China has made significant progress in increasing the quantity of health workers in rural areas. Attention is shifting to improving the quality of health workers. This article documents several features of health workers in rural China. Many have not received formal training to a level implied by their rank and title, and there is no clear relationship between the skills of health workers and the functions they perform. Many better-qualified personnel have left lower level health facilities for more attractive employment in higher level and urban facilities. A system of professional licensing is currently being considered that will link educational requirements to employment and promotion. This article outlines some of the issues that should be taken into consideration in formulating this system. In particular, licensing may have unequal impacts on rich and poorer areas. This article argues that other regulatory measures will be necessary if licensing is to be an effective mechanism for controlling the quality of health workers, and contribute to the provision of affordable health services in both rich and poor areas.
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