As China embraces the market economy, are inequalities in health services widening? Is China succeeding in its declared aim of establishing a regulatory health framework to protect the interests of the poor? How are institutions responding as centralised control of health services weakens? Are maternal and infant healthcare (MIHC) services adequately funded and accessible?

A report from the Liverpool School of Tropical Medicine, Peking University’s School of Public Health and the Chinese Ministry of Health Centre for Health Information and Statistics looks at the impact of China’s 1995 Maternal and Infant Health Care Law. Focusing on the factors influencing the effective implementation of the health legislation and access to healthcare services at county and township levels, it suggests how policy-makers can strengthen supervision and enforcement, and improve equitable access to basic healthcare services.

The law (the original draft of which was controversial due to its focus on eugenics – that is, improving the quality of China’s population) seeks to improve indicators of maternal and child health through developing MIHC services. It sets out the broad responsibilities of health institutions and the Government to provide a range of services including peri-natal care, pre-marital and ante-natal health and additionally provides guidelines on technical implementation, management and legal liability. It commits the state to providing the necessary conditions and material support to make health services more accessible for mothers and children, particularly in remote and poor areas.

Evidence from the two counties studied in the Three-Gorges Dam Area of Chongqing Municipality found that to date the law has to some extent had a positive impact on service provision, particularly in relation to investment in equipment and training (mostly due to external support). However, lack of funding from all levels of government limits the ability and willingness of service providers to provide key MIHC services. Shortages in full-time professional staff and the low level of skills and qualifications of staff limit the quantity and quality of services provided.

The paper also notes that:

• In the poorest areas, around 50 per cent of women do not receive ante-natal and postnatal care, 90 per cent of women deliver at home and only one third of home deliveries are assisted by trained midwives.
• The infant mortality rate (IMR) in the poorest rural areas is four times higher than the average level of IMR in the urban areas, where access to services is greater.
• Municipal subsidies and international aid are often concentrated in urban areas.
• As preventive services are not subsidised, providers focus on income-generating curative services.
• There is a low demand for MIHC services, particularly amongst the poor, due to low educational levels, lack of purchasing power and opportunity costs (the social or economic costs are incurred through spending time seeking health services).
• The law lacks detailed regulations, supervision arrangements and the ability to discipline.

The research calls for greater financial investment in health from all levels of government. Policy-makers are also urged to:

• clarify financial investment arrangements from all levels of government
• improve the quality of human resources
• implement better supervision arrangements and strengthen sanctions against those breaching the law
• focus performance evaluation methods on quality improvement, rather than on individual reward or punishment
• apply the MIHC law to all government institutions, and particularly to family planning authorities
• pass specific, detailed regulations on the provision and management of MIHC services at the central and local levels.

Source(s):
‘Is health legislation in China being implemented effectively and is it benefiting the rural poor? A collaborative policy evaluation project’, by Rachel Tolhurst, Zhang Tuohong, Yang Hui, Gao Jun and Tang Shenglan, July 2002

Funded by: DFID (SSRU R7641)

id21 Research Highlight: 24 January 2003

Further Information:
Rachel Tolhurst
Liverpool School of Tropical Medicine
Pembroke Place
Liverpool L3 5QA
UK

Tel: +44 (0)151 705 3251
Fax: +44 (0)151 705 3364
Contact the contributor: r.j.tolhurst@liv.ac.uk

Liverpool School of Tropical Medicine (LSTM), UK

Other related links:
See id21's links related to maternal and child health

Taking aim: using 'near misses' to evaluate maternal healthcare

'Birth rights: new approaches to safe motherhood'

'Lessons learned - what do we know about health education?'