Surrounded by the grasslands of Inner-Mongolia, Duguerzhabu, 80 years old, has spent her life in the remote Hulunbuir. The landscape takes your breath away, as the steppe stretches to the horizon it reveals the challenges of a rural life: there are no health care facilities nearby. With sparse population density of only 10 per square km, accessing health care services is an issue for residents in remote rural areas due to high cost and inconvenient transportation.
“I suffer from cerebrovascular disease and paralysis, and was recently diagnosed with hypertension. My children left Hulunbuir to go to the city, they work hard to make money and succeed in life. I can’t afford to go to the hospital every time I need or bother them to assist me,” reports Duguerzhabu.
As many other countries, China is facing both an ageing population and a rapidly escalating burden of chronic diseases such as cancer, cardiovascular disease and diabetes. China’s ability to deal with the challenges relies on primary health care interventions.
No health system in the world can cope with these challenges without a properly functioning tiered health care system: hospitals will be overwhelmed if they remain the main providers of health care. In this context, family doctors are essential to filter and redirect patients.
“Training a good number of qualified general practitioners will ease the huge workload on big public hospitals, and is important to strengthen grassroots healthcare service,” explains Dr Gauden Galea, WHO Representative in China.
However, China currently does not have enough family doctors to reach its national goals. According to the target of 2-3 qualified general practitioners per 10,000 urban and rural residents in 2020 put forward by China’s State Council, a total of 280,000-420,000 new general practitioners will be needed by 2020, accounting for China’s population of 1.4 billion.
Since the health reform of 2009, there have been many achievements to improve tiered-health care service delivery. With the support of WHO, the Chinese government is developing a strong primary care system to achieve equal access to healthcare for all people in China, focused on establishing a strong network of community health centres and rural health workers, led by family doctors, to bring quality, affordable health care closer to the population.
In 2016, the Chinese government issued a series of national guidelines, to encourage family doctors to settle in areas with sparse populations and limited transport, in order to improve the capacity of service delivery in primary health care settings and to promote service delivery innovations such as wearable health monitoring devices.
“In the past, medical services were completely inaccessible to me. I am now equipped with the medicines I need for my hypertension and a blood pressure monitor. Dr Wu, my family doctor, regularly checks my blood pressure and is on call to send a car if I need to go the hospital. My children and I are relieved, I get all the support I need,” explains Duguerzhabu.
Over the last 15 years, the number of community health centers increased by 320% (2002 – 2016) and the number of certified family doctors has been growing at a steady pace over the past three years (21% increase from 2014 to 2016).
Looking forward, China, will continue to strengthen its primary health care system, emphasizing the value of primary care providers (family doctors) as the first point of contact.
“The government has reaffirmed its commitment to increase the number of qualified family doctors by improving training and incentive mechanisms. The goal is that by 2020, every 10,000 urban and rural residents will have two to three qualified general practitioners and, by 2030, the number will rise to five,” explains Dr Galea.