Health Sector Reform and its Implication on Reproductive Health Service Provision and Utilization in Poor Rural China - PowerPoint PPT Presentation

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Health Sector Reform and its Implication on Reproductive Health Service Provision and Utilization in Poor Rural China

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Title: Health Sector Reform and its Implication on Reproductive Health Service Provision and Utilization in Poor Rural China


1
Health 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

2
Outline 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

3
Introduction
  • 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.

5
The 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.

6
The 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.

7
The Reproductive Health Service Provision in Poor
Rural Areas
8
Public 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.

9
Lacking 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

11
The 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

12
Basic 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

13
Basic 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

14
An 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

15
An 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

18
Discussion 2
  • The current health sector reform strategies have
    not yet addressed reproductive health services in
    poor rural areas effectively and efficiently

19
Discussion 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?

20
Discussion 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 .

22
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