What is the weakest link in China’s healthcare system?

Finance, infrastructure and governmental attention are all candidates, but Vice Minister of Health Gao Qiang suggested on Thursday that it might be the shortage of qualified professionals, particularly in rural areas and in the public healthcare system.

The ministry views bolstering medical services and improving the public’s ability to ward off infectious diseases as priority tasks for the next few years.

The central government has made great efforts to improve China’s public healthcare system and medical service in the rural areas since last year’s deadly SARS outbreak.

These efforts include increasing financial investment, building infrastructure and revamping policies and programs, Gao said at a two-day national health conference that opened Thursday in Beijing.

“However, one thing might be most important and it has been ignored. We must greatly strengthen talent-building in the various health fields,” Gao told the conference.

Without qualified people, the investment, advanced equipment and various improvement projects will mean nothing, he noted.

Official statistics indicate the rural areas, with 70 percent of the country’s population, have less than 30 percent of the medical resources.

More highly qualified healthcare professionals usually do not want to work in rural areas, choosing instead to throng to big city hospitals.

Nationwide, the number of doctors with a master’s degree or higher accounts for less than 1.5 percent of the total.

In the public health system, the situation is even worse, Gao said, noting: “In many disease control centers (CDCs) at the county level I have visited, about 90 percent of the staff are not professional workers.”

Gao’s concerns were echoed by Li Malin, vice president of Kunming Medical College, who said that medical students usually hesitate to work in CDCs because of the neglect from government and society, and low income.

Moreover, public health education has long been ignored in Chinese medical universities. For every 50 students majoring in public health, more than 1,000 are pursuing degrees in clinical healthcare.

The shortage of qualified doctors and public healthcare workers is also having a tremendous impact on the control of HIV/AIDS, said Gui Xi’en.

Gui is a renowned HIV/AIDS expert who discovered the HIV/AIDS epidemic among hundreds of farmers in central China’s Henan Province was caused by illegal blood sales.

Gui said there is a serious lack of experienced doctors in the HIV/AIDS epidemic areas, and most of the work of providing free medicines for AIDS patients is being done by village doctors who usually have little knowledge of AIDS treatments.

As a result, many rural HIV/AIDS patients have given up on the treatment or refused to take the drugs under medical supervision, Gui said.

The Ministry of Health will increase efforts to improve the training of doctors and try to change the situation that results in the big medical institutions “reserving” the most skilled doctors.

(China Daily April 9, 2004)