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China

China

 

Background

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

News
FHS partners meet to discuss work on health systems accountability, resilience and equity

On 17-18 July 2017, FHS partners met at the Institute of Development Studies in Brighton, UK, to take forward work on deepening equity analysis; extending primary research on community empowerment strategies; and applying FHS learning to strengthen health system resilience.

Recent FHS China Publications

Publications

Huang F, Blaschke S and Lucas H (2017) Beyond pilotitis: taking digital health interventions to the national level in China and Uganda, Globalization and Health, 13:49, doi: 10.1186/s12992-017-0275-z

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.

Husain L (2017) Policy experimentation and innovation as a response to complexity in China’s management of health reforms, Globalization and Health, 13:54, doi: 10.1186/s12992-017-0277-x

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.

Wang L, Zhang X, Liang X and Bloom G (2016) Addressing antimicrobial resistance in China: policy implementation in a complex context, Globalization and Health, 12:30, DOI: 10.1186/s12992-016-0167-7

The effectiveness of antibiotics in treating bacterial infections is decreasing in China because of the widespread development of resistant organisms. Although China has enacted a number of regulations to address this problem, but the impact is very limited. This paper investigates the implementation of these regulations through the lens of complex adaptive systems (CAS).