At the national level, policies such as the National Work Standard for Free Pre-pregnancy Eugenic Health Examination Project [ 1 ] and the “Healthy China 2030” Planning Outline clearly require strengthening the construction of primary maternal and child health talent teams and improving pre-pregnancy eugenic service capabilities. At the Guangxi level, although the incidence of birth defects showed a fluctuating downward trend from 2010 to 2023, it was still higher than the national average level. Among them, thalassemia, congenital heart disease and other diseases are highly prevalent, and it is urgent to strengthen primary prevention and control capabilities through technical training [ 2 ].

There are two prominent problems in primary medical institutions: first, the knowledge update of professionals is lagging behind, and they have insufficient mastery of new technologies such as genetic testing and eugenic consultation; second, the service awareness is weak, and poor communication with the examinees leads to low participation rate in the project. Therefore, building a targeted training system has become the core to solve the above problems.

This training is guided by “people-oriented, oriented to the grassroots, and serving the people”, integrating the “Competency-Based Education (CBE)” theory and the “hierarchy of needs theory”: the former emphasizes designing training content with post ability as the core, and the latter focuses on meeting the learning needs of personnel at different levels through hierarchical training. At the same time, combined with the regional characteristics of Guangxi, the contents such as ethnic minority language communication skills and regional high-incidence disease prevention and control are incorporated into the training system to ensure the adaptability of theory and practice.

Professional and technical personnel engaged in pre-pregnancy eugenic health examination in primary maternal and child health care hospitals and township health centers in 112 counties (cities, districts) of Guangxi, including inspectors, clinicians, health consultants, etc., 80% of whom are from county-level and below medical institutions [ 3 , 4 ].

Construction of hierarchical training system

Design of training content

Innovation of training methods

From 2010 to 2024, a total of 120 centralized training sessions, 15 special training courses were carried out, 92 further study personnel were selected, with a total of 1086 person-times trained, covering all project counties (cities, districts) in the region [ 5 ]. The participation rate of primary personnel increased from 65% in 2010 to 98% in 2024.

1) Knowledge and skills: The qualified rate of laboratory technicians' assessment increased from 72% in 2013 to 96% in 2024, among which the proficiency in genetic testing technology operation improved the most significantly; 85% of physicians could independently complete risk assessment for high-risk groups.

2) Service quality: Since the implementation of the project, the feedback time of abnormal results of pre-pregnancy examination has been shortened from an average of 48 hours to 24 hours, and the satisfaction of the examinees has increased from 78% to 92%.

1) Expansion of coverage: The number of examinees increased from 22,800 person-times in 2010 to 298,800 person-times in 2023, with a total of 4.832 million people served, and the coverage rate of the target population reached 89%.

2) Birth defect prevention and control: The intervention rate of high-risk groups increased from 68% in 2010 to 100% in 2023. The incidence of birth defects in Guangxi decreased from 15.6‰ in 2010 to 11.2‰ in 2023, which was lower than the national average level in the same period.

A technical collaboration network covering 14 cities in the region has been established, forming a linkage mechanism of “provincial guidance - municipal coordination - county-level implementation”; the training content has been included in the performance assessment indicators of primary medical institutions to promote the transformation of training results into long-term service capabilities. See Table 1 below for details.

Note: “-” indicates that there is no clear initial data or the data is not counted separately at the corresponding time node. The qualified rate of laboratory technicians’ assessment in 2013 is used as the initial reference data.

Demand-oriented hierarchical design: Precisely implement policies according to the ability shortcomings of personnel at different levels in the grassroots, avoiding resource waste caused by “one-size-fits-all” training. For example, adding language service courses for ethnic minority areas has significantly improved the participation rate of the project in local areas [ 6 ].

Government-medical collaborative implementation mechanism: The Autonomous Region Health Commission and the Reproductive Hospital cooperate with each other, combining policy support with technical guidance to ensure that training and project promotion are in the same frequency and resonance.

Closed-loop management for quality control: Through the “training - assessment - supervision - feedback” process, the short-term training effect is transformed into long-term service ability, solving the problem of “disconnection between learning and application” in primary training [ 7 , 8 ].

Uneven distribution of training resources: Personnel in remote areas have high training costs (transportation, accommodation), so it is necessary to increase investment in online training and develop mobile learning platforms.

Insufficient training on emerging technologies: The training on the application of new technologies such as gene sequencing and artificial intelligence-assisted diagnosis is lagging behind, so it is necessary to cooperate with universities and scientific research institutions to update the curriculum system.

Lack of long-term incentive mechanism: The training results of primary personnel are not closely linked to professional title promotion and salary, so it is necessary to promote the inclusion of training assessment into the personnel management system.