With the largest population in the world, China is managing major health system reforms against a background of rapid economic and institutional change. This has posed a serious challenge in increasing access to health services, especially for poor people living in both rural areas and as internal migrants.
FHS Phase 1
In the first phase of FHS China, the focus was on the merger of the New Rural Cooperative Medical Scheme (NCMS) with the Medical Financial Assistance Scheme (MFA) for improve the rural poor’s access to essential health services, to reduce their economic burden of disease and to prevent the vicious circle of "disease caused by poverty and poverty caused by disease."
There was a big gap in the integration process of NCMS and MFA because the two schemes that target rural residents were administered by different government departments, the Ministry of Health and the Ministry of Civil Affairs, respectively. After years of work, the official policy was issued by the Ministry of Health and the Ministry of Civil Affairs was in 2009, which is an important milestone in the development of NCMS and MFA system.
FHS Phase 2
In addition to insurance schemes, one of the five priorities on China's health reform agenda is to build a national essential drug system that ensures the rational use and effective delivery of essential drugs and that reduces the financial burden of drug cost.
FHS China will shift its work to this key area. The aim is to identify existing and impeding problems emerging during the reform on drug delivery system in rural areas, and to find out the linkage and conflicts between the drug delivery system and other functions of health system. With this knowledge we will propose suggestions from the perspective of strengthening the whole health system on how to eliminate technical and institutional obstacles and improve the access to clinical preferred, essential, safe and effective, affordable and rational drugs for rural residents.
FHS Partners in China
News and announcements from FHS China
FHS is pleased to announce the publication of a new supplement in BMC Globalization and Health, titled Innovation in health systems in low- and middle-income countries. There is a growing interest in new technologies and innovative organizational arrangements as a means to improve a health system’s performance. However, only a small proportion of the many investments in innovations have been shown to have an impact on health system performance at scale. The papers in this series, published in Globalization and Health, analyze the factors that enable and constrain the emergence and diffusion of health system innovations. They bring alternative perspectives to this issue, based on diverse local contexts and different types of innovation. The aim is to provide a stronger basis for the formulation of strategies for managing health system change in low- and middle-income countries.
A “learning-by-doing” approach, using tools and techniques that are inclusive, participatory, and flexible, can help engagement and learning in different contexts to improve the delivery of health services.
This DC Health Systems Board event will bring together researchers and practitioners to share their experiences of engaging and working alongside service providers, beneficiaries, officials, and other local stakeholders through implementation research, and to discuss tools that can support such processes.
FHS is pleased to announce the publication of a new BMC Health Research Policy and Systems supplement , titled Engaging Stakeholders in Implementation Research: tools, approaches, and lessons learned from application.
Implementation research and the engagement of stakeholders in such research have become increasingly prominent in finding ways to design, conduct, expand and sustain effective and equitable health policies, programmes and related interventions.
The articles in this supplement examine some of the tools and approaches used to facilitate stakeholder engagement in implementation research, and describe learning from the experience of the Future Health Systems (FHS) Research Programme Consortium.
Recent FHS China Publications
Healthcare systems are increasingly recognised as complex, in which a range of non-linear and emergent behaviours occur. China’s healthcare system is no exception. The hugeness of China, and the variation in conditions in different jurisdictions present very substantial challenges to reformers, and militate against adopting one-size-fits-all policy solutions. As a consequence, approaches to change management in China have frequently emphasised the importance of sub-national experimentation, innovation, and learning. Multiple mechanisms exist within the government structure to allow and encourage flexible implementation of policies, and tailoring of reforms to context. These limit the risk of large-scale policy failures and play a role in exploring new reform directions and potentially systemically-useful practices. They have helped in managing the huge transition that China has undergone from the 1970s onwards. China has historically made use of a number of mechanisms to encourage learning from innovative and emergent policy practices. Policy evaluation is increasingly becoming a tool used to probe emergent practices and inform iterative policy making/refining. This paper examines the case of a central policy research institute whose mandate includes evaluating reforms and providing feedback to the health ministry. Evaluation approaches being used are evolving as Chinese research agencies become increasingly professionalised, and in response to the increasing complexity of reforms. The paper argues that learning from widespread innovation and experimentation is challenging, but necessary for stewardship of large, and rapidly-changing systems.
Morgan R, Ayiasi RM, Barman D, Buzuzi S, Ssemugabo C, Ezumah N, George AS, Hawkins K, Hao X, King R, Liu T, Molyneux S, Muraya KW, Musoke D, Nyamhanga T, Ros B, Tani K, Theobald S, Vong S and Waldman L (2018) Gendered health systems: evidence from low- and middle-income countries, Health Research Policy and Systems, 16:58, DOI: 10.1186/s12961-018-0338-5
Gender is often neglected in health systems, yet health systems are not gender neutral. Within health systems research, gender analysis seeks to understand how gender power relations create inequities in access to resources, the distribution of labour and roles, social norms and values, and decision-making. This paper synthesises findings from nine studies focusing on four health systems domains, namely human resources, service delivery, governance and financing. It provides examples of how a gendered and/or intersectional gender approach can be applied by researchers in a range of low- and middle-income settings (Cambodia, Zimbabwe, Uganda, India, China, Nigeria and Tanzania) to issues across the health system and demonstrates that these types of analysis can uncover new and novel ways of viewing seemingly intractable problems.
Innovation theory has focused on the adoption of new products or services by individuals and their market-driven diffusion to the population at large. However, major health sector innovations typically emerge from negotiations between diverse stakeholders who compete to impose or at least prioritise their preferred version of that innovation. Thus, while many digital health interventions have succeeded in terms of adoption by a substantial number of providers and patients, they have generally failed to gain the level of acceptance required for their integration into national health systems that would promote sustainability and population-wide application. The area of innovation considered here relates to a growing number of success stories that have created considerable enthusiasm among donors, international agencies, and governments for the potential role of ICTs in transforming weak national health information systems in middle and low income countries. This article uses a case study approach to consider the assumptions, institutional as well as technical, underlying this enthusiasm and explores possible ways in which outcomes might be improved.
Bloom G, Berdou E, Standing H, Guo Z and Labrique A (2017) ICTs and the challenge of health system transition in low and middle-income countries, Globalization and Health, 13:56, doi: 10.1186/s12992-017-0276-y
The aim of this paper is to contribute to debates about how governments and other stakeholders can influence the application of ICTs to increase access to safe, effective and affordable treatment of common illnesses, especially by the poor. First, it argues that the health sector is best conceptualized as a ‘knowledge economy’. This supports a broadened view of health service provision that includes formal and informal arrangements for the provision of medical advice and drugs. This is particularly important in countries with a pluralistic health system, with relatively underdeveloped institutional arrangements. It then argues that reframing the health sector as a knowledge economy allows us to circumvent the blind spots associated with donor-driven ICT-interventions and consider more broadly the forces that are driving e-health innovations. It draws on small case studies in Bangladesh and China to illustrate new types of organization and new kinds of relationship between organizations that are emerging. It argues that several factors have impeded the rapid diffusion of ICT innovations at scale including: the limited capacity of innovations to meet health service needs, the time it takes to build new kinds of partnership between public and private actors and participants in the health and communications sectors and the lack of a supportive regulatory environment. It emphasises the need to understand the political economy of the digital health knowledge economy and the new regulatory challenges likely to emerge. It concludes that governments will need to play a more active role to facilitate the diffusion of beneficial ICT innovations at scale and ensure that the overall pattern of health system development meets the needs of the population, including the poor.
There are increasing criticisms of dominant models for scaling up health systems in developing countries and a recognition that approaches are needed that better take into account the complexity of health interventions. Since Reform and Opening in the late 1970s, Chinese government has managed complex, rapid and intersecting reforms across many policy areas. As with reforms in other policy areas, reform of the health system has been through a process of trial and error. There is increasing understanding of the importance of policy experimentation and innovation in many of China’s reforms; this article argues that these processes have been important in rebuilding China’s health system.
Liu T, Hao X and Zhang Z (2016) Identifying community healthcare supports for the elderly and the factors affecting their aging care model preference: evidence from three districts of Beijing, BMC Health Services Research, 16:1863, DOI: 10.1186/s12913-016-1863-y
The Chinese tradition of filial piety, which prioritized family-based care for the elderly, is transitioning and elders can no longer necessarily rely on their children. The purpose of this study was to identify community support for the elderly, and analyze the factors that affect which model of old-age care elderly people dwelling in communities prefer.