Giving birth gets a makeover in rural China
6 August 2008
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Millennium Development Goal 5: Maternal health
 Over the last decade, a range of reforms aimed at mothers-to-be has transformed
the perilous business of being pregnant and giving birth in China's
farthest-flung areas.
Funded by DFID, the World Bank and the Chinese Government, and intended to turn
around years of decline in rural healthcare, the eight-year project has played a
major part in cutting the number of rural women who die during childbirth.
Now, more women are being persuaded to go to hospital to deliver their babies,
and, crucially, they aren't being let down by shabby facilities and sub-standard
medical care once they arrive - proof that, even in the hardest-to-reach places,
it's still possible to overhaul public services and change traditional
attitudes.
Get out of the house!
When the project launched in 1999, it was one thing to convince rural-dwellers
about the benefits of giving birth in hospital rather than at home, and quite
another thing to get them out of their homes, into the hospitals and receiving
the treatment they needed and deserved.
As well as raising awareness of the greater safety of hospital deliveries -
which was achieved through the use of local media, community champions and group
learning activities - it also introduced new schemes to ensure that obstetric
services were, in the first place, actually affordable.
Some of the rural counties involved in the project used their funding to
subsidise hospital births, while others provided health insurance so that
patients could be reimbursed part of the cost of their delivery. But, across all
of the counties, a "safety net" scheme ensured that, when the very poorest women
went into labour, a place in a medical institution was guaranteed.
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Clinics fit to give birth in
However, all of these efforts would have been wasted if the medical institutions
themselves, and the staff working within them, were not capable of providing a
quality service for the new women coming in.
Under the project, local health centres received a substantial investment to
make them places that people would want to visit. A flurry of building and
renovating followed, which saw rooms being heated for the first time, new
toilets installed, and patients' concerns about privacy incorporated into
designs. Up-to-date equipment, selected with local needs or demands in mind, was
also introduced.
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A well-oiled machine
 Alongside these upgrades to the physical infrastructure, training sessions were
held to improve the way that health workers dealt with their patients. As well
as being taught vital technical skills, they were shown how to listen better and
be more responsive to expectant mothers' needs. Special training saw
staff of maternal and paediatric departments work closely with village midwives
to encourage more women to deliver in hospital.
Ensuring that health centres ran like well-oiled machines also involved
addressing managerial issues. Supervising this work, and pushing it forward, was
a team of expert management thinkers. Soon, many of the newly renovated
centres obtained directors whose fresh approaches brought about higher pay
for workers and made it easier to recruit and retain staff.
But by the time the project came to an end in 2007, the statistics showed that
the biggest benefits of all were being felt by the many women who, though they
lived in remote parts of the country and often suffered great poverty, had
brought their children into the world in a safer, more comfortable way.
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Facts and stats
- DFID provided £21 million funding to the "Basic Health Services Project"
(known as H8/SP) from 1999 to
2007.
- Forty-seven million people were covered by the project in 97 counties
and 10 provinces. Twelve million people
enrolled in its medical financial assistance scheme.
- Between 1998 and 2005 the maternal mortality ratio in project counties
fell from 125.5 to 68.2 per 100,000 births, a decrease of over 40%.
- Between 1998 and 2005 the percentage of women in project counties
receiving at least one antenatal visit rose from 67.9 to 86.6%.
- Between 1998 and 2006 the proportion of women in project counties delivering in a health institution
rose from 20
to 70%. (The rapid rise began in 2001/2002 stimulated
by a Government policy that discouraged home deliveries.)
- H8/SP ran in parallel to the £10 million Urban Health and Policy
Project, which achieved similar successes in urban areas.
- DFID continues to support the reform of China’s health sector through the £6
million Health Policy Support Project and the £5 million Rural Health
Project.
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