Title: Health Sector Reform and its Implication on Reproductive Health Service Provision and Utilization in Poor Rural China
1Health Sector Reform and its Implication on
Reproductive Health Service Provision and
Utilization in Poor Rural China
-
Fang Jing - Institute for Health Sciences, Kunming
Medical College, - Yunnan
Province, P. R. China
2Outline of the Presentation
- Introduction
- The major rural health sector changes and reforms
- Reproductive health service provision in poor
rural areas - Reproductive health service utilization in poor
rural areas - Discussion
- Recommendations
3Introduction
- Focusing on poor rural China
- Focusing on maternal health care services
- Data sources secondary data
- First hand data
4 The Major Rural Health Sector Changes and
Reforms
- Decentralization of the fiscal and management
responsibilities of rural health facilities - Local governments have been assigned the
responsibility of financing local public health
facilities since the early of 1980s. - The management and supervision responsibility of
local health facilities has been shift to local
governments Since the middle of 1980s.
5The Major Rural Health Sector Changes and Reforms
- Privatization of health service
- Many village doctors who used to be the barefoot
doctors of the CMS became private practitioners
due to the collapse of CMS in most rural areas. - Individuals and collective are allowed to open
private hospital or clinics. - The staff of public health facilities are
permitted or even encouraged to excise private
medical practice during their spare time. - Some rural public health facilities, mainly refer
to township health centers, have been contracted
or rented, or even sold in some cases to the
private In 1987. - Huge number of private drug stores and shops
occurred in rural areas, even the poor areas, due
to the rapidly growth of pharmaceutical industry.
6The Major Rural Health Sector Changes and Reform
- Introduction of fee-for-service mechanism
- The collapse of rural CMS. In 1999 the CMS
coverage rate decreased to only 6.5. - County and township public health institutions do
not have fund to cover the services utilized by
farmers. - The policy issued by the Ministry of Health in
1979 health sector should operate according to
economic rules.
7The Reproductive Health Service Provision in Poor
Rural Areas
8Public Health Facilities Lack of Finance Resource
to Provide Reproductive Health Services
- Health facilities in poor settings could only get
very limited fund due to the serious financial
resources shortage of local governments, and the
limited fund is entirely used to cover the wages
of the staff. - The fund needed for maintaining equipment,
supply, training, monitoring and supervision has
to be generated from curative services. - Current health policies in many localities also
explicitly or implicitly tend to allocate less
fund to health sector, Health institutions have
been increasingly perceived by some local policy
makers as business units that can make a living
by providing health services.
9Lacking of Finance Resource Lead to the Following
Consequences.
- Hard to expand service scope
- Lack of training opportunity to upgrade
providers knowledge and skills - Weaken the supervision and technical guidance
from the upper - level health institutions to the low level
ones - Curative biased service provision
- Depend on projects sponsored by donors
- Current situation we can not even maintain our
office telephone operation without these projects
- Big concern among health facilities and providers
is what are we going to do if these projects
finish?
10 Multiple Service Providers and Inadequate
Regulation
- Public health facilities
- Private clinics and practitioners
- Family planning system and its network
- Drug stores and shops
- Inadequate regulation of government over those
providers.. - Weak voice of clients, particular poor women .in
influencing service delivery and monitoring
service quality. - Drug abuse, rapid rising of medical service fee,
low service quality and bad competition
11The Reproductive Health Service Utilization in
Poor Rural Areas
- Extremely low utilization of basic reproductive
health service - Utilization of alternatives or informal health
care by poor women
12Basic Reproductive Health Service Utilization in
5 Poor Counties of China
- Prenatal check up rate 18-84
- Hospital delivery rate 5-15
- Postnatal visit rate 14-55
- Health care seeking rate for abnormal conditions
during pregnancy 26-32 - Health care seeking rate for abnormal conditions
during delivery 13-29 - Health care seeking rate for abnormal conditions
after delivery 15-24
13Basic Reproductive Health Service Utilization in
5 Poor Counties of China
- Health care seeking rate for abnormal conditions
after having FP operations - 25-45
- Health care seeking rate for RTIs associated
symptoms 12-28
14An Example the Health Sector Reform Strategies
in One Poor County
- The Principles set up by the county government
- No more adding to the health human resources and
budget
15An Example the Health Sector Reform Strategies
in One Poor County
- Strategies
- To combine the two big county health facilities
to become a big hospital - To change the comprehensive township health
centers into hospitals that focus on curative
service and provide preventive care for the
township residents - To change the township health centers that lack
of equipment and competence personnel into health
facilities that specifically provide preventive
care, the salary of staff will be 100 paid, but
no fund for operation - To practice fee-for-service for preventive care
such as immunization
16 Discussion 1
- Passive adaptation rather than active reform
17 Positive and Negative Implications
- Negative implications
- Ignorance of preventive care.
- Undermine health equity and that further
aggravated by gender inequity. - Rapidly rising of medical care fee, drug abuse
and bad competition among providers
- Positive implications
- More options and alternatives on curative
services for people - Improve service availability
18Discussion 2
- The current health sector reform strategies have
not yet addressed reproductive health services in
poor rural areas effectively and efficiently
19Discussion 3 the Role of State providing public
goods and regulation
- How to define public goods of general health
service and reproductive health service in
particular? - How much fund is needed to help poor areas to
provide these public goods? Where does the fund
come from? - How to use the fund in a transparent and
accountable way? - Through what mechanism and measures to regulate
a health service market that mixed with public,
private and commercial service providers?
20Discussion 4 The Role of Community and Poor
Women
- What roles community and poor women should play?
Expressing needs Participating in
decision-making and plan Monitoring service
delivery Holding service institutions
accountable. - What roles could community and poor women
feasibly and practically play in the context of
present China? - How to design a mechanism to bring community and
poor womens voice into reproductive health
service delivery?
21 Recommendations
- Conducting research to explore the answers of the
critical issues such as states role and public
service accountability and use the findings to
inform policy formulation. - Development of an active feasible and practical
rural health sector strategies that address
reproductive health needs and towards health
equity and gender equality. - Strengthening states role in health issues of
poor rural areas. - Developing and strengthening intermediate
organizations that can on behalf poor community
and womens interests .
22Thank You for Your Attention