News Release

Improved distribution of doctors and nurses and absorption of medical graduates in heatlh workforce

...are priorities for China

Peer-Reviewed Publication

The Lancet_DELETED

Policies to address inequitable distribution of doctors and nurses and ensuring that medical graduates enter the health workforce are among the priorities China must tackle as it seeks to achieve its aim of a Healthy China by 2020. These are the conclusions of the fifth paper in The Lancet Series on Health System Reform in China, written by Professor Sudhir Anand, University of Oxford, UK, and colleagues.

Unlike most countries, China has more doctors than nurses. Latest data from 2005 show there were 1.9 million licensed doctors and 1.4 million licensed nurses. Most of China's doctors (67.2%) and nurses (97.5%) have been educated only up to junior college or secondary school level, and doctor density in urban areas is more than twice that for rural areas; for nurses, this difference is three-fold. Analysis shows that increasing the density of health professionals by 1% leads to a decrease of 0.133% in the infant mortality rate. The authors say: "This maldistribution can only be corrected through national or provincial policies that create effective incentives for health professionals, especially physicians, to work and remain in rural health stations."

There is an apparent surplus of people trained as health workers but who are not employed as such. The authors estimated that almost 1 million graduates of medical and health-related education programmes were produced during 2000-05 who were not absorbed into the health workforce. Many of these may have gone to the pharmaceutical or biotechnology industries instead. The authors say: "This mismatch suggests a less than optimal allocation of educational investment in China; it also suggests the need for improved coordination between the Ministry of Health and the Ministry of Education."

Finally, China faces the challenge of educational programme diversity and skill mix so as to best meet the needs of its population – eg, a doctor may not need eight years training to serve the basic health needs of a rural population, yet this could be necessary to become a specialised surgeon in a large city hospital. The authors say: "There is no clear-cut answer in the debate on setting uniform national standards for physician training and qualification."

They conclude: "Although the production of doctors and nurses has greatly expanded in recent years, serious problems of distribution remain. As the government seeks to achieve its aim of a Healthy China by 2020, the goal of its health reform should be to promote equitable and universal access to basic health services. This will require that every Chinese family — living in poor or rich counties and rural or urban areas — has access to an appropriately trained and supported health worker."

An accompanying Comment, by Dr Daqing Zhang, Peking University, and Dr Paul Unschuld, Charite Universitatsmedizin, Berlin, Germany, discusses China's barefoot doctor programme from 1968, which effectively reduced costs and provided timely treatment to rural people. They conclude: "The new cooperative medical system…which draws heavily on the experiments of the barefoot doctor programme, will take responsibility for the healthcare of peasants in rural China."

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Professor Sudhir Anand, University of Oxford, UK T) +44 (0) 1865-281287, E): sudhir.anand@economics.ox.ac.uk

Dr Daqing Zhang, Peking University, China T) +8610-82801568 E) zhangdq@bjmu.edu.cn

Full paper: http://press.thelancet.com/china5.pdf


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