Objective  To examine the status and influencing factors of satisfaction to health reform policies among administrative staff in township health centers for exploring main obstacles to the implementation of health reform policies at grassroots level in rural areas.

  Methods  We conducted a survey among 1 445 main or charged administrators selected from all township health centers across Guihzou province (one respondent for each center) with typical sampling in July 2017. Information about cognition on and satisfaction to health reform policies were collected with a self-administered questionnaire among the respondents.

  Results  Of the 1 285 eligible responders, 77.0% to 93.5% reported the understanding on main health reform policy domains and 59.3% to 66.9% reported the satisfaction to the implementations of the domains, with a significant positive correlation between the satisfaction and the understanding (P < 0.01). The results of multivariate ordered category logistic regression analysis demonstrated that the responders at elder age (≥50 years: odds ratio OR = 9.328, 95% confidence interval 95% CI: 3.868 – 22.482), with a working duration of ≥10 years (OR = 1.946, 95% CI: 1.353 – 2.799), with a senior professional title (OR = 3.117, 95% CI: 1.342 – 7.236), having less understanding on the policies (OR = 11.090, 95% CI: 6.406 – 19.198), and paying less attention to the policies (OR = 2.936, 95% CI: 1.746 – 4.941) were more likely to be unsatisfactory to the policies.

  Conclusion  The managers of township hospitals have a better understanding on but a lower satisfaction to the rural health reform policies and the satisfaction is mainly influenced by the manages' age, working years, professional title, understanding and concerns on the policies. The results suggest that relevant efforts should be taken to promote the implementation of health reform policies in rural areas.