Lacking of Finance Resource Lead to the Following Consequences. Action in 2004 Thank You! Health Care in Rural ChinaWang, Bin M.D., M.P.HDirector of Woman Health DivisionDepartment of PHC & MCH , Ministry of Health P. R. ChinaPresented at the Forum of Federations conference onDecentralization of Health Care Delivery in India –New DelhiFeb. 8 to 10, 2004General InformationPopulation: 1,295,000,000( 2002 National Census)Health Expenditure of GDP : 3.7%, less 4%Maternal Mortality Rate(MMR): 43.8/100,000 Live BirthInfant Mortality Rate(IMR): 28.7/1000 Live BirthHospital Delivery of Birth: 73%( urban: over 99%, rural: less 60%)8~2020~4040~6060~100100~401The Distribution of Maternal Mortality in China, 2002 (1/100,000)Health Service System in Rural AreaCounty : Hospital, Center of Disease Control, MCH Hospital, Chinese Medicine HospitalTownship: Township Health Center( integrated county health facilities )Village: Clinics hosted by barefoot doctors( More than 60% belong to private and others supported by the local government or collective income)Before 1980’s, all of the health facilities in rural are public propertyThree-tier health network: county, township, villageCooperative Health SystemBarefoot doctor –village doctor, including traditional doctor worked in villagesAfter 1980’s:With the transition from planned-based to market-based economy developing , the rural health system lack of support is incompatible with marketing economy. 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.Coverage rate of cooperative health system in rural is reducing gradually, less 10%( from 90%, in 1980) 90% farmers get fee-for-service for theirs health. Large numbers become poor or fall back into poverty because of illness.Lacking of Finance Resource Lead to the Following Consequences.Hard to expand service scopeLack of training opportunity to update providers’knowledge and skillsWeaken the supervision and technical guidance from upper level health institutions to lower level ones Curative –biased service provisionPrivatization of health service occurred in grass Privatization of health service occurred in grass rootMany village doctors who used to be the barefoot doctors of the CMS became private doctor in village due to the collapse of collective support in most rural areas.Some rural public health facilities, mainly refer to township health centers, have not be renewed due to the fund burden.Largenumber of private drug stores and shops occurred in rural areas, even the poor areas, due to the rapidly growth of pharmaceutical industry.rural health reform decision issued by the central By the year 2003, Strengthening and reform for government :Key points of the decision:1. Recovering new CMS and initial pilot countiesFunding Resources: 1/3 from farmer and family1/3 from local government1/3 from central government 2. Decentralization of the fiscal and management responsibilities of rural health facilitiesLocal governments have been assigned the responsibility of financing local public health facilities.The management and supervision responsibility of local health facilities has been shift to local governments.3. Village doctor regulation issuedset up registration procedure strengthening trainingold village doctor will be replaced by professional physician, eliminated generally.clarified the duty of village doctor: basic medical service,preventive, health information collection and report, health education to folks , infectious disease report, ect.5. Reform and strengthening rural health facilitiesImproving the quality of health facilities network;Limited the scope of township health centers;Electing the director of THC;Integrated the service between township and village;Changing service model: curative to comprehensive, focusing on preventive serviceTechnology support from urban hospital;6.Training health staff in THC and village clinicEncourage medical professional to go to rural area, higher salary standard than who work at urban;THC director are appointed and trained by county health bureau;Extending existed medical courses and developing traditional medicine courses in secondary health school;Encourage health workers in THC and village doctor to take continuing education. Action in 2004Strengthening government role in health issues of poor rural areas.Collaborating among government components to implementation policy formulation. Central government have allocated the fund to west provinces for rural health and required matching fund by local government. Development of an feasible and practical rural health sector strategies actively that address basic health service and public health service to reduce difference between urban and rural.Thank You!