Limited resources

Statistics from the Ministry of Health for 2005 indicate that doctors at grassroots clinics diagnosed and treated about 13 patients daily on average. This workload keeps doctors busy receiving outpatients and leaves them with little time for other tasks such as disease prevention and health awareness education.

According to the August circular on developing grassroots clinics, they will be staffed with two to three general practitioners, one public health doctor, and three to four nurses for every 10,000 people.

Although Yan Li's 16-person clinic- including six doctors of traditional Chinese medicine, one general practitioner and three nurses-meet the staffing requirement in terms of numbers, she still feels the acute shortage of hands. For a lecture on diabetes care, for example, she has to carefully apportion the work among her 16 staffers for contacting the expert, preparing the conference room and helping senile attendees climb the stairs, besides regular outpatient care.

But what was even worse than inadequate staffing was the lack of professional training, she said. "I hear that community health care has developed to an advanced level in the United States," said Yan. "Their community clinics have professional care managers who have received comprehensive training and even their volunteers can educate the public on health awareness in a professional manner. People in that country can have all their health care and consultation needs met from cradle to grave without leaving their community. We still have a long way to go."

"The quality of the medical staff is the key to a functional community-based clinic network," said Chen. "China has a very small number of general practitioners of international standards. While foreign medical schools offer a major in general practice, it is a relatively new concept in China."

However, as community clinics develop in big cities such as Beijing, Shanghai and Shenzhen, more and more comprehensive hospitals are starting their trial programs to train qualified general practitioners. For example, Fuxing Hospital in Beijing set up a training center for general practitioners in 2005. The training programs include offering clinic staff temporary work opportunities in hospitals and starting a master's course for general practitioners with more than four years' working experience.

Yan Li, who has been working in the clinic since graduation from a medical college in 2002, assumed the position of acting director this April. When asked whether the promotion was a reward for her diligence, the young doctor said, "A better reward would be sending me to a hospital ward for training. I would look forward to it."