Objective: To observe the evolution of township health centers (THCs) competitiveness during 2009-2015, explore the key factors of the change, and provide reference for the development of township hospitals. Methods: Using provincial data from China health statistics yearbook to calculate the service share in target population of THCs in 2009 and 2015, Pearson correlation coefficient was used to measure the relationship between service share and related factors. Results: Compared to 2009, the relevant economic and social variables had increased significantly in 2015. The per-capita level of government expenditure on health, number of hospital beds and health personnel increased 190%, 62.5% and 54.2%. The outpatient service shares of THCs increased 4.1%, and the inpatient service shares decreased 14.9%. The share of outpatient service was positively correlated with per capita disposable income of rural inhabitants (r=0.39), and negatively correlated with the village doctors per 1000 rural inhabitants (r=-0.39) in 2009 but was no statistical significance in 2015. The share of inpatient service was moderate negative correlated with per capita government health expenditure (r=-0.58) and per capita number of hospital staff (r=-0.56) in 2009 but was not relevant in 2015, THCs personnel per 1000 rural inhabitants was not related with inpatient shares in 2009, but was moderate positive correlative in 2015. Conclusion：Since 2009, the competitiveness of outpatient service of township hospitals increased slightly, but the competitiveness of hospitals declined significantly. The factors affecting THCs competitiveness showed great change, the competitive relationship with competitors in medical system were weakening, so did its relationship with the economic factors. The competitiveness of THCs mainly depends in human resource and hardware. The future development orientation of THCs should focus on enhancing human and hardware resources on the basis of reasonable position in health system.