Evaluation of responsiveness of community health services in urban China: a quantitative study in Wuhan City.

Abstract

BACKGROUND: With the objective of the national health services systems reform to move care to the community, community health services (CHS) are becoming the gateways of the health system in China. This study aims to evaluate the levels and distributions of the responsiveness of CHS in urban China and identify the relevant features to provide the government with policy advice on the improvement of CHS responsiveness. METHODS: A total of 872 face-to-face interviews were conducted in community health centers (CHCs) from 2007 to 2009. Indicators of responsiveness that were recommended by the World Health Organization were adopted, and non-conditional logistic regression analysis was performed to explore the factors associated with the levels and distributions of the responsiveness of CHS. RESULTS: The responsiveness scored at a fairly 'good' level of 7.45, 7.45, and 7.46 for CHS in years 2007, 2008, and 2009, respectively. The representative responsiveness inequality indexes were 0.097, 0.101, and 0.109, respectively, indicating the moderately balanced distributions of responsiveness in these three years. During this period, the scores of responsiveness elements were highest at 7.44 to 8.34 in "dignity", "communication", and "social support", while lowest at 6.76 to 7.54 in "autonomy", "confidentiality", and "basic amenities". The results of the logistic regression analysis suggested that five elements (OR value), namely, "dignity" (1.414-3.345), "communication" (1.218-3.655), "basic amenities" (1.251-2.362), "prompt attention" (1.098-1.590), and "autonomy" (1.416-2.173), had significant associations with CHS responsiveness. CONCLUSIONS: The responsiveness of CHS in Wuhan City was fairly good but still requires further improvement, particularly on the working conditions of CHCs and communication skills trainings among CHS workers.