Table 2 Capacity of LHWs delivering BPHS in PHC sectors

Staffing

Almost all the LHWs reported that they had to undertake several BPHS programmes simultaneously. The workload to deliver HR and health management for residents is very heavy. Almost all leasers revealed that PHC sectors lacked staff to deliver BPHS, particularly general practitioners (GP) and public health professionals.

Indeed, there is a lack of personnel…, everyone has a lot of work to do, at least two or three projects at hand. (Director of BPHS department in Chongqing PHC sector)

Our staff is definitely not enough. We 7 staff deliver HR for more than 50,000 residents. (LHW responsible for Health records)

All THCs lack public health professionals, and almost all BPHS programmes are delivered by nurses. (Director of PHC sector in Chongqing)

Staff size

All the leaders in the PHC sectors consistently reported inadequate posts for BPHS provided by the government in PHC sectors.

This THC does not have enough staff …. For example, we have a population of 100,000 in this township, but at the present, the government only provides 25 posts in this TCH for BPHS delivery, which cannot meet the requirements of the public health service. (Director of PHC sector in Chongqing)

Stability

Nearly all the leaders consistently agreed that LHWs were unstable due to low income and limited personal development.

We have 7 staff in the Department of Public Health, and all of them are retired nurses. They are not stable due to the low salary, and they often resign if they get new job. (Director of PHC sector in Guizhou)

The staff in the Department of Public Health is indeed not stable. Within 2 to 3 years, all of the staff turnover. (Director of BPHS department in Chongqing)

People are not willing to work in PHC sectors because the salary is too low there. That is the first reason. The second reason is due to the limited career development for young people. There are very few opportunities for promotion to a high professional title, which is a disadvantage of personal development for the youth. (Director of PHC sector in Chongqing)

Academic background structure

A majority of the leaders reported that the majority of LHWs had low levels of education, college or below.

We have 9 staff members in the Public Health Department, but only one graduated from college. …. You can see, the majority were nurse and graduated from technical secondary schools. We even have difficulty recruiting a clinic doctor who graduated from a medial university. (Director of PHC sector in Guizhou)

Major structure

All the leaders reported that the PHC sectors lacked staff with backgrounds in public health; most of the LHWs are nurses.

Now we really lack staff. We have no public health professionals. We have nine staff in the Department of Public Health with only one physician …. (Director of PHC sector in Chongqing)

In our CHC, now there are 18 staff; only 2 of them are doctors, and the rest are newly recruited nurses. They are only capable of filling out the forms related to BPHS delivery, but they have little knowledge about chronic disease management, such as hypertension, diabetes (Director of PHC sector in Guizhou)

professional title structure

All the leaders remarked that the majority of staff delivering BPHS only have junior professional titles. It is difficult to be promoted to higher titles because limited high professional titles are assigned to PHC sectors by the government, which in turn results in residents’ lower trust in the PHC sector’s quality.

As for professional title, only 3% of staff have the opportunity to be promoted to a high professional title. In this CHC, only 1 staff member can have a high professional title among the 30 staff. There are no more staff with a high professional title; we cannot provide qualified services to residents, and the residents would not trust your skills. (Director of PHC sector in Chongqing)

Competency

Most of the LHWs considered themselves incompetent to undertake their jobs due to a lack of professional knowledge or skills. Almost all the leaders complained that further competency building of LHWs is needed to deliver BPHS, particularly management of patients with severe mental illness and chronic disease management. LHWs lack professional knowledge and skills to guide medicine use, rehabilitation or follow up and assessment.

People with both professional knowledge and communicative skills are rare. (LHW responsible for Chronic diseases management in Guizhou)

We lack public health knowledge because most of us were nurses before. Now we are engaged in public health services. We are not qualified. (LHW responsible for health management for the aged in PHC sector in Guizhou)

We are incompetent. Regarding the education of our nine staff members in the Public Health Department, the highest education achieved is college, and they do not have any clinical experience. A few of them were nurses before, and some of them had no professional titles. They lack professional knowledge and have little knowledge of hypertension and diabetes management. (Director of PHC sector in Guizhou)

We lack professional staff for severe mental disease management,..., and our staff can only provide medication guidance and regular monitoring of the side effects of medicines. (Director of PHC sector in Chongqing)