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M-13: Development Challenges for Maternal and Child Health Care Institutions in China: A Qualitative Study in Chengdu
University of Macau Macao
To ensure sustainable development of Maternal and Child Health Care Institution (MCHI) in China, this study qualitatively identifies the key development challenges by a case study of Chengdu City. Six challenges were revealed from the view of key informants along with governance reform suggestions.
In August 2016, Qualitative approaches, including focus group, semi-structured interview and documental analysis were employed to some key officers of district MCHI and key government institutions for studying MCHIs in Chengdu City, China.
The study revealed six main development challenges for MCHIs, relationships among these challenges were summarized as Figure1.
Challenge 1: Incapability to provide differentiating medical service
The participants generally thought that MCHIs needed to differentiate themselves from general hospitals by providing medical service crossing the continuum of maternal and child health care. Which can be explained as:(1)Inadequate capability to provide advanced care;(2)Difficulties to integrate clinical and care;(3)Lack of innovation capability.
Challenge 2: Lack of sufficient financing
While all the participants thought that government greatly increased investment into MCHI in the past several years, they also agreed that MCHIs still had the problem of sufficient financing. They pointed out two reasons:(1)Insufficient and unstable government funding;(2)Price control on medical service by government.
Challenge 3: Shortage of gynecologists and pediatricians
All the participants acknowledged that MCHIs should input more financing to attract and keep gynecologists and pediatricians.
Challenge 4: Limited facilities and medical equipment
Since all the facilities and medical equipment of MCHIs mainly depend on government investment, the facilities and medical equipment of MCHIs were still not complete and appropriately-supplied compared with general hospitals.
Challenge 5: Weakness in applying information technology
The interviewees generally agreed that MCHI had less resources to invest into electronic health record and customer relation management like general hospital.
Challenge 6: Constraints of laws and regulations
The participants indicated that recently some private hospitals competed with MCHIs, they had advanced equipment and attracted experienced gynecologists and pediatricians by offering higher compensation. MCHIs needed more investment except government input. But current laws and regulations constrained MCHI to acquire investment other sources.
This study found that MCHIs were facing the challenge of providing differentiating medical service. From a perspective of health system dynamics framework, service delivery is directly related to resources and governance. The challenge of incapability to provide differentiating medical service was much due to resource challenge and governance challenge. The resource challenges MCHIs faced including insufficient financing, shortage of gynecologist and pediatricians, limits of equipments, and weakness in applying information technology. However, these resource challenges were much rooted in the governance challenge. As public welfare institution, MCHIs had to solely rely on government fiscal input to construct main facilities, buy main medical equipment, and pay basic salary of employees.Consequently, MCHIs did not have autonomy to attract new financing input and reform its management system, which led to resource challenges above.Meanwhile, the government has its upper limit of fiscal input.Thus, government should open private investment into MCHI and introduce more flexible management mechanisms for more professional management, like public-private partnership.
While this study focused on Chengdu City at southwest of China, its findings can be advanced through future study. First, as MCHI needs to decide its service mode according to domestic social and economic environment, future study can understand deeper the possible service patterns of MCHIs according to different context. Second, while public-private partnership is suggested for sustainable development of MCHI, there are much uncertainties within public-private partnership. Future study needs to investigate the key governance structure and mechanisms that are specific to public-private partnership of MCHIs. Third, how MCHIs at different levels can cooperate with each other to realize medical value as one whole of specific health system demands further exploration.