Thursday, 29 November 2012

News in brief ...

The Ministry of Health has limited power to implement health system reforms in the provinces

Provincial leaders may block China's health reforms

by Michael Woodhead
The second phase of China's health reforms being pushed by the State Council may stall because the real reforms must be made at local level where the Ministry of Health has little sway, a new report claims.
The report by health analysts and economists notes that China's social sectors are heavily decentralised and the Ministry of Health has limited influence on the detailed design and implementation of the health service reforms at provincial level.
The report says provincial leaders in China are mostly driven by economic progress and revenue generation; whereas health is generally regarded as consuming, not generating revenue.
The analysts say a new health management information system and performance-based management of health staff may enhance oversight
"However, parallel reforms in governance, financing, and accountability are also needed in China, to ensure achievement of the equity objective of its health service reforms, "they conclude.
"Pursuing health service reform in China has the potential to improve equity by bringing standardised primary care and public health to those whose health status implies they need it most. However, it will only succeed if sub-national governments are accountable for related public resource allocation, and if vertical monitoring of the quality, equity, efficiency, and effectiveness of the health sector is improved. In addition to HSR, reforms are also needed to align the responsibilities, capacity, and monitoring of all sub-national authorities with health-related national policies, standards, and regulations, and to improve their accountability to the population. These additions go beyond the influence of the Ministry of Health, but accord with the evident priority assigned to health service reform by multiple national authorities, the benefits to other sectors, and the increasing focus of the state on evaluating local government's commitment to public welfare. "
Read more: PLOS Medicine

Hepatitis B the most common infection in Chinese donor blood

Hepatitis B virus infection is the primary threat to blood safety in China, but the increasing prevalence of syphilis might also be a potential threat, researchers say
Researchers from the  School of Public Health at the Fourth Military Medical University,  Xi’an, analysed trends in the prevalence of transfusion-transmissible infectious pathogens among Chinese, first-time, voluntary blood donors from 1999 to 2009 to evaluate the potential for disease transmission.
Blood donations from 263 000 first-time blood donors were analysed. The overall prevalence rates of infection were 1.16% for hepatitis B, 0.5% for HCV, 0.02% for HIV, and 0.3% for syphilis. There was a significant decrease in the trend for hepatitis B and hepatitis C infections, while a significant increase was found for syphilis. The prevalence of HIV infection remained low and stable during the study period.
Read more: International Journal of Infectious Diseases

Asthma in China: less common but less well controlled 

Asthma is less common in China than in the west, but it is poorly controlled where it does exist, a study from provincial Jinan has suggested.
A survey of more than 13,400 people in urban and rural areas of Jinan found that the prevalence of asthma was 1.1%. A history of allergies, asthma family history, household size, and age were independent factors related to asthma.
Dr Wang Dexiang and colleagues fro the Department of Respiratory Medicine, Qilu Hospital, Shandong University, also found that among patients with asthma, control of the condition was poor in a high proportion of patients and even worse in those living in rural areas.
"The asthma prevalence for all ages in Jinan was relatively low compared with that in western countries, however, local asthma control fell markedly short from the goals of GINA (Global Initiative for Asthma) criteria for asthma management, which may be attributed to the poor adherence to GINA guidelines, especially the underuse of preventative medication of inhaled corticosteroids," the researchers say.
Read more: Respirology

Rural migrants get substandard antenatal care in Shanghai

Many migrant women in Shanghai do not receive adequate antenatal care  a new study shows.
Researchers from the School of Public Health at Fudan University interviewed 767 migrant women who had been living in Shanghai for more than six months and who had a baby in hospital there. They foun d that only half had adequately utilised antenatal care (i.e., made five or more antenatal care visits), although 90% made at least one antenatal care visit. Only 20% of migrant women visited an antenatal care centre during the first trimester (12 weeks).
Antenatal care was used most by older migrant women and migrant women whose husbands held Shanghai residency status. Women from high-income households were also more likely to receive antenatal care during the first 12 weeks.
The researchers say that improving utilisation of antenatal care is a critical strategy for achieving China's Millennium Development Goal of decreasing the maternal mortality ratio.
"While overall utilisation has increased recently in China, an urban vs. rural disparity in access remains," they note.
They suggest that more tailored health education is needed for migrant women and their husbands to improve maternal health. Financial support should also be e provided to improve the utilisation of antenatal care, they add.
Read more: BMC Public Health

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