Country Overview
Over the long term, China can justifiably feel proud of its achievements in the health sector. During the 1960s, despite being one of the world’s poorest countries, China almost halved its under-five mortality rate, and ranked 13th out of 161 countries in terms of its annual child mortality reduction. China maintained this impressive performance in the 1970s. Recently, though, China has had to confront the limits of its laissez faire health sector. The SARS epidemic brought home in a dramatic way the inability of the market to protect the population from public health disasters. The need for urgent and substantial health reform is therefore now readily acknowledged by senior government leaders. Moreover, in China, as in other countries, the importance of health as a driver of economic development and poverty reduction is also becoming increasingly appreciated. Recent research shows that China’s fast economic growth has been due in part to health improvements. But it is also becoming increasingly clear that continued high rates of growth and further successes in poverty reduction will hinge on China’s ability to update its rural health system. The collapse of the rural Cooperative Medical System has left the bulk of the rural population exposed to the risk of impoverishment through high out-of-pocket payments for health care, as well as to the risks associated with poor quality—if not downright dangerous—care. And while the health of the Chinese population has for the most part continued to improve, China’s recent successes are far less spectacular than the achievements of the 1960s and 1970s. By the 1990s, China had slipped to 94th position in the world when ranked by the annual rate of reduction of under-five mortality. By 2000, in the majority (69) of the countries that reduced mortality faster than China in the 1990s, under-five mortality had fallen or stayed below China’s 2000 rate of 40 per 1000 live births. Back to top
Ongoing Projects Project: P071147 - Tuberculosis Control ProjectApproval Date: 31 March 2002, Closing Date: 15 March 2010 Estimated Project Cost: US$242.33 Million The objective of the Tuberculosis Control Project for China is to reduce tuberculosis morbidity and mortality through an effective and sustainable National Tuberculosis Control Program, especially among the poor. The project has three broad components, one at the national level and two at the provincial level. The first component aims at strengthening institutions at the national level. This component includes establishing a central project coordination group, strengthening a central management unit to carry out a national tuberculosis control program, and strengthening a central reference laboratory with required staff and resources. The second subcomponent assists the government in developing policy guidelines and specific components of the national TB control program, while the third subcomponent ensures the coordination and management of the implementation of project activities. Project: P036953 – Health Nine ProjectApproval Date: 4 May 1999, Closing Date: 30 June 2006 Estimated Project Cost: US$100 Million The Ninth Health Project for China has three main goals. The first is reducing maternal and child mortality and morbidity and improving child survival and development in the poorest areas of five provinces of China. The second is preventing and controlling morbidity and mortality due to HIV/AIDS, and to sexually transmitted diseases (STDs) by implementing comprehensive programs at the provincial levels, and by building technical capacity at the Central level. The third is reducing the transmission of blood borne infections by assuring a safe and adequate blood supply with improved transfusion practices. Project: P003566 - Basic Health Services (“Health Eight”) ProjectApproval Date: 19 May 1998, Closing Date: 30 June 2007 Estimated Project Cost: US$185 Million The objectives of the Basic Health Services Project are: (a) improved allocation and management of health resources; (b) upgrading of rural health facilities; (c) improved quality and effectiveness of health services and programs; and (d) increased risk sharing and affordability of essential health care for the poor. The components include: (a) improved planning, management and health infrastructure; (b) improved health service quality and effectiveness; (c) increased affordability of health services; and (d) project coordination and support. SARS and Infectious Diseases Response Program The World Bank, the Chinese Ministry of Health and the Chinese Ministry of Finance jointly launched a program in Beijing in July 2003 to support the country’s efforts in combating SARS and other potential infectious disease threats. The unique multi-donor supported program is funded by US$11.5 million equivalent of confessional loans from the World Bank, a ₤3 million grant from the UK’s Department for International Development, a C$5 million grant from the Canadian International Development Agency. A regional grant of US$2 million from the Japan Social Development Fund complements those funds. The program is designed to tackle the issues of SARS-related diagnosis, clinical management, and infection-control needs in case the disease reemerges. The program also aims to strengthen the capacity of the public health system more generally for infectious disease prevention and control.  Board Report
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Closed Projects Project: P003589 - Disease Prevention (Seventh Health Project)Approval Date: 12 Dec. 1995, Closing Date: 30 June 2004 The Seventh Health Project had two distinct objectives: prevent and control vaccine-preventable diseases to reduce morbidity, disability and mortality in ten of the poorest provinces of China (Gansu, Guangxi, Guizhou, Hebei, Henan, Hubei, Shaanxi, Shanxi, Xinjiang, and Yunnan), and improve the capacity of the health sector to design and implement health promotion programs to prevent and control the rising prevalence of NCDs (non-communicable diseases), STDs, HIV and injury. All ten provinces reported over 95 percent coverage of the basic four vaccinations, at the end of the project. Starting from a very insignificant base for hepatitis B vaccination, five programs have reported over 90 percent coverage and three others reported over 75 percent coverage during the duration of the project. Implementation Completion Report Project: P037156 – Iodine Deficiency Disorders ControlApproval Date: 28 June 1995, Closing Date: 31 Dec 2000 The Project’s aim was to support the production, iodization, packaging and distribution of iodized salt as part of the National Iodine Deficiency Disorder Elimination Program. Considering the country as a whole, the percentage of households using quality iodized salt at household level increased from 39.9 percent in 1995 to 88.9 percent in 1999. Measures of goitre and low urinary iodine in school children also declined dramatically in the same period. The project helped enhance physical capacity building as well, by supporting the construction of capacities for salt production, iodization and packaging. Implementation Completion Report Project: P003634 – Mother and Child Health (Sixth Health Project)Approval Date: 18 Oct. 1994, Closing Date: 30 June 2002 The project's principal goal was to reduce maternal and child morbidity and mortality in the some of the poorest areas of China (like for example, Chongqing, Gansu, Guangxi, Jiangxi, Inner Mongolia, Qinghai, Shaanxi, Sichuan and Yunnan). During the project period, 630 clinical bases were established at provincial, prefecture and over 24,000 trainers completed short-term training programs in all the provinces. In addition, overseas training and study tours were arranged for local staff to obtain advanced knowledge of Maternal and Child Care. Implementation Completion Report Project: P003624 – Infectious Diseases (Fifth Health Project)Approval Date: 12 Dec. 1991, Closing Date: 30 Dec 2002 The project supported the government's national tuberculosis control program in selected provinces and the main parts of the national Schistosomiasis control program. During the project, the number of case finding for TB increased to above 50%. The prevalence of TB declined by 36.1 percent or about 4.1 percent annually. On the other hand, the Schistosomiasis Control Component made possible an almost 49% reduction in prevalence of human infection. The number of persons infected dropped from about 1.64 million before the project to 0.82 million in 2001. Implementation Completion Report
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Analytical and Advisory Activities Project: P082296 - Rural Health Reform (in progress), Economic Sector Work
This work addresses the overarching issue of how health reform in China can improve health outcomes, reduce inequalities in access to health care, and improve financial protection in health. The Government's Rural Health Policy issued in October 2003 as well as other public statements with respect to deficiencies in the health system (revealed by the SARS crisis) clearly signaled a serious intention to address health sector problems and challenges. In light of this, leading local Chinese scholars are working with international experts on key substantive policy areas to provide an updated piece of Analytic and Advisory Activities (the last one was completed in the mid-90s). The UK Department for International Development and the World Health Organization, the Bank's two main partners in the sector, have strongly endorsed the proposed initiative.
Addressing Inequity in the Access to Health Care in Urban China (2003), Working Paper No. 31340
The objective of this paper is to review the attempts to reform urban health insurance schemes made in China over the past two decades and to assess their impact on equity in financing of and access to health care. The paper specifically examines how changes in characteristics of new health insurance schemes have affected equity in terms of insurance coverage, financing, access and utilization.
The paper also discusses what lessons were learnt from the reform of urban health insurance schemes and what challenges lie ahead in developing sustainable urban health care systems in China.
The health sector in China: Policy and institutional review (2004), Working Paper No. 34525 This report reviews the health care policy and institutional changes in health care delivery during the last 5 decades in China. China operates the largest and most complicated publicly owned health care delivery system of the world. This publicly owned delivery system has been in transition since economic reforms in the early 1980s, undergoing privatization, atomization, becoming user-fee based, etc, and has changed Chinese health care delivery system into a public and private mixed system, with market principles dominating providers' behaviors.
Health care coverage once extended to 90 percent of the population. Following economic reform, mostly because of the disappearance of the cooperative medical system (CMS), the majority of the rural population has to pay out-of-pocket to receive health care. Only until recently has the government started to experiment with the new CMS to cover all the rural population. The urban Government Health Insurance Scheme and the Labor Health insurance Scheme survived the economic reform but had to undergo many changes. The current reform aims to replace them with a unified social insurance scheme with personal medical savings accounts being integrated in it.
Major challenges ahead not only include how to fully implement the current reform policies, such as urban and rural health care financing reforms, development of community health care, separation of drug prescribing from dispensing, and regional health plans, how to fill the great gaps left by the current reforms, such as extending health care coverage to those uncovered and the poor, and how to regulate and balance the rapidly developing health care market, but also include how to develop comprehensive and coherent policies for the whole sector. What will the Chinese health care system look like 20 years from now? There seems a lack of vision at both the central and local levels. An overall framework of health development and reforms is necessary, but absent so far.
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