Community Health Service Work Guide

Author: Liang Zhenyu
Publisher:
Publish Date: 2006-06-01
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III. The Development of Community Health Services in China
In the 1920s and 1930s, community medicine began to take root in China. Some visionary scholars started practicing community medicine at the grassroots level, such as in Ding County, Hebei Province, Zouping County, Shandong Province, Jiangning County, Jiangsu Province, and Dongcheng District, Beijing. Under extremely difficult conditions, they made pioneering contributions to community medicine in China. Unfortunately, these practices were largely interrupted by the War of Resistance against Japan.
After the founding of the People's Republic of China, the government has always attached great importance to health and medical work, emphasizing prevention and focusing on rural and grassroots areas. It established and gradually improved the three-tiered medical prevention and health care network. In rural areas, the practice is based on village health clinics (primary level), with township health centers (secondary level) as hubs, and county-level medical and health institutions (tertiary level) as technical guidance centers and training bases. In cities, street health centers, factory and school medical clinics (primary level) serve as the foundation, district-level medical prevention and health care institutions (secondary level) act as intermediaries, and provincial and municipal general hospitals, affiliated hospitals of medical colleges, specialized hospitals, health and disease prevention stations, and maternal and child health hospitals (institutions) (tertiary level) serve as the core, providing step-by-step business guidance to affiliated medical prevention institutions and health personnel. Due to the establishment of the three-tiered medical prevention and health care network, a solid organizational foundation was laid for the development of community health services in China.
Since the 1980s, to implement rural development strategies and promote primary health care, many medical colleges in China have included the development of community medicine education as a key objective and recognized that strengthening community medicine education is an important way to link health human resource training with community health services. The prototype of China's community health services can be traced back to a health service survey conducted by Chinese and American experts in a county in Shanghai in 1981. However, it was not until Dr. Raiakumar proposed that China should develop family medicine in 1988 that substantive progress was made in China's community health services.
In 1989, the first International Family Medicine Symposium was held in Beijing, and the Beijing and Guangzhou Family Medicine Associations were established, as well as the Capital University of Medical Sciences Family Physician Training Center. In 1993, the Chinese Family Medicine Association was founded. Across the country, efforts were intensified to develop community health services on the basis of existing grassroots health work, with increased investment in community health services, the issuance of relevant documents, and the formulation of community service fee standards and reimbursement policies. Under favorable conditions of government support and targeted investment, community health services in some cities began to develop their own characteristics.
In 1997, the National Health Work Conference adopted the "Decision of the CPC Central Committee and the State Council on Health Reform and Development," which proposed the implementation of community health services nationwide. The Decision stated that it was necessary to "reform the urban health service system, actively develop community health services, and gradually form a health service network that is functionally rational and convenient for the public."
In 1996, General Secretary Jiang Zemin's speech at the National Health Work Conference called for "accelerating reforms in the health management system, the health service system, and the operational mechanisms of health institutions, and actively promoting the reform of the medical insurance system for urban employees." Premier Li Peng also pointed out that "actively developing community health services and establishing a functionally rational and convenient health service network are an inevitable trend in the development of the health sector." The statements of national leaders laid a policy foundation for the development and implementation of community health services.
In 1997, the National Community Health Service Work Site Symposium was held in Jinan, and State Councilor Peng Liyun delivered an important speech titled "Vigorously Develop Community Health Services," proposing that "developing community health services is a major reform and restructuring of the urban health system," and that the "ultimate goal is to form a health service system in cities with a rational layout of various types of medical institutions, reasonable functional positioning, greater economic efficiency, and the ability to maximize the health needs of the people, changing the situation where large hospitals are overcrowded while grassroots medical institutions are underutilized, in order to make full use of existing health resources and control the rapid growth of medical expenses." Minister of Health Chen Minzhang delivered a speech titled "Summarizing Experience and Deepening Reform, Actively Developing Community Health Services."
At this point, community health services rapidly expanded nationwide. In 1998, Vice Premier Li Lanqing, at the National Urban Employee Medical Insurance Reform Work Conference, clearly stated on community health services, "The reform direction of China's medical service model is to treat minor illnesses in the community and major illnesses in hospitals, and to establish and develop a community health service system with Chinese characteristics." This speech pointed the direction for the development of community health services in China.
On July 18, 1999, the State Council issued the "Opinions of Ten Ministries and Commissions on the Development of Urban Community Health Services," which defined community health services as: "Community health services are an important part of community construction, guided by the government, involving the community, and supported by higher-level health institutions. They are primarily provided by grassroots health institutions, with family physicians as the backbone, making reasonable use of community resources and appropriate technologies. Centered on human health, with families as units, covering the community, and guided by demand, they focus on women, children, the elderly, chronic patients, and the disabled, aiming to solve major health problems in the community and meet basic health service needs. They integrate prevention, treatment, health care, rehabilitation, health education, and family planning technical services into a unified system (briefly referred to as 'six-in-one'), providing effective, economic, convenient, comprehensive, and continuous grassroots health services."
The World Health Organization believes that community health services can address 80% or more of residents' health problems. In 2000, the National Development and Reform Commission, the Ministry of Health, and eight other ministries and commissions jointly issued the "Guidelines on Urban Medical and Health System Reform," which included eight of the 14 guidelines related to the community.