Keeping health close to home

COMMUNITY services are part of the core of China’s health care system. In urban neighborhoods today, community healthcare centers are seldom more than 15 minutes’ walk away. With their medical treatments across the board, inexpensive prescriptions and considerate service, community clinics are becoming popular in China. More residents are preferring to turn first to community healthcare centers rather than major hospitals.

Closer, Cheaper, More Convenient

For years, Mrs. Song has suffered from a serious cough each winter. A time-proven traditional Chinese medicine (TCM) therapy for such chronic winter ailments is to apply medicated plasters on particular acupoints in high summer, when the heat opens the pores and the herbs used are more easily absorbed.

Although quite a few large hospitals offer the remedy, which is applied in three phrases, their distance and long queues are a great inconvenience to Mrs. Song, especially in the heat of summer. This TCM treatment, however, has been available in community healthcare centers in Beijing since 2010, and Mrs. Song and many patients like her now can receive it near their homes.

Covering numerous types of medical services, community healthcare centers are now an important part of people’s lives. In Zhanlanlu Community Healthcare Center in Xicheng District, Beijing, visits have undergone a significant increase over the past few years, as the result of the steady upgrading of services and equipment. The center has departments and medical apparatus as good as can be found in major hospitals. This is a far cry from the situation just a few years ago, when most community healthcare centers were scantily funded and received few patients.

China’s healthcare institutions, including those at the community level, are only partly funded by the government, and have to depend on income from patient visits to keep them in the black. Before the recent medical reforms were launched in

2006, community healthcare centers, understaffed and poorly equipped, were in no position to compete with bigger medical care providers, and many were deep in debt. People had little confidence in the quality of their services and flocked to larger hospitals regardless of the seriousness of their conditions, putting great pressure on those hospitals and pushing up medical costs.

In October 2006 reforms began to create a basic healthcare system covering both the urban and rural population. As the fundamental part of the public health system, community healthcare centers are essential to achieving the government’s goal of providing basic health services to all, and were the first to undergo medical reforms. They have witnessed remarkable developments over the past few years.

In this reform the central government defined the nonprofit nature of community clinics and explicitly set forth that their services should be affordable to the public. To achieve this, the government allocated RMB 60 billion in subsidies from 2009 to 2011. As of December 2006, commonly used medicines available in community clinics have been supplied by the government at wholesale prices. In this way their quality is guaranteed, and prices lowered through the removal of intermediate links in the supply chain. Mrs. Song no longer has to go to a large hospital for her medicine, and has found that it is cheaper in a community clinic than in a major hospital.

Today, the facilities, services and human resources at community clinics and healthcare centers have been greatly improved and their popularity is on the up. For example, in January 2012 over 40 percent of patients in Beijing chose to seek treatment at community healthcare centers, compared to just five percent in 2006.

Jack of All Trades: From Chronic Illness to Emergencies

Primary healthcare institutions have also expanded the range of medical services available to residents within their own communities. Normally they cover six areas disease prevention, healthcare, health education, medical services, maternity care and rehabilitation. In the case of conditions that cannot be dealt with by the resources at their disposal, they can refer patients to specialists at major hospitals.

“In contrast to big hospitals that usually focus exclusively on diseases, community clinics pay more attention to people, family and community,” said Chang Shuling, director of the Zhanlanlu Community Healthcare Center. Community healthcare centers monitor the overall health condition, prevalence of certain diseases and the main factors affecting residents’ health in their areas by keeping a database of their patients and making regular analyses. Community health workers are expected to use this information to offer appropriate help to different groups of people and safeguard the whole of society from physical, mental and economic problems that can arise from poor management and low health awareness.

Control of chronic diseases is one of the key tasks that primary healthcare institutions take on. One of China’s biggest chronic diseases is diabetes, which affects 92 million Chinese adults. This and other chronic health problems such as hypertension and coronary heart disease have been on the rise in recent years.

Chang Shuling, who believes that such diseases are caused by modern lifestyles, says that communitybased healthcare institutions are essential as the first point of contact for residents in order to prevent and control chronic disease. Doctors in community clinics analyze patients’ diet and physical activity in order to find the best course of action. Many sufferers of chronic diseases end up changing their unhealthy lifestyles alongside the treatment they receive. From eating a balanced diet to engaging in regular exercise, advice from community doctors has helped patients better manage their health and has raised public awareness of health issues.

Community clinics also offer training to family members of chronic patients to become household health workers, so they can help their entire family lead a healthy lifestyle. Liu Wei is one of the 120,000 household health workers in Beijing. Since her husband was diagnosed with coronary heart disease, Liu assumed the responsibility of assisting community doctors to monitor his condition. She knew nothing about the disease before her training and had no idea what to do if faced with an emergency. “The community health center organized related training programs and I learnt first aid for myocardial infarction, and about rehabilitation. Now I can take good care of my husband.”

Community healthcare centers also provide special care for children, the elderly and people with disabilities. Beijing West Chang’an Avenue Community Health Service Center organizes clubs for the elderly who do not have family close by to look after them, giving health lectures and counseling. That in the Zhanlanlu neighborhood offers complementary therapy integrating preventative TCM with standard disease management, targeting those in high-risk groups or with poor health. The treatments include acupuncture, massage, and advice about how to integrate herbal remedies into their diets.

Though aware of the merits of TCM, such as lower side effects, Mrs. Song was previously not keen on it, mainly because it takes at least two hours every day to prepare each batch, and a course of treatment usually spans several weeks or longer. “But now community clinics offer ready-prepared TCM medicines,”Mrs. Song, who has joined the growing ranks opting to use TCM locally, says happily. Furthermore, as the cost of the medicine is partly covered, she pays little for the treatment.

Naturally, community healthcare institutions also play a crucial part during public health emergencies. When H1N1 influenza broke out in 2009, community healthcare institutions across the country took on the responsibility of monitoring returning international travelers, paying follow-up visits to patients with fever and respiratory symptoms, and sterilizing public places in their districts. Providing so many essential services, community healthcare centers may be small in size, but they build a solid foundation for citizens’ health.

Knowing Me, Knowing My Health

Community doctors have a close relationship with the public. In Mrs. Song’s experience, community doctors are more patient than doctors in large hospitals, and ready to spare the time to explain complicated conditions in a way that she can easily understand. Community doctors get to know patients, along with their health, medical history and even living habits, very well. Such detailed knowledge of seemingly insignificant details can help doctors with diagnoses.

Cao Guozhi has been suffering for years from shoulder and back pain caused by fasciitis. One day, she went to Zhanlanlu Community Healthcare Center complaining of continuous pain in her chest and back. Dr. Guo, who was quite familiar with Cao Guozhi’s condition and knew that her pain always focused in certain spots, noticed that the pain had expanded to her entire back and that it could not be caused by her usual problem. On the advice of the doctor, Mrs. Cao had an electrocardiogram, which revealed signs of a myocardial infarction. Staff at the center immediately transferred Mrs. Cao to a bigger hospital nearby and informed her family.

The close relationship between community doctors and patients is best seen in the home visit service that community health centers provide. The service is rendered by a team made up of a general practitioner (GP), a nurse and a health worker. They offer free medical care to families in the community, making regular follow-up visits, tracking patients’ conditions and conducting health assessments. The team not only provides medical services round the clock, but also shows extra consideration to needy families and people with disabilities, especially during festivals and holidays. Seniors without children to support them regard the teams as family members, and not only consult them about health problems, but also tell them about their personal problems.

Over the past five years of development, community healthcare institutions have won people’s trust and are making great contributions to the nation’s drive to improve public health. As of the end of October, 2011, 33,000 community healthcare centers had been established nationwide. In the first ten months of 2011, they received 400 million visits. The surge in the number of patients seeking community medical services has highlighted the shortfall of GPs, who constitute the core of community medical workers. There are just 78,000 registered GPs in China at present. China hopes to provide two to three general practitioners per 10,000 residents by 2020, which means increasing the total number to between 300,000 and 400,000.

In the past, medical graduates preferred to work in major hospitals rather than become GPs in community healthcare centers, where salaries are lower and work toilsome. The low pay for community medical workers has proved a barrier to the nation’s attempts to improve community healthcare. What’s more, being a GP not only requires comprehensive medical knowledge, but also involves making home visits, helping patients with rehabilitation, and documenting the medical health of families. Another problem is that China previously made training specialist physicians a greater priority. This led to the situation where patients only trust specialists in major hospitals.

To reverse this trend and encourage more graduates to enter careers in community healthcare, the central government is launching a series of policies to increase salaries and improve the welfare of community health workers. At the same time, community healthcare institutions all over the country are providing GP internships for medical school students. In June 2011, the State Council decided to establish a systemic training program that includes five years of clinical medicine undergraduate education and three years of GP training at medical institutions. This new system guarantees professionalism among community health workers entering the field.

China’s economic growth and improved social security system offer increasingly favorable conditions for the establishment of a complete public healthcare system. Although community healthcare is still nascent in China, it is growing fast with support from government policies and people’s changing attitudes. In time, GPs will become the trusted guardians of the nation’s public health and form the backbone of an efficient health system.