mex. 2011, 147: 262-265.PubMed
66.
Van Greuningen M, Heiligers PJ, Van der Velden LF: Motives for early retirement of self-employed GPs in the Netherlands: a comparison of two time periods. BMC Health Serv Res. 2012, 12: 467-CrossRefPubMedPubMedCentral
67.
68.
Taylor AL, Hwenda L, Larsen B-I, Daulaire N: Stemming the brain drain — a WHO global code of practice on international recruitment of health personnel. N Engl J Med. 2011, 365: 2348-2351.CrossRefPubMed
Metadata
Title
Aging village doctors in five counties in rural China: situation and implications
Authors
Huiwen Xu
Weijun Zhang
Linni Gu
Zhiyong Qu
Zhihong Sa
Xiulan Zhang
Donghua Tian
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Human Resources for Health / Issue 1/2014
Electronic ISSN: 1478-4491
DOI
https://doi.org/10.1186/1478-4491-12-36

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