The ReEmergence of Primary Health Care in Urban China Mark A' Strand, PhD CCIH Conference

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The (Re)Emergence of Primary Health Care in
Urban ChinaMark A. Strand, PhDCCIH Conference

• May 2008

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Learning Objectives

• Grasp Chinas development and challenges in
  providing primary health care
• Understand the balancing roles of big government
  and small communities in implementing primary
  health care.
• See the role of the Christian NGO to enhance this
  process

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History of Chinas primary health service
system

• 1949 to 1980
• 80 of urban residents covered by work units
• 90 of rural residents were covered by
  cooperative health plans
• 1985 to 2002
• The health system was turned over to the market
  and became dependent on fee-for-service.

• ???,???

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Chinas Challenges

• Hypertension rate of 28.2 age 50-60 and 42.4
  over age 60.              
• Urban diabetes rates for over age 20 rose from
  4.6 in 1996 to 6.4 in 2006.
• Public health uncoordinated and passive
• With a service popn for our CHS of 25,000 in one
  week our catchment area will have 1915 disease
  events (2003).
• Tertiary hospitals expensive and relatively
  impersonal

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Chinas Challenges

• No medical records for out-patient care
• Frequent use of ancillary tests and sales of meds
• Rapidly growing urban population, with a goal of
  50 urban by 2020, meaning the move of 275
  million people into urban areas over the next 12
  years
• Urbanization resulted in loss of community and
  social dislocation
• Need to stretch limited health resources

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Current Policy of Chinas Primary Health Service
System

• 2003 to now
• Rural The New Rural Health cooperative began.
  80 of farmers are covered now.
• ??????
• Urban Community health system was started in
  2006 in major cities and all cities should have
  the system in place by 2010.
• ????????

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Spring 2007 Jinzhong Gets Going

• 6 in 1 CHS
• Train nurses and doctors
• Set up clinics
• 10 yuan per person for each served

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CHS Components ????

• Health Education ????
• Disease Prevention ??
• Health Maintenance ??
• Medical Treatment ??
• Rehabilitation ??
• Family Planning ????

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Urban Community Health (CHS) System ???????????
?? ??
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Hospitals Specialized Hospitals
CDC MCH Management Center
Two-way referral
Consulting and training
Reports
Community Health Center ????????
Clinics ??
CHS Station ???????
Nursing homes ???
Other
Civil Affairs
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1. Health Education ????

• Cooperated with local CHS center
• Started with a HTN screening
• Organized by community leaders
• Did 3 years group health education
• Focus on chronic diseases HTN, DM, Coronary
  Heart disease etc.
• Serving church as a community member

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Health Records ????

• CHS training
• First step in CHS development
• Help to understand situation of the families and
  their service needs
• Started in April 2007
• Health education opened the door
• Visited 2741 families served 7035 people

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2. Disease Prevention ??

• Infectious TB prevention
• Chronic HTN, DM management

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3. Health Maintenance ??

• Well Baby Project in urban nursery schools
• Could address many areas

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4. Medical Treatment ??

• Family Medicine work at CHS
• Trained and empowered Social Workers

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5. Rehabilitation ??

• No work in this area yet

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6. Family Planning ????

• Still functioning tightly under the Family
  Planning Commission

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Health Systems

• Significant gap
• Little accountability
• What are some example nations?

Weak Government System
Large NGO Systems
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Health Systems

• Large gap, limited communication
• NGOs struggle for space
• NGOs serve a small population
• Limited NGO impact

Big Government
Small and weak NGO
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Health Systems

• Government is strong, and responsible
• NGOs are small but effective
• For responsibility and sustained impact NGOs in
  strong overlap with government

Large, Responsible Government
Impacting the system
Small but strong NGO
Serving population
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Engaging the Government System

• Regularly visits with government bureaus
• Look at newspapers, TV news, internet to
  understand changes and opportunities
• Talk with partners to understand opportunities
  and to find someone with a vision and passion for
  the work you are interested in
• Have your local staff participate in local
  government training opportunities.
• Do research in the community about local health
  issues important to the people and the government.

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Challenges

• Transitioning from a medical to a CH perspective
• Clinical work with weak connection to community
  health outreach
• Govt motivated, so it has support, but under
  compulsion
• Community participation is limited, but the
  argument is made that urgency precludes community
  involvement. Will this threaten the
  sustainability and depth of the model in the
  years to come?
• Chinas ability to openly embrace a daunting
  challenge is impressive.
• Through political will, and the talents of 1000s
  of flexible Chinese medical workers, it is coming
  to pass.
• Has to happen overnight, compromising quality

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• No community council yet
• It is a privilege to be involved at this level,
  as a public witness for Christ. But it is not
  easy to bring the church into community service.
• We prioritize both skills and the spirit of PHC,
  which flows from a Christian spirit of love and
  sacrifice

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Christian Community and Wholeness CCIH
conference theme.
Recent home visit outing, mother with TB
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Conclusions

• Political will is essential. ICDP was difficult.
• While now our work is smooth.
• Implementation of the Community Health Service
  Model may avert a primary health care disaster in
  China.
• This development has the potential of
  (re)establishing China as a global leader in
  cost-effective primary health care delivery for
  developing nations.