Strengthening community-based health care: Addressing human resource needs

China faces a rapidly rising burden of non-communicable diseases, where 79% of deaths are due to chronic diseases. International experiences have shown that chronic disease is expensive to treat in hospital settings, but can be effectively prevented and managed through community-based primary care. Despite this, community health centers in China are widely available but underutilized, while tertiary hospitals are routinely used for minor health problems. Using data from China's National Health Services Surveys and other sources, this study examines existing health human resources to explore the gaps in meeting public needs and how these can be effectively addressed. Results show that though community health services are perceived to be convenient, many patients feel the quality is poor and do not trust them. The average level of training of the health workers in urban community health centers is low, with only a quarter of doctors having a 5-year medical degree. Nurses are outnumbered by doctors, though they are key providers of primary care. In order to strengthen primary care resources to address community needs, we recommend a new curriculum be developed for primary care providers, existing training institutions be strengthened, incentives for performance and retention be introduced through appropriate compensation, and supervision be provided through vertical integration with higher levels of care. This approach could build consumer confidence, and provide cost-effective community based services and appropriate referral services to address the growing burden of chronic disease in an efficient and equitable manner.