Laying down the law – protecting access to health services in rural China

In the transition to a market economy, China has passed many laws aimed at protecting public interests, especially those of poor people. One example is the Maternal and Infant Health Care (MIHC) Law. Further regulations and resources will be needed to strengthen the MIHC Law, however.

The MIHC law came into force in June 1995. Its 38 articlescover the period before women get married, antenatal and perinatal health andinclude guidelines on technical implementation, management and legal liability.Researchers from the Liverpool School of Tropical Medicine in the UK, andPeking University in China, explore the factors affecting the implementationand impact of the law in Yunyang and Zhongxian - two poor rural counties in Chongqingmunicipality. They ask:

• What access do people in the study areas have tothe essential health services guaranteed by the law and what factors affectthis?
• What impact has the law had on inequities inaccess to and financing of these essential health services?
• What are the major factors influencing the law’simplementation and access to health care in the two counties?
• What are the lessons for policy-makers aiming toimprove access to basic health care services?

The research found positive changes in attention to MIHCservices by leaders, the allocation of resources and quality of services asperceived by users. But it also identified barriers to the effectiveimplementation of the law in the study counties:

• The lack of financial support from government atall levels inhibits the ability and willingness of service providers to deliverMIHC services.
• The low levels of skills and qualifications ofstaff limit the quality of services provided and the capability of supervisors.
• The lack of regulatory power of the law,combined with low levels of government finance and weak regulators, severely reducesits influence on provider behaviour.
• There is low demand for MIHC services,particularly among poor people, due to low educational levels, lack ofpurchasing power and opportunity costs. This restricts the effectiveness of thelaw in improving access to services.

Legislators have tried to provide a broad framework to coverChina’s huge variety of local situations. The development of local regulations,implementing plans, supervision and monitoring of the law is a politicalprocess, where health competes with other government priorities for scarceresources.

Further clear and detailed regulations are needed toaccompany the law, stating the roles and responsibilities of differentinstitutions and ways to discipline those who break the law. This will requiremore resources for MIHC services, subsidies for poor people and incentives forunqualified providers to follow the new rules.