outcome is a decrease in the number of rural doctors and the near elimination of health
care workers in Shaanxi province (see Table 3.). The dramatic reduction in health care
workers is because rural residents would rather spend money for medical services from
the country doctors rather than unlicensed health care workers. Without a medical
license or government subsidies, the rural health care workers cannot compete with the
country doctors. In Shaanxi, between 2001 and 2003 there was an 82 percent decrease in
the number of rural health care workers and only a 23 percent reduction in the number of
country doctors. According to an interview with an official from the Shaanxi Province
Public Health Department, the combination of the TFR and the personal contract
responsibility system have reduced the rural medical personal and has had a negative
influence on the provision of rural public health services.
The reduction of medical personal is also a problem in Anhui province where the
TFR was first introduced in 2000. Between 2001 and 2003, the number of rural doctors
decreased 14 percent and the number of health care workers declined 80 percent (see
Table 4.). Some districts experienced over 20 percent drop in rural doctors and over 90
percent reduction in health care workers. Thus the significant reduction in rural medical
practitioners is not restricted to Shaanxi or northwest provinces.
In Shaanxi province, the township governments also manage the village medical
clinics while the county manages the township and county hospitals.
a significant influence on the reduction of village clinics because of the elimination of
township fees (tongchou), but the county managed hospitals and medical personal have
suffered only minor reductions in facilities and staff. Between 2001 and 2003 the
number of village clinics in Shaanxi province dropped 25 percent (see Table 5.).
13
Interview with researcher from the Statistical Office of the Shaanxi Province Public Health Department
on July 15
th
, 2005.
14
At the township level the county (tiaotiao) manages the township hospitals and personal (see Table 1.)
19
Convention