A qualitative study of two management models of community health centres in two Chinese megacities

ABSTRACT

Two common public models of community health centres (CHCs) exist in China, i.e. the ‘government-owned and government-managed’ CHCs (G-CHCs) and the ‘government-owned and hospital-managed’ CHCs (H-CHCs). Shanghai and Shenzhen are two Chinese megacities that lead the primary care development on the G-CHC and H-CHC models, respectively. Using a qualitative case study design, this study compares the management of the G-CHC model in Shanghai and H-CHC model in Shenzhen, through perspectives of a range of health providers. In each city, we randomly selected four CHCs and in total conducted 31 interviews with officers from the municipal health authorities, directors, GPs, nurses and public health doctors of the CHCs. When comparing with the H-CHC model in Shenzhen, the G-CHC model in Shanghai, a model with more simplified but accountable structure tended to present better management conditions, in terms of financial transparency, recruitment autonomy, community health workforce development (CHC staffing and family medicine training), funding and priority for public health. However, regardless of the models, staff retention remained a challenge. While our study tends to suggest that the G-CHC model in Shanghai presents better management conditions, future study can test whether and to what extent the model itself can lead to such differences.

KEYWORDS:

• Primary healthcare
• community health centre
• model
• management
• China

Acknowledgements

The authors thank colleagues from the Chinese University of Hong Kong (CUHK), and the Health Bureaus in Shenzhen and Shanghai who facilitated in data collection. Special thanks also go to Miss Nan Yang who provided the support throughout the project.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The study was funded by the Research Grants Council (RGC) of Hong Kong (CUHK 4002-SPPR-10), and the Communicable Disease Health Service Delivery (COMDIS-HSD) Research Consortium from the Department for International Development from the UK Government (UKAID).