Evolving village clinics secure rural public health

As the only doctor in the Tibetan-inhabited village of Gongongma, Wangchen has knocked on Yang Paljor's door three times this year—once to vaccinate the villager's six-year-old grandson, once to offer the child a routine medical check-up and in the latest visit to check up on the youngster's mother.

Almost every month, 50-year-old Wangchen patrols on his motorbike, with a medical kit on his back, around this pasturing village of more than 500 households, or roughly 2,870 people, in Kangtsa County of northwest China's Qinghai Province. His face has tanned from prolonged sun exposure on the Qinghai-Tibetan Plateau.

Vaccinating kids, running physical check-ups on seniors and women of reproductive age, maintaining villagers' health records and monitoring infectious diseases constitute the major part of his everyday work.

He is one of many hard-working provincial doctors in China toiling so the country can meet its aim of bolstering medical care in remote areas. He is helped by authorities pumping funds into rural medical facilities, as part of a healthcare reform program that is set to achieve a major milestone this year.

In 2009, the Chinese government launched a nationwide campaign to extend basic medical services to rural and urban residents alike. The State Council, or China's Cabinet, set the goal of ensuring a clinic for each administrative village and a village doctor for every 1,000 rural residents.

According to officials, China had set up more than 25,000 village clinics by the end of 2011, "very close to achieving the goal."

Gongongma was one of the villages to get a new clinic in the drive. And Wangchen's access to resources continues to improve, as does the availability of affordable medicines for his patients. Nevertheless, China still requires the dedication of Wangchen, and many like him, if it is to meet its health goals.

In sparsely-populated Gongongma, some families live more than 40 km from the clinic. "It usually takes five to six days for me to finish patrolling the village," Wangchen says.

Across the province, there are a total of 6,689 doctors of his kind scattered in 4,243 village clinics, according to Ma Zhong, a rural health official with the provincial health department of Qinghai.

"Village clinics and the great number of doctors therein are playing an increasingly important role in giving rural residents access to basic public health services," Ma explains.

For decades, people living in the countryside have had difficulty seeing a doctor, adds Zhu Hua, a rural economy research fellow with the Qinghai Academy of Social Sciences. "For one thing, they have to travel far to the nearest hospital in town. For another, medical expenses are usually too high to afford."

Therefore, Zhu notes, it is necessary to cultivate medical personnel and improve medical services for the more than 700 million Chinese now living rurally.

"Village clinics form the foundation of medical care, and the increasing number of clinic doctors will be of great help to addressing rural residents' difficulty in acquiring medical services," he says.

In 1983, Wangchen followed in his father's footsteps and started to practice medicine in the village. For the following 20 years, he diagnosed patients in his house using little more than a stethoscope, sphygmomanometer and thermometer.

In 2003, however, the village clinic was built with the government's assistance. Comprised of a consulting room, transfusion room and pharmacy, it now features regular medical facilities such as an examining table, autoclave sterilizer and transfusion stands.

According to Wangchen, the county government of Kangtsa equipped the clinic with a computer last year to help him keep an electronic record of villagers' health status. And he is expecting to receive a portable ultrasonic device this year.

Since 2000, village doctors in Kangtsa have shifted the focus of work to providing villagers with public health services, including vaccination, and health care for children, pregnant and parturient women, says Liu Guangming, head of the county's bureau of health and family planning.

"But during the initial years, they could get little, if any, financial support from the village committee and county government," he adds.

According to Liu, it was in 2008 that village doctors started to receive fiscal subsidies from governments at the central, provincial, prefectural and county levels.

In 2011, Wangchen was given more than 6,000 yuan (about US$953.4) in public health service subsidies.

Counting the 8,000 yuan per year that the provincial government in 2011 started to grant each village doctor in pasturing areas and other types of subsidy, his income added up to around 20,000 yuan last year, "almost tripling that of 2010."

Furthermore, the Qinghai provincial government plans to further increase subsidies for village doctors' public health services.

In 2012, per capita spending on basic public health services will rise from 25 yuan to 40 yuan, at least 30 percent of which will go to village doctors, promises Ma Shunqing, vice-governor of Qinghai and head of the province's healthcare reform program.

While increasing village doctors' income and upgrading village clinics' facilities, China has also extended its "essential medicine system" to these clinics to ensure rural residents' access to key drugs that satisfy priority health-care needs and are affordable for the public, and in this way cut their medical costs.

All village clinics across Qinghai have adopted the system, giving priority to using essential drugs when treating patients and with government subsidies, selling the drugs at purchase price, according to Ma.

"There has been a 15 percent drop in medicine prices since the clinic started to sell essential drugs at cost prices last July," says Wang Shengxu, the doctor in Qinghai's Shangxinzhuang village.

The clinic now offers 300 kinds of western and traditional Chinese medicines, as well as ethnic drugs, all on the state's and province's essential drug lists.

Village clinics used to rely heavily on profits from selling drugs, Zhu Hua says. "But the extended use of essential medicines sold at purchase prices is transferring the profits to rural residents and making them the biggest winner."