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China: celebrating frontline health workers

On the second morning of the China Maternal and Child Health  High-level Development Forum, I’m with Save the Children China colleagues who are co-hosting an event on frontline health workers.

With colleagues at the forum

Having brought together village and township doctors and health bureau representatives from seven provinces around the country, this is an opportunity to share experiences and learn from each other.

We heard of remarkable efforts from health workers in the community, and motivating speeches from representatives from the regional bureau and the China Maternal and Child Health Association, with a visit from dignitaries including the former Minister of Health, Dr. Zhang Wenkang.

A big thank you to Yang Ruikan for her tireless translation!

Address from the former Minister of Health

Today is also the first day of the Party Congress in Beijing, where new party leaders will be inaugurated. Dr. Zhang Wenkang made many references to this opportunity to establish universal welfare.

Typically, health sector resources have been directed to tertiary care with an emphasis on equipment and technology rather than workforce.

Now there’s more funding, he has high hopes that the equal importance of frontline health workers as specialist doctors will be recognised by addressing the inadequate benefits that cause high levels of attrition at the community level: “It will take time, but I am confident our party will make it happen.”

He also thanked Save the Children as a key partner in this endeavour to bring the voice of those unheard. The former Director of Maternal, Child and Community Health at the Ministry added: “We need analysis, evidence, negotiation with the Ministry of Finance, but the attention is there, so thank you for your work.”

From provincial representatives, we heard of efforts to standardise training; to interpret national policy; to advocate for the provision of state pensions to long-serving retired village doctors; and for village doctors to be formally employed by the government and receive adequate benefits.

Moving testimonies

Village, township and county doctors, often with just secondary education, shared testimonies from their day-to-day life.

We heard emotive and inspiring accounts of their commitment to improve maternal and child health; to raise sufficient resources for a local clinic; to self-train to better meet the communities’ needs; to forgo private employment opportunities that would have meant better incomes.

Growing health inequalities

China has made huge progress on maternal and child health over the past decades. Nationally, Millennium Development Goals 4 and 5 have been achieved. No doubt these successes should be celebrated.

But while aggregate progress is remarkable, inequalities are widening and remote, rural, poor, marginalised and vulnerable children are being left behind.

In 2010, over 300,000 children under five died from preventable causes. Child mortality rates vary from fewer than five deaths per 1,000 live births in Shanghai, to almost 40 in Sichuan province.

Further, 80% of inequalities in China occur within provinces. While the burden of non-communicable diseases is growing in urban areas, infectious diseases associated with poor obstetric and neonatal care, pneumonia and diarrhoea persist in rural areas.

Time to invest

Unlike many lower-middle income countries, China isn’t a crisis country for health workers (defined as <23 doctors, nurses and midwives per 10,000 population). In fact, China has more doctors than nurses/midwives.

Over the past two decades, investments have focused on improving tertiary care to the detriment of primary healthcare.

Given the disparities across provinces and population groups and the diversity of epidemiological needs, the imbalance in health investments must be addressed to meet the needs of the most vulnerable and to ensure that there’s sufficient supply of appropriate cadres at the rural level.

Frontline health workers in China have an ambiguous status, many are denied a formal contract and while they receive some payment for their services, this is totally inadequate. There’s no system for supportive supervision and their roles and responsibilities remain poorly defined.

It’s time to bring frontline health workers formally into the health system and provide them with a fair wage. They are crucial to China’s ability to address health inequalities.

With the 12th Five Year Plan, China must seize this opportunity and translate policy into practice across and within provinces so that no child is left behind.

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