China: Doctors on Wheels Bring Quality Care to Rural Residents

Chongqing, China – Chen Guangming, a 70-year-old resident in a small village deep in the Chinese countryside, sits in the courtyard of her home, waiting for guests.

They are regular visitors, a couple of doctors who check up on her after she was diagnosed with high blood pressure two years ago. Her condition has stabilized and she has not needed hospitalization in the past two years. “I feel healthy now,” she says.

In the meantime, Zhou Fengyong, one of the doctors who do the follow-up care for Chen, rides her bike through twisting mountain roads. It rained earlier and started drizzling again. The road is wet and slippery.

Doctor Zhou has come to terms with different situations on the road. She bikes to see her patients at least five days a week, under the scorching sun or in drenching rain.  

As soon as Doctor Zhou arrives in Chen’s house, she pulls out a blood pressure meter from her backpack and checks Chen’s blood pressure. Three other doctors, who came together with her also on bikes, perform checkups for Chen’s family members.

The family also receives a brochure with health tips and listens to the doctors explain how to better manage health by eating healthy and exercising more.

“In the past, we had to go to hospitals in the closest city when we were sick. They were far and very crowded. It was not easy,” Chen says. “Now it is different. Doctors visit us at home and take care of our health. So we get ill less often and hospital visits are less frequent.”

Chen and her family are not charged for these regular checkups. The services are covered by the government’s basic public health program and free to rural residents. 

Bringing “Sunshine” Health Care to Rural Households

Doctor Zhou and her fellow doctors are members of a special health service team from the Township Health Center of Tongguanyi, on the outskirts of Chongqing Municipality in China’s southwest.

They pay house calls to patients living in rural areas who have difficulty traveling long distances to get to a hospital, especially the aged with chronic diseases like Chen.

The Township Health Center of Tongguanyi named the team “Sunshine on the Road”, since the team’s mission is bringing to rural families health care that is as warm and accessible as sunshine.

In China’s health care system, people with ailments typically go to large hospitals in big cities and wait in long queues for hours to see a specialist rather than starting with a family doctor in their communities.  

But for rural residents, transport to city hospitals can be exhausting and expensive. So with the “Sunshine on the Road” team, the Township Health Center of Tongguanyi has adopted a family medicine approach to fill the gap.  

“We keep track of people’s health status so that we can design a more personalized health management plan for them,” says Doctor Zhou Fengyong. 

“Early detection, prevention and treatment of diseases will help improve their health,” she says. “Going to residents offers a good chance for health education, to help them form a healthy lifestyle and develop healthy behaviors.”

Nurturing Innovations in Rural Health Care

What is being piloted in Tongguanyi is one of the many innovations under the “Rural Health Project”, part of the World Bank’s support to China’s ongoing health care reform and efforts in strengthening health services at the grassroots levels to reduce the wide gap that exists between the country’s urban and rural areas.

Stronger health services at the grassroots levels mean that rural residents could enjoy lower health care costs, better quality of care and more efficient service delivery, says Shuo Zhang, a senior health specialist at the World Bank. “Encouraging the project counties to come up with innovations and pilot different ways to achieve this goal is a very important feature of this project,” she says.

Zhang Ping, Chief of the Health Bureau of Jiulongpo District, Chongqing, says the process of innovating has helped introduce new concepts and solutions. “That is our biggest gain from the project. It is like handing us a key to open the gate for addressing many of the challenges in rural health care in China,” she says.

She cites two innovations in her district that have worked well, first, a performance-based pay system that has been implemented in all the primary care facilities in her district as well as other project counties. The system links employees’ salaries to their performance at work – how much they do, how well they do, and the patients’ feedback.

Also, rural doctors now have more resources to improve their professional skills. For example, in the Jiulongpo District, rural doctors are paired with experienced doctors in city hospitals to observe and learn from the good practices and get one-on-one mentoring from them.

Doctor Zhang Chongzhong with the Township Health Center of Tongguanyi says that an important learning for him is the need to shift from mere medical treatment to integrated services of treatment and prevention. “Now I talk to patients about their lifestyles, trying to make an impact on both their current and future health and not just provide one-time treatment.” he says.