Second Training Workshop of China-Tennessee Rural Healthcare Exchange Program completed

Tennessee Governor Phil Bredesen initiated the program in 2007 in partnership with the Chinese Ministry of Health Foreign Loan Office. Dr. Sten Vermund, the Director of the Vanderbilt Institute for Global Health (VIGH), played a vital role of proposing this collaboration with the Foreign Loan Office. Three U.S. academic institutes are involved in the program, including Vanderbilt University, East Tennessee State University, and the University of Memphis.

In 2008, with sponsorship from the Tennessee government, a delegation of 43 Chinese health officials and scholars were invited to attend a three-week training program in three Tennessee universities and tour a wide range of healthcare and public health delivery sites in both rural (east Tennessee and southwest Virginia) and urban (Memphis and Nashville, Tennessee) settings. The participants have since published an article in a Chinese language academic journal called “Journal of Chinese Health Economics” reflecting their experiences and observations from their visit to Tennessee.

As a continuation of this program, the second training workshop was sponsored by the Chinese Ministry of Health and was held in Xi’an, China, with eight faculty members and state health care officials from Tennessee working with over 100 participants from eight pilot project provinces and a panel of central government experts in a variety of formats, including seminars, workshops and group presentations. VIGH faculty member Dr. Han-Zhu Qian was among the Tennessean training delegates. These trainings have covered the following topics:

1. International experience on the improvement of access to health services in remote areas among vulnerable populations
2. Rural health and rural public health in the U.S.
3. Evidence-based rural public health practice
4. Global approaches to public health
5. Evidence-based priority settings in public health
6. Response to public health emergencies
7. Health care management and service delivery in the U.S.
8. Health maintenance organizations and management care practices in the U.S.
9. Supervision models and methods of medical institutions in the U.S.
10. Quality medical service control in the U.S.
11. Basic health services delivery
12. Health care financing
13. Payment methods for medical insurance in the U.S.
14. Health marketing and health communication
15. Telemedicine
16. Development of an integrated, patient-centered, health care information system
17. Leadership development.
    

The Tennessee delegation also toured several rural health facilities and had dialog with frontline health care workers in the An-kang area of southern Shaan-xi Province before returning to Xian to begin the workshop. The first-hand site visits to medical facilities and other healthcare entities such as providers of telemedicine, medical devices, and both western and traditional pharmaceuticals were most beneficial to the Tennessee delegation in improving their understanding of rural health care needs and challenges in China. These visits, though brief, substantially improved the relevance of the delegation’s presentations to the workshop participants during the training sessions that took place from June 15-19, 2009.

From the 1950s to 1970s, China built a three-tier rural health care system (county hospital, township hospital, and village clinic) and community-based rural health financing and provision system called the Rural Cooperative Medical System, which provided basic health care to every village. Free vaccinations, antibiotics, and instruction on sanitation led to a rapid rise in life expectancy and decrease in maternal and infant mortality. The rapid economic development brought by free-market reforms since the late 1970s resulted in a collapse in the country's health care system in rural areas. Under-funded hospitals refused treatment to the poor, and medical professionals left impoverished rural areas. Many rural residents are left without basic medical care. Now, the Chinese government has pledged to rebuild the health care system and provide health care insurance for rural populations, partly to boost confidence and encourage consumer spending while its export-oriented economy shrinks.

By using a loan from World Bank, Chinese government is implementing pilot rural health projects in 40 counties in eight provinces. Its primary objectives are to increase more equitable access to quality health services, improve financial protection, and better respond to public health threats in these pilot provinces and counties, as well as to learn lessons for supporting healthcare reforms in non-project areas. The China-Tennessee Rural Healthcare Exchange Program serves well for this pilot project. Both Tennessee and China are exploring new funding possibilities to support future activities for this Exchange Program.