How has China formulated health policies during the transition to a market economy? How can government help localities improve their rural health services? An Institute of Development Studies working paper reviews how a large rural health reform project was designed to gain insights into the policy process in China.

By the 1970s China had an effective healthcare system throughout most of the country. The rural health services experienced problems associated with the transition to a market economy in the 1980s and 1990s. Government health budgets in many areas did not cover the cost of basic salaries and few fully trained members of staff remained in poor rural areas. By 1995, a large number of rural health centres in poor counties had financial difficulties. Many were dilapidated. The cost of care to patients increased rapidly while most local forms of health insurance collapsed.

Between 1994 and 1997 the Government of China and the World Bank developed a project to help poor rural counties rehabilitate and reform their health services. The project's aims were to:

• improve the facilities available
• improve the quality of the healthcare
• make the health service more affordable for the poor

The project was designed through many discussions between several national ministries and participating provincial governments. This process took place at a time when the government was formulating a new health policy. The study found that:

• National and provincial governments designed the project, but county governments had to implement it. The outcome will be strongly influenced by the constraints these local administrations face.
• The decentralised structure of Chinese government has a big impact on how change is managed. Local governments are encouraged to test different models so that other counties could learn from their experience.
• The expectations and understandings of providers and users of health services strongly influence the performance of health services.

The researchers suggest that the project will need to change as problems arise in its implementation. They recommend that:

• Information from local experiences should be used to inform national debates on policy. Policy-makers need to understand the problems that facilities face and how specific reforms affect them.
• The design of interventions should balance the desire to make an immediate impact with an allowance of time for people to adapt their thinking, attitudes and working to changes in the organisation of the health system and the wider market economy.
• To ensure that the health system meets needs, stakeholders need access to information about how local institutions perform.

Source(s):
‘Designing a rural health reform project: the negotiation of change in China’, IDS Working Paper 150, by Y. Liu and G. Bloom, 2002 Full document.

Funded by: UK Department for International Development (ESCOR)

id21 Research Highlight: 11 March 2003

Further Information:
Gerald Bloom
Institute of Development Studies
Brighton
Sussex BN1 9RE
UK

Contact the contributor: G.Bloom@ids.ac.uk

Institute of Development Studies (IDS), UK

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