Alibaba Health Leverages Internet to Empower Grassroots Medical Poverty Alleviation: A Case Study of Nangqian County People's Hospital in Yushu

Nangqên County, under the jurisdiction of Yushu Tibetan Autonomous Prefecture in Qinghai Province, is located at the southernmost tip of the province, with an average altitude exceeding 4,000 meters. Traveling from the nearest Yushu Batang Airport to Nangqên County requires a drive of more than three hours along winding mountain roads. The high-altitude environment, characterized by low atmospheric pressure and hypoxia, often leaves visitors from lower-elevation regions disoriented. Symptoms of acute mountain sickness, such as dizziness, shortness of breath, and chest tightness, are common, severely hindering learning and communication.

As the hinterland of the Sanjiangyuan (Three-River-Source) region, Nangqian County is a semi-agricultural and semi-pastoral area dominated by animal husbandry with supplementary agriculture. It is regarded as the “sub-center” for the future development of Yushu. Since 2014, poverty alleviation investments in Nangqian County have been uninterrupted, with “cumulative investments in various funds for poverty alleviation totaling approximately RMB 1.973 billion.” Meanwhile, “the medical insurance enrollment rate among the permanent residents of Nangqian County has reached 100%.”

Nangqian County People's Hospital, which is responsible for providing medical services to insured individuals, has a maximum service radius of over 200 kilometers and once covered areas surrounding Tibet.Today, Nangqian County People's Hospital, with a total of 68 doctors, sees more than 4,900 inpatient visits annually and over 100,000 outpatient visits.

Caiwang Nanjia, Deputy Director of Nangqian County People’s Hospital, who has served at the institution for 37 years, recalled, “When I first joined the hospital in early 1983, the total staff, including nurses and logistical personnel, numbered only 27, with approximately 20 general inpatient beds. Today, the total workforce has grown to around 250. The hospital has evolved from a single inpatient department into a facility with 38 departments, featuring specialized clinical units in internal medicine, surgery, obstetrics and gynecology, pediatrics, and other disciplines.” Behind these impressive achievements, Nangqian County People’s Hospital, like other grassroots healthcare institutions, continues to face significant challenges.

The most pressing issue facing Nangqian County People’s Hospital is a severe shortage of physician resources. The hospital struggles to retain competent doctors, resulting in an overall low level of medical care. Most physicians at Nangqian County People’s Hospital hold associate degrees; those with bachelor’s degrees are rare, and individuals with graduate degrees are virtually nonexistent. This situation is partly attributable to the relatively underdeveloped state of local education.

In high-altitude regions, the treatment of cardiopulmonary diseases differs and must be adjusted according to the specific characteristics of these areas. However, research into the treatment of high-altitude diseases is hindered by the limited educational backgrounds and professional competencies of primary-care physicians. Furthermore, primary healthcare facilities lack adequate medical equipment. Even when such equipment is provided, there is a scarcity of clinicians proficient in its operation, ultimately resulting in the equipment being left unused.

Nangqian County People's Hospital has long been striving to address the challenges of scarce human resources and limited clinical competence among physicians. Previously, the hospital conducted internal training programs in which senior physicians mentored newly hired doctors to enhance their professional capabilities. According to Caiwang Nanjia, Vice President of the hospital,“It is very difficult to recruit talent from outside. The goal of our county hospital’s talent development and training program is to invite external professionals to join the hospital and to send physicians to higher-level hospitals for advanced training, thereby improving the overall professional competence of our medical staff.”

As early as 1987, Qinghai Red Cross Hospital signed a cooperation agreement with Nangqian County People's Hospital to help improve the professional competence of physicians and cultivate specialized talent. Mi Fuhai, the current Deputy Director involved in the medical aid program for Tibet, is a representative figure in this effort. Originally a hepatobiliary surgeon at Qinghai Red Cross Hospital, Dr. Mi has been dispatched to work at Nangqian County People's Hospital.

Vice President Mi Fuhai introduced the roles of the recipient and supporting institutions: “The recipient and supporting parties engage in prior consultations to assess the needs of grassroots hospitals, subsequently dispatching specialized physicians to address these needs and enhance professional research capabilities.” When hospitals face temporary demands for managing complex and refractory cases, Qinghai Red Cross Hospital also deploys experienced physicians to grassroots hospitals following mutual consultation.

On-site assistance enables more effective resolution of region-specific diseases and other challenges in primary care hospitals. Meanwhile, hands-on practical training helps primary care physicians better master key treatment techniques. Furthermore, when patients are referred from Xiangqian County People’s Hospital to Qinghai Red Cross Hospital, primary care physicians can stay informed about the patients’ latest progress, monitor their clinical course, and evaluate the appropriateness of prior diagnosis and treatment.

However, the actual process of facilitating doctors’ “inbound outreach and outbound engagement” proves more challenging than anticipated. Dr. Guo Yi, Director and neurosurgery specialist at Beijing Tsinghua Changgung Hospital, recalled, “During one poverty-alleviation mission, we spent four days in total, with two days consumed by travel. We also suffered from altitude sickness, leaving us with only half a day to provide clinical services at the local hospital.”

As a representative of the physicians dispatched by Nangqian County People’s Hospital, Zashi Pengcuo, a resident physician at the hospital, added, “In the past, traveling to Yushu or Xining for training involved not only long distances but also challenges related to funding, inability to care for family members, and local adaptation, which to some extent affected our motivation and learning outcomes.”

Offline physician assistance and training entail substantial costs in terms of time and money, hindering the enhancement of medical service capabilities at Nangqian County People’s Hospital.Can online methods be used to provide assistance to regions with underdeveloped medical resources, while also addressing the challenges faced by offline aid efforts?

AliHealth, in collaboration with charitable physician organizations such as China Volunteer Doctors, has explored and established a medical poverty alleviation platform that integrates online and offline services. In its medical poverty alleviation initiatives, AliHealth first partners with physician organizations to conduct on-site free clinics and surveys at the grassroots level, gaining an in-depth understanding of local conditions. Leveraging AliHealth’s digital capabilities, the company then formulates personalized assistance plans.

Ling Feng, founder of the Chinese Volunteer Doctors initiative and chief expert in neurosurgery at Xuanwu Hospital of Capital Medical University, recalled, “During our time in Nangqên County, E Cairen, the president of the county people’s hospital, immediately presented us with a list of training needs covering more than 50 common diseases.” This left a deep impression on Ling Feng.In fact, the primary needs of Nangqian County People's Hospital remain focused on managing high-altitude diseases, common conditions, and frequently occurring illnesses; providing initial diagnosis and treatment for critically ill patients; and ensuring that physicians stay abreast of cutting-edge therapeutic approaches.

Upon learning of the needs of Nangqian County People’s Hospital, AliHealth collaborated with organizations such as Chinese Volunteer Doctors to establish a comprehensive system platform. Under this initiative, a specialist is assigned each week to conduct online training for the hospital’s physicians, focusing on a specific disease theme. E Cairen, President of Nangqian County People’s Hospital, stated, “We have previously engaged in some online training programs, but doctors often struggled to maintain consistent participation due to various reasons. Leveraging the platform provided by AliHealth enables us to organize and encourage participation more effectively.”

How to Better Motivate Physicians Has Always Been a Question Worthy of Reflection.Some physicians are overly busy with offline duties or lack sufficient motivation, resulting in suboptimal learning outcomes. AliHealth addresses this by providing operational support and incentivizing online learning among physicians. Initiatives include encouraging doctors to share their learning insights, regularly recognizing and rewarding active learners, and granting physicians with high point scores greater access to communicate with senior specialists. This enables senior specialists to assist primary-care physicians in analyzing complex cases. To further reinforce learning outcomes, AliHealth also provides course recordings and post-course examinations for primary-care physicians. Furthermore, the platform built by AliHealth automatically tracks each participant’s learning activities and interactions. These records can be fed back to cooperating primary-care hospitals, helping them better organize and supervise their staff’s learning, thereby ensuring that the effectiveness of online training is fully realized.

Regarding the specific curriculum design, AliHealth has tailored the program to meet the needs of Nangqian County People’s Hospital, focusing on the treatment of common and frequently occurring diseases, as well as the preliminary diagnosis and management of critical and severe conditions. In terms of frequency, online instructional sessions are scheduled primarily on a weekly basis, with an annual plan comprising 58 lectures. AliHealth remains flexible to accommodate any ad-hoc teaching requests from the hospital. Given the specialized nature of the course content and the limited capacity of grassroots physicians to absorb complex material, these physicians are encouraged to engage in online discussions with the instructing physicians and participate in post-session exchanges.

Nangqian County’s geographic location makes patient transfer particularly challenging. For Nima Jiangcai, a young physician and Director of the Emergency Department at Nangqian County People’s Hospital, the hospital often serves as the first point of contact for patients. Primary care physicians require substantial clinical knowledge to manage patients’ acute conditions.Through online learning and training, primary care physicians can better manage critical and severe conditions, provide initial diagnosis and treatment, perform surgeries, and facilitate more effective referrals of patients to higher-level hospitals.

In the ongoing online training program, in addition to enhancing primary care physicians’ ability to manage common and frequently occurring diseases, it also helps standardize the clinical diagnosis and treatment processes at Nangqian County People’s Hospital.Moreover, certain departments at Nangqian County People’s Hospital have gradually developed during this process. For instance, the newly established CT department, equipped with advanced imaging devices and supported by online training in relevant technical expertise, now enables physicians to diagnose patients’ conditions effectively.

Due to limited local educational levels, patient compliance is often low. Previously, Nangqian County People's Hospital would use messaging apps and telephone follow-ups to monitor patients' conditions and inform them of precautions.With the involvement of AliHealth, primary care physicians with available capacity can not only join AliHealth’s internet healthcare platform to reach a broader patient base online but also leverage DingTalk for patient population management and health education, thereby improving adherence among patients with chronic diseases.

Ling Feng, the founder of China Volunteer Doctors, stated, “There is no doubt that leveraging the internet to enhance the professional competence of primary-care physicians, thereby addressing the imbalance in China’s healthcare standards, will prove to be a beneficial supplement and a key direction for offline poverty-alleviation efforts.”

It is not only Nangqian County in Yushu Prefecture that faces challenges in grassroots healthcare; similar issues are also present in regions such as Ganzi Tibetan Autonomous Prefecture and Songpan County in Aba Prefecture, Sichuan Province, as well as Weinan in Shaanxi Province. AliHealth has extended its reach to these areas and, in collaboration with the Chinese Volunteer Doctors Organization, has conducted offline poverty-alleviation free clinics and research in counties such as Yutian, Luopu, and Moyu in Xinjiang. AliHealth expects to launch digital healthcare poverty-alleviation projects in these regions in the near future.

Ma Li, Senior Vice President of AliHealth, stated in an interview, “Only when doctors reach the grassroots level can they truly understand the prevalent diseases at that level, the health status of the local population, and the prevailing medical conditions.” Based on this insight, AliHealth has conducted offline visits to assess grassroots needs, including determining which courses to offer, which specialties to cover, the pacing of the curriculum, and the overall planning. Meanwhile, through operational support, AliHealth helps grassroots hospitals learn to utilize the DingTalk platform and provides them with backend data summaries and feedback to encourage offline physicians to engage in continuous learning.

AliHealth plans to sequentially launch modules including one-on-one remote case discussions, remote consultations, remote ward rounds, and public-domain content operations targeting a broad audience, building upon its existing one-to-many online training framework. These initiatives aim to effectively enhance the professional competencies of healthcare workers in poverty-stricken areas and grassroots communities.

Ma Li pointed out that the ideal scenario involves online doctors actively participating in training and interactions, thereby fostering more diverse forms of engagement and a more vibrant environment for learning and exchange. In selecting physicians, AliHealth prioritizes those who are compassionate and committed to providing sustained assistance, followed by consideration of their technical and clinical expertise (typically associate senior physicians at tertiary Grade A hospitals). Ma Li, Senior Vice President of AliHealth, also called on more compassionate institutions and physicians to join the initiative. Meanwhile, he welcomed primary healthcare institutions in need of support to contact AliHealth, working together to address the imbalance in medical resource distribution across China.

AliHealth plans to promote a new model of digital medical poverty alleviation over the next three years, covering 100,000 primary care physicians in more than 1,000 counties across China and benefiting 200 million people. Meanwhile, AliHealth will establish a permanent “medical advisory team” for remote areas in western China.