Li Zhijuan is dealing with child illness case. Photo credit: Save the Children/ Liu Chunhua.

Li Zhijuan is a village doctor from Yunnan Province. Li Zhijuan has been working in Manlai village clinic of Cangyuan county for 15 years. It is the only clinic in the village serving members of the Wa ethnic group. Over 1000 villagers rely on Zhijuan and one other young doctor to provide the health services they need. She has to works 7 days a week, around 10 hours per day to keep up with demand.

The child mortality rate in Cangyuan country is more than double the national average. Pneumonia is one of the leading causes of death. Many sick children were found not to be properly assessed and treated by health care providers, and parents were not well informed about what to do when their children fell ill.

Zhijuan and her colleague have been trained to use the Integrated Management of Childhood Illness (IMCI) approach to treat childhood illnesses. She says “Before, I would diagnose illnesses based on the symptoms present without considering other potential factors causing the illness. With the ideas from the IMCI, I learnt to perform a full assessment of a child’s condition before making a diagnosis for treatment. Besides the obvious symptoms, I will ask about the child’s general health, more specifically about diarrhoea, coughing, immunization and diet, and check his nutrition status. With this full information, I can identify the true cause of his illness and provide the most appropriate treatment.”

Neonatal mortality rate  (per 1,000 live births) (2011) 9
Under-five mortality rate (per 1,000 live births) (2011) 15
Maternal mortality ratio (per 100,000 live births) (2010) 37
Number of doctors, nurses and midwives per 10,000 people (2010) 29.7
Births attended by skilled personnel (2009) 96.3%
Total expenditure on health as a percentage of gross domestic product (2011) 5.2%
General government expenditure on health as a percentage of total expenditure on health (2011) 55.9%

China is making good strides towards meeting MDGs 4 and 5. There is no single universal health coverage scheme, but a variety of different schemes exist for different population groups, including a mandatory scheme for all formal sector workers. The New Rural Cooperative Medical Scheme now covers more than 90% of the rural population in China, a significant part of China’s efforts to reach UHC. In practice, financial coverage depends on the availability of funds, although this is being substantially improved.

Overall, there is a good availability of skilled health professionals in China, above the 22.8 threshold and on track to meet the 34.5 per 10,000 indicative threshold by 2035. China benefits from a low-cost medical education system, graduating about 175,000 doctors annually. However, the distribution of health workers is not equitable throughout the country. Most are concentrated in urban areas.

Around one million village doctors, who mostly have vocational training, play a key role in serving in rural areas. For example, Chen Yidong is the only doctor in Wujiagou village. To reach his patients, he must travel over land and water with his medicine box. Further efforts are required to increase access to health workers in remote villages and migrant communities. The national HRH plan for 2011-2020 is attempting to address some of these issues with measures to improve retention, distribution and performance of the health workforce.

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