SHI YU/CHINA DAILY

Measures help bring together top-tier, grassroots health institutions

Whenever Zhang accompanied his grandmother to the hospital in the past－the 80-year-old has recently received a coronary stent－he said his greatest concerns were convenience and trustworthy care.

Until recently, the two were contradictory. The clinic in their hometown of Balidian township in Zhejiang province, was small and inefficient, and it was hard to secure appointments at well-known hospitals in Huzhou city, where Balidian is located.

"Just driving to Huzhou and finding a parking lot would take me several hours," said Zhang, who only gave his surname. "But now, my grandma can obtain consultations from three experienced doctors at the same time near her home."

The conundrum facing Zhang and his grandmother, who is surnamed Sun, has been solved thanks to a set of healthcare reform measures that included arranging closer partnerships between top-tier hospitals and grassroots medical facilities.

The three doctors that discussed Sun's diagnosis and treatment plans via video link one October morning were from the First People's Hospital of Huzhou. A doctor at the Balidian township health clinic helped set up the meeting and kept the records.

The partnership between the two institutions began in March 2019, when the city-level hospital was designated as the overarching body in charge of guiding the development of a number of lower-level healthcare facilities, including the Balidian clinic.

Xu Wei, deputy head of the Balidian clinic, said that before the partnership, neither patient information nor the availability of appointment slots were shared between urban and rural hospitals.

"Under the partnership, the hospital in Huzhou is required to reserve appointments for serious cases at its rural partners," he said. "Sun underwent surgery, but she suffers from multiple chronic illnesses and needs to make frequent follow-up visits to the hospital," he said.

During the online session, Sun received advice from a pharmacist, a nursing care professional and a cardiologist.

Zhang said that "such a scenario was unimaginable a few years ago".

China's healthcare reforms are poised to benefit an increasing number of patients like Sun, particularly residents of rural and less-developed regions.

A guideline released in early October by the State Council, China's Cabinet, requires local governments to enact medical reforms based on the success of Sanming, a city of about 2.5 million people in Fujian province, which is widely regarded as the trial ground of China's healthcare reform.

Xu Shuqiang, head of the National Health Commission's department of healthcare reform, said during recent briefings that a key lesson from Sanming is the need to consolidate a region's medical resources and rearrange them to improve grassroots medical services.

The new guideline also stressed the need to ramp up the establishment of medical partnerships, improve clinical treatment capacity at county-level hospitals, nurture more rural doctors and encourage more people to seek medical help at local healthcare facilities.

After enrolling in the medical partnership program, the Balidian clinic has set up a number of new departments, including ones targeting rehabilitation, skin diseases, dental health, high blood pressure and diabetes, according to Ye Qing, head of the township-level clinic.

An 84-year-old patient surnamed Lu, who had a stroke about a month ago, is now able to receive regular rehabilitation at the clinic's new convalescent rehabilitation ward.

"Our neighbor recommended the place, saying that therapies here are up to standard and affordable," said Lu's son, who did not offer his name. "In the past, we had to travel to hospitals in the city center, which was strenuous for my mother and cost a lot more."

Wang Fei, the doctor attending Sun, was dispatched by the First People's Hospital of Huzhou to help build and manage the new department.

"There is a growing demand for rehabilitation services for the elderly at primary care clinics, particularly as society is aging fast," he said.

"In Lu's case, she received surgery at the city-level hospital and was discharged after her condition stabilized," Wang said. "Neither she nor her family have the knowledge or the equipment to aid her recovery, so coming to the clinic was the most convenient solution."

According to local authorities, Huzhou has set up two city-level partnerships and eight county-level partnerships so far. Last year, more than 90 percent of visits paid to the city's medical institutions by rural residents occurred through local clinics.

In the meantime, Huzhou has stepped up efforts to nurture and retain grassroots healthcare workers.

Huang Lulu, a former pharmacist from Huzhou's Anji county, is about to become a rural doctor in her hometown of Dazhuyuan village after completing a three-year training program.

"My mother sent me information about the program in 2018," she said. "I just jumped at the opportunity, because I felt if I could get in and graduate from the program, I could work very near home and help people I have known since childhood."

Anji rolled out the program in 2018 after identifying a shortage of young rural doctors.

Huang said she first took lessons at the Zhejiang Chinese Medical University in Hangzhou, Zhejiang province, and received training in both traditional Chinese medicine and Western medicine. She then apprenticed at a clinic, and is now preparing to sit for her qualification exams next year.

"Rural doctors must have broad knowledge of common illnesses and be capable of delivering emergency aid," she said. "The program has taught me a lot and equipped me with a comprehensive set of skills."

According to local authorities, nearly 50 rural doctors like Huang have gone through the program so far.

Wang Gang, Huzhou vice-mayor, said the city planned to intensify efforts to monitor and manage chronic illnesses in the future, while continuing efforts to direct medical resources to the grassroots level.