Document of the People's Government of Hainan Province 

Q.F.B. [2023] No. 23

Circular of the General Office of the People's Government of Hainan Province on Printing and Issuing the Implementation Plan for Promoting the Standardized Construction and High-Quality Development of Village Clinics in Hainan Province

To the people's governments of all cities, counties, and autonomous counties, as well as units directly under the provincial government:

The Implementation Plan for Promoting the Standardized Construction and High-Quality Development of Village Clinics in Hainan Province has been approved by the provincial government and is hereby issued to you. Please implement the plan earnestly.

 The People's Government of Hainan Province
Aug 9, 2023 

Implementation Plan for Promoting the Standardized Construction and High-Quality Development of Village Clinics in Hainan Province

In order to thoroughly implement the Opinions on Further Deepening Reform to Promote the Sound Development of the Rural Medical and Healthcare System issued by the General Office of the CPC Central Committee and the General Office of the State Council, this implementation plan, in accordance with the decision-making arrangements of village clinics development made by the provincial Party committee and the provincial government, is hereby formulated to comprehensively implement the policy on healthcare affairs with a focus at the grassroots level in the new era, to further improve the rural medical and health service system, to promote the standardized construction and high-quality development of village clinics across the province, to strengthen the foundation of the rural health service network, and to provide robust healthcare support for the comprehensive advancement of rural revitalization and the development of the Hainan Free Trade Port.

Ⅰ Work Objectives

1. Overall Goal

After three years of effort, the overall planning and distribution of village clinics across the entire province will be more rational. Efforts will be made to boost the modernization of infrastructure and ancillary facilities, refine relevant institutions and mechanisms, and conduct more standardized management. For rural doctors, efforts will be made to significantly improve their capacities and composition, to raise their remuneration, to effectively address related social security issues, such as pensions, and to maintain a workforce. Health management will be carried out in a smarter way, and disease prevention and treatment capacities will be enhanced. Plenty of work will be done to construct village clinics in a standardized manner, to ensure the supply of qualified rural doctors, and to achieve full coverage of standardized management and digital support. With the steady increase in various key indicators (Attachment 1), more healthcare needs of the rural population will be satisfied in a better way.

2. Annual Objectives

By the end of 2023, a new round of planning and refining standardized construction of village clinics will take place across the board. The star-rating assessment for village clinics will be initiated, and progress will be made in the intensive rural integration reform. Based on optimized allocation and improved functions, more than 80% of village clinics across the entire province will meet construction standards, and over 85% of village clinics will be in public ownership.

By the end of 2024, the intensive rural integration reform will be completed, and the star-rating assessment for village clinics will be conducted across the board. Over 95% of village clinics will meet construction standards, and more than 90% of village clinics will be in public ownership. Issues related to the treatment of rural doctors, including old-age pensions, will be essentially resolved.

By the end of 2025, standardized construction for village clinics will be completed across the entire province, with intelligent health management equipment, smart auxiliary diagnostic systems, and remote diagnosis and treatment. All village clinics will be covered by integrated management and star-rating assessment, and will be staffed with at least one qualified rural doctor.

Ⅱ Work Description

1. Enhancing Standardized Construction of Village Clinics

a. Improving the planning. Based on changes in forms of the countryside and in population migration, village-level medical resources should be reasonably allocated according to local conditions, in order to shift the focus from achieving the fully institutional coverage to ensuring the service coverage across the board. In principle, village clinics should be planned and set up with an administrative village as the basic unit; and for villages with a relatively large permanent population (over 2500 people), branches or central village clinics might be established based on realities. For villages with a relatively small permanent population (fewer than 800 people), in principle, their village clinics should be jointly established with neighboring administrative villages. In principle, no village clinics should be opened in an administrative village where a township health center is located, and relevant medical services should be provided by mobile clinics. Rural-urban fringes should be given priority in constructing community health service stations. Clinics for administrative villages and reclamation areas’ administrative regions at the village level should be planned and set up in a coordinated way.

b. Improving Infrastructure and Supporting Facilities.

(a). After adjusting the planning, for village clinics in public ownership with a business area reaching 60 square meters, their functional layout should be further improved. There should be four rooms at least which are separate and relatively independent, including a consultation room for a general practitioner, a treatment room, a pharmacy, and a public health room (observation room). It is imperative to ensure that functional areas of clinics are arranged reasonably and comply with relevant hygiene standards.

(b) For village clinics with a business area of less than 60 square meters or without public ownership, they should be improved based on rural comprehensive service facilities, such as working places for Party committees at the village level and village committees. If those working places are not available, relevant construction land should be guaranteed by local government in a coordinated way to construct a new village clinic, or to renovate and expand the old ones. For a new village clinic as well as a renovated or expanded one, its floor area, in principle, should not be less than 100 square meters, and branches or a central clinic (with a floor area of less than 150 square meters) should be established if there is a large covered population. Efforts should be made to encourage integrated construction and sharing usage of a public health room (observation room), a health education room, a convenience service room, a public restroom, and rural comprehensive service facilities. In principle, in newly built or expanded village clinics there should be a Traditional Chinese Medicine room and a rehabilitation room.   Environment-friendly toilets should be built in a standardized manner, and resting rooms for medical staff should be set up. Every effort should also be made to construct supporting facilities, including temporary storage rooms for medical waste, sewage disposal, firefighting facilities (equipment), air conditioners or cooling devices, and environmental improvement facilities.

c. Necessary drugs and medical devices. Based on the roles of village clinics and the actual needs for medical and healthcare services, efforts, in accordance with the Village Clinic Service Capacity Standards (2022 Edition) and the principle of "filling gaps and remedying deficiencies," should be made to strengthen the supply of basic devices, essential drugs, basic instruments, and basic office equipment (computers, printers, etc.), to enhance maintenance and upkeep, and to meet the requirements of initial diagnosis and identification of common and frequently-occurring diseases, prevention and control of infectious diseases, as well as the diagnosis and treatment relating to Traditional Chinese Medicine (TCM). By 2025, it is expected that all of village clinics across the province will provide at least 80 types of drugs. The village clinics should generally meet the B-level requirement for equipment and facilities (30 or more types), and those with better conditions are encouraged to meet the A-level requirement (48 or more types). The equipment and facilities, including AEDs, smart follow-up devices for key groups, and healthcare integrated machines, should be available in all village clinics.

2. Strengthening Standardized Management of Village Clinics.

a. Promoting Integrated Management for Rural Healthcare. It is necessary to properly replicate the experience of the intensive rural integration reform accumulated by Qionghai City. Based on their jurisdictions, township health centers should conduct unified management of six aspects for village clinics, including administration, business, personnel, medical products, financial affairs, and performance assessment, and take performance assessment results as a crucial deciding factor for handing out subsidies. Township health centers should be encouraged to support or manage village clinics.

b. Enhancing the service capacities of village clinics. Village clinics should give full play to their capacities to provide basic medical services, basic public health services, and health management services. If a village clinic cannot provide all three kinds of services, the relevant township health center should appoint medical personnel, or establish mobile clinics. It is imperative to offer and improve family doctor contract services, strengthen the role of village doctors as guardians of health, and provide continuous healthcare services for residents across the board and throughout their entire life cycles.

c. Intensifying assessment and evaluation of village clinics. For village clinics’ performance assessment and high-quality development evaluation, relevant major indicators should include medical insurance reimbursement, health management for key groups, and resident satisfaction, and they should also be significant references for allocating funds. Efforts should be made to establish a star-rating assessment and management mechanism for village clinics, and to promote relevant development and improvement through the assessment and evaluation, in order to improve service quality and capacity for the clinics. By the end of 2025, all of the village clinics are expected to complete star-rating assessments and implement relevant management.

3. Strengthening the Development of Rural Doctor Teams

a. Qualified medical personnel. Each village clinic should be staffed with at least one qualified rural doctor (including licensed physicians, licensed physician assistants, rural general practitioner assistants, and rural doctors) and necessary nurses. Highly skilled rural doctors are encouraged to conduct regular consultations at the affiliated township health centers. Township health centers should hire licensed rural doctors first. It is imperative to conduct a special plan for rural doctors selecting from university graduates, to recruit recent graduates with junior college diplomas or above in medical majors (including those who have not secured employment during the career choice period) to work in village clinics. These graduates will be exempt from the examination for rural doctor registration, but they must obtain a license within three years. Rural doctors are encouraged to take licensed physician (or physician assistant) examinations so that licensed ones (including rural general practitioner assistants) may account for over 60% of all rural doctors by 2025. Efforts should be made to raise the education levels of rural doctors, and at least 350 rural doctors graduated from specialized secondary schools under the age of 50 should be selected each year to receive higher continuing education at Hainan Medical University or Hainan Health Vocational College. Support should be provided to Hainan Health Vocational College in offering clinical medicine or general practice courses for rural doctors, in order to cultivate qualified medical talent for village clinics. It is necessary to promote the rural revitalization village doctor training project, and cultivate every year at least 180 young rural doctors with strong skills who are willing to work at the grassroots level. Efforts should be made to encourage in-service or retired physicians (under the age of 65) from township health centers and hospitals at the secondary level or above, and migratory-bird talent to work in village clinics. After conducting the rural integrated management, licensed physicians (or physician assistants) in village clinics should be involved in the professional title evaluation and employment system of township health centers.

b. Improving the service capacity of rural doctors. There should be more training for medical personnel working in village clinics on basic medical capacities (including TCM appropriate skills), as well as basic public health and health management capacities. It should be guaranteed that rural doctors will receive free training at medical institutions affiliated to municipal or county-level administration or qualified township central health centers each year. Intensified efforts should be made to train young rural doctors with the help of experienced physicians. After a round of training for rural doctors within three years, it is suggested that, by 2025, a proportion of village clinics capable of identifying and initially treating 20, 30, or 40 or more types of common and frequently-occurring diseases will reach 100%, 60%, and 40% respectively. Additionally, over 80% of village clinics may make use of 6 TCM appropriate skills covered by 4 categories.

Increasing the income of rural doctors. In principle, no less than 40% of basic public health services should be available in village clinics, and relevant basic public health service funds should be approved in a timely manner according to regulations. Rural doctors are encouraged to continuously improve their basic medical service capacities, expand the range of medical services provided by village clinics, and increase medical service income. It is vital to strictly implement insurance reimbursement policies on basic drug subsidies, general outpatient fees, and others. Policies on job subsidies for rural doctors should be fully conducted, according to Several Measures for Deepening the Reform of Incentive Mechanisms for Medical and Healthcare Talent Receiving Education at Grassroots Level (Q.R.C.J.T. [2022] No. 8).

c. Improving security policies for rural doctors, such as old-age pensions. Township health centers should shoulder responsibility for managing rural doctors who meet the job requirements and recruitment regulations for employees in public institutions, and enable them to be covered by social insurance according to relevant regulations. Other in-service rural doctors are encouraged to be covered by basic social insurance for enterprise employees or basic old-age insurance for urban and rural residents as flexible employees, and subsidies will be provided by municipal or county finances. After the implementation of rural integrated management, all staff in village clinics will be employed according to the principle of "admission by township and working for village," sign labor contracts with township health centers, and will also be covered by social insurance based on relevant regulations.

With subsidies from municipal or county finances, all village clinics should be covered by medical liability insurance. The municipal or county health commissions or health centers should be policyholders, and the medical staff of village clinics will be the insured. The insurance policy will be issued in a unified manner at the municipal, county, or township levels. The annual premium for each member of medical staff for village clinics should not be less than 500 yuan, so as to ensure the effective separation and transfer of relevant medical liability risks.

4. Strengthening Support and Guarantee Relating to Policy and Mechanism

a. Improving the mechanisms for grassroots health governance. Efforts should be made to strengthen the responsibilities of grassroots organs, such as township Party committees, governments, and village "two committees" (village Party committee and village committee), in terms of leadership, guarantee, administration, and supervision. After establishing and improving working mechanisms, they should give full play to their advantages in organization, mobilization and publicity and contribute to work relating to public health, epidemic prevention and control, as well as health management. This aims to enhance the capacity and level of grassroots health governance. The village committee should clarify the composition of its public health committee and relevant job roles within 30 days after the handover of power to newly elected members. Under the guidance of the relevant township (sub-district) and the leadership of the related village (community) Party committee, the public health committee will strengthen the development of relevant mechanisms, personnel, and capacities, aiming to enhance the standardization, systematization, and socialization of public health in the village (community).

b. Implementing finance supporting policies. The expenses for constructing necessary rooms of village clinics will be jointly paid by the provincial and municipal/county-level finances. Starting from 2024, subsidies for running village clinics will be provided by the provincial and municipal/county-level finances at a ratio of 7:3. The provincial budget should cover AEDs, intelligent assistance systems for diagnosis and treatment, improvement of rural doctors’ educational level (from specialized secondary schools to junior colleges), and one-time subsidies for rural doctors passing accreditation tests. The Expenses of the rural revitalization village doctor training project will be borne by municipal and county-level finances. Social donations and charity funds are encouraged to be used in the standardized construction of village clinics and relevant talent training.

c. Improving policies on medical insurance and drug support. Village clinics meeting relevant requirements should be timely listed in the designated medical institutions covered by medical insurance. Based on related regulations,

Some medical services relating to TCM herbal decoction pieces and appropriate skills should be covered by medical insurance in village clinics, including acupuncture, massage, cupping, and moxibustion. It is imperative to gradually increase the annual payment standards for outpatient services covered by medical insurance for urban and rural residents, to appropriately raise the reimbursement by village clinics, to support the development of the family doctor contract service mechanism, and to formulate policies on medical insurance payment and pricing to support the development of village clinics. Supporting services of outpatient drugs should be available for patients with hypertension or diabetes in village clinics. Rural doctors are supported in providing TCM services through shared TCM dispensaries or decoction centers at the county level. It is necessary to establish a mechanism to coordinate the supply of drugs within close medical consortia, in order to reduce loss and waste due to expiry. Village clinics are allowed to be equipped and use non-essential drugs that count for less than 20% of total drugs, and they should determine the proportion of clinical drug use in a reasonable way. The clinics are suggested to prioritize the use of drugs covered by the National Essential medicines List, the National Medical Insurance Catalog, the National Centralized Drug Procurement Catalog, and the National Negotiated Drug Catalog, to promote the rational clinical use of drugs, and meet the needs at the grassroots level.

d. Strengthening information technology support. It is necessary to create a terminal by integrating village clinics’ information systems, including grassroots medical institution administration, 5G Telemedicine, and "Village Doctor Services," and to ensure that all the clinics will be equipped with intelligent assistance systems for diagnosis. It is imperative to streamline system operation, to simplify data reporting, to achieve real-time information sharing, and to ensure health records will be updated timely and be accessible to residents. Efforts should be made to promote "Village Doctor + 5G Telemedicine," to expand new business models, such as "Cloud Pharmacy" and "Cloud Telemedicine" within urban medical groups or county-level medical communities, and to make sure that high-quality medical resources and information will also be available in village clinics. It is essential to boost the connectivity of information platforms relating to medical care and insurance, and to make good use of the "Village Doctor Services."

3. Implementation Steps

a. Initiation Stage (February 2023 - August 2023)

In August of 2023, the provincial administrations should issue an implementation plan for promoting the standardization construction and high-quality development of village clinics, organize a comprehensive investigation into village clinics based on municipal or county-level jurisdictions, as well as categorize and register those that do not meet the standardization requirements. Before the end of August, cities and counties should formulate construction plans for village clinics in their jurisdictions, specifying the number of clinics constructed annually and list. After filing with the Provincial Health Commission, an initiation meeting should be convened to officially start the construction.

b. Implementation Stage (September 2023 - November 2025)

Strictly following the construction plans, cities and counties should fulfill responsibilities, well organize, and arrange things, and ensure the completion of construction tasks by taking steps toward the development of infrastructure, equipment and supporting facilities, personnel, capacities, digitalization, and support mechanisms. The Provincial Health Commission and relevant organs should enhance coordination, provide training and guidance, and improve relevant policies and support measures.

c.Evaluation Stage (Every December)

Cities and counties are required to submit, in written form, the progress of annual construction tasks to the Provincial Health Commission by the end of every November. After receiving the reports, the Provincial Health Commission should organize expert assessments in accordance with relevant standards, as well as summarize and exchange experiences.

4. Organization and Implementation

a. Strengthening Organization and Leadership:

Local governments at the municipal and county levels must effectively shoulder primary responsibilities. In accordance with relevant regulations, the construction and high-quality development of village clinics should be listed in government working objectives and assessment targets. Based on practical considerations, they should develop working plans, coordinate fund supply and construction, and ensure work on village clinics will progress in an orderly and effective way. A coordinated group should be established at the provincial level, and relevant departments and bureaus should jointly make coordination and support efforts to ensure the objectives will be achieved on schedule. 

b. Enhancing Supervision and Evaluation:

Cities and counties should refine and implement detailed measures based on working objectives and tasks. It is necessary to make detailed working plans, progress according to the blueprint, and join hands to move forward. The Provincial Health Commission, in collaboration with relevant departments, will create a mechanism for supervision, inspection, rewards, and penalties. Efforts should be made to strengthen supervision and evaluation, promptly report progress, and ensure that actual progress will be made.

c. Publicity and Guidance

Proper publicity and guidance should be conducted at all levels to further unify in mind and achieve consensus. It is crucial to identify and publicize exemplary cases concerning the improvement of health service levels in village clinics. More efforts should be made to guide public opinion, and promote the implementation of policies and measures related to the standardization construction and high-quality development of village clinics. It is significant to positively publicize, report models, timely summarize and share useful experiences and practices, and play a demonstrative and leading role.

Attachment 1: Key Indicators for Promoting the Standardized Construction and High-Quality Development of Village Clinics in Hainan Province

Attachment 2: Task List of the Implementation Plan for Promoting the Standardized Construction and High-Quality Development of Village Clinics in Hainan Province