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Dr. Zhu CHENMinister of Health, China

(8 July 2009, Geneva)

Health-related MDGs in China

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2

Context

1. Development of China2. MDGs on Health in China 3. Experiences in Achieving MDGs on Health 4. Challenges5. Health Care Reform in China6. Ways Ahead

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1. Development of China

3

Social and Economic Growth

Source: National Bureau of Statistics of China and “Human Development Report 2007/2008”

0.5950.559

0.530

0.6340.691

0.7320.7810.777

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

HD

I

0

5000

10000

15000

20000

25000

per

capi

ta G

DP

HDI

Per capita GDP

Trends in Human Development Index (HDI) and per capita GDP (RMB), 1978-2008

4

9422.8

4006.7

10.2%

4.2%

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

2000 2008

10

th

ou

san

d

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

no. ofpeopleliving inpoverty

povertyincidence

Poverty Reduction

Comparisons in “no. of people living in poverty” and “poverty incidence rate”

5

Health care systems has developed in positive ways

Many communicable diseases have either been wiped out or brought under control

The health of the Chinese populace has improved considerably

Health and Health Care

67.968.6

71.4

73.0

65

66

67

68

69

70

71

72

73

74

1981 1990 2000 2005

China’s average life expectancy (years),1981-2005

Source: Health Statistics yearbook of China 2008

6

2. MDGs on Health in China

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MDG 4 - Reduce Child Mortality

China’s Under-5 Mortality Rate (‰)

Goal

Real

8

MDG 5 –Improve Maternal Health

China’s Maternal Mortality Rate (1/100 000)

Goal

Real

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The spread of AIDS is slowing down

MDG 6 - Combat AIDS, Malaria and Other Diseases 10

DOTS coverage rate (1991-2005)

0%

20%

40%

60%

80%

100%

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

DOTS coverage for TB has reached 100%

MDG 6 - Combat AIDS, Malaria and Other Diseases 11

Reported Incidence Rate of Malaria stays at a low level

malaria free

incidence < 1/ 100000

incidence >1/100000

incidence > 10/100000

incidence >100/100000

Malaria distribution in China

MDG 6 - Combat AIDS, Malaria and Other Diseases 12

Emergency Response System has been strengthened

MDG 6 – Combat AIDS, Malaria and Other Diseases

State Council State Council

Ministry of Health Ministry of Health Provincial Government Provincial Government

Provincial Health BureauProvincial Health Bureau City Government City Government

City Health BureauCity Health Bureau County Government County Government

County Health BureauCounty Health Bureau Emergency surveillance instituteMedical institutes and relevant units

Emergency surveillance instituteMedical institutes and relevant units

2

hours

2 hours

ASAP

2 hours 2 hours

2 hours

2 hours

1 hour

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Prevention and Control Strategy

Contain imported Contain imported

cases cases

Prevent domestic Prevent domestic

transmission transmission

Prepare for Second Prepare for Second

WaveWave

Reduce secondary Reduce secondary casescases

Prevent community Prevent community transmissiontransmission

Treat severe casesTreat severe cases

Prepare for epidemic Prepare for epidemic changeschanges

Gradual transition

Strategies are adjusted in time according to the characteristics of different development stages of the epidemic

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Achievements

Effectively slowed down the import, spread and prevalence of the disease in China.

Gained precious time to prepare for more serious potential epidemic, improve

stockpiling of vaccines and drugs, etc.

Helped building a favorable environment for China to recover from the global

financial crisis as early as possible.

Contributed to lowering the global peak of the first wave of Influenza A(H1N1).

Confirmed Cases of A(H1N1)

766

8279

27717

7775

0

5000

10000

15000

20000

25000

30000

4-2

4

4-2

7

4-3

0

5-3

5-6

5-9

5-1

2

5-1

5

5-1

8

5-2

1

5-2

4

5-2

7

5-3

0

6-2

6-5

6-8

6-1

1

6-1

4

6-1

7

6-2

0

6-2

3

6-2

6

6-2

9

Date of report

Cases

Mainland ChinaMexicoUSACanada

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Lab testing training for ASEAN

countries.

International exchanges and assistance

ASEAN plus three Health Ministers (China, Japan, Korea)’ Special Meeting on influenza A(H1N1)

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Meeting between Health Ministers of China and Mexico during the 62th WHA, 2009

3. Experiences in Achieving MDGs on Health

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Ⅰ.Uphold people-oriented

principle, and put people’s

health and life safety at

priority

Ⅱ.Start from national

reality, and follow the

rules of healthcare

development

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Ⅲ.Focus on prevention, and establish a medical insurance system covering both residents at rural and city areas, which should also center on disease prevention and primary health care

Coverage rate of New Rural Cooperative Medical Scheme

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Ⅳ. International Cooperation

• WHO, UNICEF, UNFPO, UNDP, WORLD BANK

• GAVI, GLOBAL FUND, UNITAID• US, DFID, AUSAID, EC, JICA, ADB• Gates Foundation, Clinton Foundation• Merck Foundation, Project HOPE• South-South Cooperation

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4. Challenges

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Unbalanced Development & Health Inequity

Number of rural and urban hospital hospital bedsbeds per 1000 people

Number of medical personnel medical personnel per 1000 people

Average hospitalized delivery ratehospitalized delivery rate in cities and types of regions

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Ageing & Disease Pattern

International comparison of average annual increase rates (%) of elderly populatiannual increase rates (%) of elderly populations

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0

100

200

300

400

500

600

700

800

900

1954 1957 1963 1975 1980 1985 1990 1995 1998

CD

R（

1/1

00

,00

0）

Tendency of Death Pattern, China, 1954-1998

OtherOtherss

Injuries & Injuries & poisoning poisoning

Non-communicable Non-communicable diseasesdiseases

CommunicablCommunicable,e,

maternal and maternal and child child

diseasesdiseases

Ageing & Disease Pattern 24

Urbanization & Migrant Population

MMRs of permanent residents and floating population in 2005 (1/100000)

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5. Health Care Reform

in China

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Health Reform PlanHealth Reform PlanObjectiveObjective To ensure universal coverage of essential health careTo ensure universal coverage of essential health care

Service delivery system

Primary Health Care System (public health and essential health services)

Tertiary Services System (acute and catastrophic services )

Social protection system

Free PHC by government’s facility

Social Medical Insurance (Essential Medical Insurance + Cooperative Medical Scheme)

Commercial medical insurance

Strategies

Health Law: Health right Role of government’s

Statutory government’s inputs;Accountability

To assure hospital social objective

Health administration on system reform

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Five key tasks for 2008-2010 28

Ⅰ. Improve grassroots medical and health service system

• To expedite the construction of urban and rural grassroots medical health institutions for extensive coverage.

• To improve finance mechanism, by pooling finance departments at various levels to ensure the input for development of grassroots health institutions and staff salaries.

• To separate income and expenses in finance and sell drugs at zero gap.

• To strengthen the training of grassroots medical workers, general practitioners, in particular. And establish mechanisms for evaluation and incentive.

• To gradually establish classified medical service and two-way referral system.

Five key tasks for 2008-2010 29

Ⅱ. Make primary public health service equal accessibility for the people

• To strengthen construction of specialized public health institutions to better serve for public health.

• To reform personnel distribution system, implement competition for all the posts and job accountability, and enhance performance evaluation.

• To improve finance mechanism for public health institutions by 100% budget management, formulate basic public health service projects, and allocate relevant amount of subsidies based on the population of service recipients.

• To provide urban and rural residents with primary public health services including disease prevention and control, planned immunization, maternal and child health care and health education, etc.

• To implement national key public health projects, and control major diseases and risk factors.

Five key tasks for 2008-2010 30

Ⅲ.Expedite the construction of basic medical insurance system

• To cover basic medical insurance system in an all-round way, and ensure the participation rate of basic medical insurance scheme for urban and rural residents to reach 90% or higher.

• Basic Medical Insurance System for Urban EmployeesBasic Medical Insurance System for Urban Employees• Basic Medical Insurance System for Urban ResidentsBasic Medical Insurance System for Urban Residents• New Rural Cooperative Medical Care SchemeNew Rural Cooperative Medical Care Scheme

• To raise the percentage of medical costs for hospitalization in insurance, and incorporate outpatient fees of common diseases and frequent diseases into medicare reimbursement.

• To resolve the insurance for university students, people employed flexibly, retirees from bankrupt state-owned enterprises, retirees and workers of ill-functioning companies, and farmer-turned workers.

• To appropriately address medical insurance for migrant population.

• To improve the urban and rural medical relief system.

Five key tasks for 2008-2010 31

Ⅳ. Establish national system of essential medicine • To scientifically determine the categories and quantities of

essential drugs, and give access to around 700 categories of drugs. • To implement bid system for fixed site manufacturing, and direct

and extensive distribution of essential drugs. • To enhance supervision over essential drugs. • Medical and health institutions must equip and prioritize essential

drugs, and grassroots medical organizations will prescribe 100% essential drugs.

• To promulgate and implement prescription collection for essential drugs and guidelines for treatment, and boost the drug prescription level.

• All of the essential drugs will be included in the basic medical insurance reimbursement catalog, and the reimbursement ratio will be much higher than non-essential drugs.

• Essential drugs will be priced by the state, and their prices will be controlled within reasonable range.

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Five key tasks for 2008-2010 32

Ⅴ. Promote reform pilot projects in public hospitals• To scientifically determine the amount, scale and layout of public

hospitals.• To increase government input, improve finance mechanism and

grant special subsidy to public health services provided by public hospitals.

• To eliminate the policy of drug price addition by adding charge for pharmaceutical services and investment.

• To reasonably adjust the prices for medical services, reflecting the value of medical services.

• To explore legal representative governance structure in public hospitals, and establish president administration system.

• To reform the mechanism of personnel distribution, all medical workers will be employed by contract terms, and the salary system will combine position and performance.

• Enhance cost evaluation and control.• To improve internal management, regulate medical practice and

optimize service flow.

Devoted to the inequities inequities in income, social insurance, medical services and educationActively involved in international cooperationinternational cooperation, and make contributions to the realization of MDGs in the world

6. Ways Ahead

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THANK YOU FOR YOUR ATTENTION

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