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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2015, Vol. 9 Issue (2) : 239-250     DOI: 10.1007/s11684-015-0392-0
Sustaining health workforce recruitment and retention in township hospitals: a survey on 110 directors of township hospitals
Jingmin Zheng1,Jie Li2,Xingxing Jiang1,Bin Zhang1,*()
1. Department of Social Medicine, School of Public Health, Chongqing Medical University, Chongqing 400016, China
2. Department of Health Policy Research, School of Public Health, Chongqing Medical University, Chongqing 400016, China
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Township hospitals, the main provider of rural primary healthcare in China, are severely understaffed. International studies on factors influencing rural working are increasing; however, studies on factors affecting the recruitment and retention of health workers in Chinese township hospitals are limited. The current study aims to understand the motivation of health workers and arrive at a systematic framework of pluralistic factors that would help support health workers in terms of receiving posts and remaining in posts in township hospitals. A three-stage integrated quantitative and qualitative methodology was employed. First, a survey on 120 directors of township hospitals was conducted to learn the latest status of health workers in township hospitals and distinguish existing problems. Second, after sending these problems back to the directors, an open-ended pen-and-paper survey was conducted to ask the directors to identify the factors influencing the attraction and retention of health workers in township hospitals. Third, four focus groups were conducted to gauge the underlying reasons. Five problems from the questionnaire survey were recognized, and numbers of thematic factors were identified at the individual, professional, and treatment environment from the pen-and-paper survey and focus group. Similar to other studies, this framing of both non-financial and financial elements affected the attraction and retention of health workers in township hospitals, thereby filling the gap in a Chinese context. Although several factors had been recognized earlier, our findings further highlighted the importance of these factors. Meanwhile, the factors identified in this study were barely explored in literature. This paper identifies and develops multi-faceted factors to call for a bundled package of multidimensional incentives if decision-makers get interested. The evidence-based findings in our study can be used to provide China-specific policy recommendations on how to recruit and retain health workers in rural areas of China.

Keywords recruitment      retention      health workers      township hospitals      rural regions     
Corresponding Authors: Bin Zhang   
Just Accepted Date: 20 March 2015   Online First Date: 17 April 2015    Issue Date: 22 May 2015
URL:     OR
Groups Number (All= 110) Percentage (%)
Gender MaleFemale 1028 92.008.00
Age (years old) <3030?3940?49≥50 2504315 1.8145.4539.0913.65
Tenure (years) 1?34?67?1011?20>20 202730285 18.1824.5527.2725.454.55
Educational background Master’s degreeBachelor’s degreeAssociate degreeSecondary technical schoolNo medical educational background None3476NoneNone None30.9169.09NoneNone
Job title DoctorAssistant doctorOther medical techniciansNo medical technical title 7520141 68.1818.1812.730.91
Professional title No professional titleJunior professional titleIntermediate professional titleDeputy senior professional titleSenior professional title None504911None None45.4544.5510.00None
Tab.1  Demographic characteristic of participants
Regions Health professionals Registered doctors (assistant) Registered nurse
Fengdu County 1.86 0.71 0.51
Kaixian County 2.68 1.05 0.59
Yongchuan District 2.74 1.15 0.69
North of Chongqing 2.88 1.38 0.73
Chongqing City 2.86 1.35 0.73
West of China 2.84 1.22 0.82
Middle of China 2.85 1.24 0.81
East of China 3.42 1.48 1.03
Nationwide 3.18 1.32 0.98
Tab.2  Densitya of health professionals
Health worker category Number Percentage (%) Densitya
Doctor 1208 49.94 1.050
Nurse 681 28.15 0.592
Public health worker 112 4.63 0.097
Pharmacist (assistant) 94 3.89 0.082
Laboratorian and technician 89 3.68 0.077
Radiographer 75 3.10 0.065
Dental technician 34 1.41 0.030
Health management and support 126 5.21 0.110
Total 2419 100.00 2.103
Tab.3  Quantity and composition of health workers
Educational level Number Percentage (%) Chongqing’s percentage (%) Nationwide percentage (%)
Master’s degree holders None None 0.13 0.10
Bachelor’s degree holders 269 10.40 14.15 14.70
Junior college graduates 1074 41.53 53.48 44.30
Secondary technical school graduates 932 36.04 26.01 32.60
High school (and below) graduates 311 12.03 6.23 8.30
Tab.4  Educational level of health workers
In-migration (N/%) Out-migration(N/%) χ2 P value
Educational background 31.2371 <0.0001
Bachelor’s degree (and above) holders 195 (31.20) 196 (46.89)
Junior college graduates 264 (42.24) 158 (37.80)
Secondary technical school (and below) graduates 166 (26.56) 64 (15.31)
Specialty structure 2.4633 0.2918
Doctors 259 (41.44) 193 (46.17)
Nurses 218 (34.88) 138 (33.02)
Others 148 (23.68) 87 (20.81)
Total 625(100.00) 418(100.00)
Tab.5  Turnover characteristics of health workers
Yongchuan Districta Kaixian Countyb
2011 2012 2013 Total 2011 2012 2013 Total
In-migration 230 214 254 698 105 184 336 625
Out-migration 87 134 172 393 92 132 194 418
Tab.6  Turnover status of health workers
Individual factors Grueling commute between workplace and home
Unbearable to live apart from families
Quality of growth environment for children
Parents’ incitement for leave
Professional factors Serious tendency of “pulling out turnips from bottom to top”
“Doctors valued, others despised”
Workload and working conditions
Career advancement and continuing professional development
Rewards and punishments
Treatment factor Limited income
Tab.7  Thematic findings of reasons
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