Objective To provide evidence for the establishment of an essential medicines list,we investigated the institutional medicine supply in rural hospitals and community health service centers in Chengdu.Methods The trained investigators collected medicine sales records and information about the management of institutional pharmacies. Through in-depth interviews with the pharmaceutical personnel,we inquired into the drug supervision and supply networks in rural areas.Then we performed secondary research based on a comparative analysis of drug classification, administration and pharmacies in developed countries.Results Seven township hospitals/community health service centers had pharmacies,facilities,storage,and a clean environment.Three of them used electrical databases to manage medicine sales records.Five township hospitals and 5 village medical rooms purchased medicines from the drug supervision and supply networks every week.In this way,they ensured the quality and accessibility of drugs in rural areas. In the urban community health service centers,medicines were supplied based on the traditional commercial distribution system.Conclusion Rational allocation of health resources to set up institutional pharmacies and village medicine rooms is important.The supervision of village medical rooms must be stricter.We should expand the use of electrical databases and integrate the supervision and supply networks with the supply system of the essential medicines.

Objective The Chengdu initiative essential medicine policy is part of the Special Healthcare Program of Comprehensive Reform for Coordinated and Balanced Urban-rural Development. We aimed to investigate the current situation of medicine use in rural hospitals and community health service centers, so as to provide evidence for policy-makers to select essential medicines and facilitate rational use of medicines. Method We selected 7 township/community health institutions from which to collect medicine use information, including medicine category, number of medicine categories, cost and consumption. Descriptive analysis and the ABC classification method were applied for statistical analysis. Resulte The number of medicine categories used in the community health institutions was four times greater than that in the township health institutions. Traditional Chinese medicine preparations accounted for 40% of the total medicine cost. Polypharmacy, overuse of injections, and improper use of antibiotics were major manifestations of the irrational use of medicines. Conclusion The selection and use of essential medicines should be base on high quality evidence as well disease burden, the economic situation and specific demands in different areas. Drug and therapeutics committees should be set up to perform dynamic monitoring, education, evaluation and continual improvement of an essential medicines list.

Objective To understand the current situation of Chengdu primary health workers' performance baseline, and to provide decision-making proof and policy recommendations for Chengdu Coordinated and Balanced Urban-rural Development as well as improve primary health workers' performance in China. Method See the second study in this series. Result The number of the patients of the Chengdu seven Rural Hospitals / Centers showed a trend of slow increase, and all was higher than the national rural hospital average level except the 2 most remote rural hospitals( "Renhe" and "Bailu" ). The seven Rural Hospitals / Centers could provide data about the "Six in One" work, and the performance was generally better than that of the world and the national average level , but showed a decreasing trend from the first circle to the third circle in Chengdu. The rate of patients' satisfaction and very satisfaction for the Rural Hospitals / Centers "Six in One" work reached 65%-80%, but the rate of health workers' job satisfaction and very satisfaction only reached 9%-46%,and also showed a decreasing trend from the first circle to the third circle. Conclusion The Chengdu primary health workers provide "Six in One" health service with a higher quality than the world and the national average levels. However, the number of the workers is less than enough; the human managerial structure is irrational; the educational and professional levels are low; their treatment and the work environment arepoor. The distribution density , the academic qualification and the structure rationality of professional ranks of health personnel show a decreasing trend, and the difficulty of the service is gradually increasing from the first circle to the third circle, which causes the satisfaction rate of the workers' job to decrease gradually from the first circle to the third circle. Suggestion: ① To make special performance assessment standard for special health institutions or personnel, and to give the continual oriented training chance for current health personnel. ② To integrate the regional health resources; to establish long-term and stable regional bilateral appointment help policy, technical and rational two-way referral system and indicator systems. ③ To take measures to solve the problems affecting the professional promotion and improvement of the grass-root health personnel.