China: Healthcare and MSF activities
Number of expats: 28
Number of local staff: 37
Collaboration with: Ministry of Health, Yunnan Tuberculosis Institute, Yunnan International NGO Organisation, Yunnan AIDS Bureau
Health endangered Health in China has come under pressure since the abolition of free healthcare introduced under Mao Zedong. The situation is deteriorating rapidly in the countryside in particular. Child mortality in some areas has now sunk to the level of the least developed countries. MSF has long-term projects for improving basic healthcare, fighting tuberculosis and venereal diseases and providing information on HIV/AIDS. It also acts in an advisory capacity to government in case of natural disasters.
Economy torn between communism and capitalism Economic reforms and liberalisation have made China one of the fastest-growing economies in the world. The old collective agricultural system began to be dismantled in 1978. Individual responsibility and a greater say for middle management are now increasingly the credo. A wide variety of small service companies and light industry are now permitted. The economy has now opened up, and foreign trade and investment have risen to high levels. The gross national product has increased fourfold since the reforms.
At the same time, China is trying to bring its socialist heritage into balance with the capitalism that is now being embraced. A "social market economy" seems to be a contradiction in terms, and there is growing tension between the strongly centralised political system and the decentralised economy.
Since time immemorial, China has been faced with periods of disastrous drought, floods and earthquakes. The vast network of rivers is a blessing for agriculture but is extremely difficult to tame. Floods occur every year. The extensive infrastructure works - in the form of dams, river embankments, canals, drainage channels and reservoirs - have not been able to change this. Air pollution, soil erosion (with agricultural land in particular being affected) and a gradual fall in the ground water level in the north of the land are further problems which make development difficult.
Politics and Population
Collapse of "medical care for all"
Healthcare in China, particularly in the countryside, is suffering as a result of the liberalisation of the economy, and has now reached crisis point. Free healthcare has been abolished and many people are no longer able to pay for even basic medical care. As a result, millions of less well-off people in the countryside, and increasingly also in the cities, are deprived of healthcare. Healthcare for various minority groups in particular has been affected, as they often live in poor, remote areas.
The rapid increase in infectious diseases (such as HIV/AIDS, tuberculosis and hepatitis) is alarming, as are the slow bureaucratic responses of central government and the ignorance of many health workers and of large sections of the population. In Yunnan province alone, where MSF is carrying out an HIV/AIDS awareness campaign, the number of HIV-positive people is estimated at 200,000. However, reliable data are not available, as the epidemic is denied.
The health workers are responsible for their own income and, increasingly, they prescribe drugs and treatment methods that are inappropriate and too expensive. Medical ethics are constantly under pressure. Preventive healthcare is neglected because it is not considered as profitable.
China regularly suffers from floods, earthquakes and epidemics. Although the Chinese have developed an aid infrastructure, it has become increasingly difficult to reconstruct and be well prepared for disasters. There is growing demand for knowledge and training in order to be sufficiently prepared.
MSF Project Activities
MSF operates in the southern provinces of Yunnan (pop. 40 million) and Sichuan (pop. 63 million). Yunnan has specific social and health-related problems because it borders on Burma, Laos and Vietnam. Many new and recurring infectious diseases are brought to other parts of China via Yunnan. The many ethnic minorities (belonging to the poorest in China) are widely spread over remote, inaccessible mountain regions.
MSF is helping these people by improving their water and sanitation conditions and is providing them with information about basic health and hygiene. A programme was started in March 1999 to tackle the alarming spread of tuberculosis among a number of minority groups. MSF acts in an advisory role in case of natural disasters.
In Sichuan province, MSF has set up an AIDS prevention programme aimed at providing information for groups that run a high risk of infection, local health workers and local leaders. Many Chinese from the countryside try to make a living in the cities but frequently fail. When they return to the provinces they are often infected with HIV.
- Yunnan, Wenshan Prefecture - Xichou county
Start: February 1998
Target group: The inhabitants of four villages directly, and the inhabitants of Xichou county (pop. 234,000) indirectly.
Activities: Health and hygiene training for members of ethnic minorities in the villages of Ma'anshan, PanGu and ShanGuo aimed at raising awareness of the importance of clean drinking water and better sanitation facilities. Refurbishing and improvement of the deficient water system and construction of sanitary facilities in Manlong en Ma'anshan. Biogas systems are being built in villages of PanGu and ShanGuo, thus improving the sanitation situation in these villages and helping to prevent the controversial cutting of wood in the region.
- Yunnan, Nujiang Prefecture - Fu Gong and Gong Shan counties
Start: March 1999
Target group: Sputum-positive inhabitants of Fu Gong and Gong Shan County in Nujiang Prefecture.
Activities: Improvements to the tuberculosis test programme in collaboration with the local health authorities. Drugs against TB are provided to local doctors, who are trained in using the DOTS method correctly. A TB advertising campaign has been started, aimed at providing information to the local population made up of Lisu, Dulong, Tibetan, Nu and Bai minorities.
- Sichuan, Liangshan Prefecture - Xichang, ZhaoJue and BuTuo counties
Start: September 1999
Target group: Drug users, prostitutes, migrants, health workers, local authorities and local leaders.
Activities: An information programme is being carried out to educate the target group about the threatened HIV/AIDS epidemic. In collaboration with local Ministry of Health, more humane treatment methods for HIV-positive patients are being introduced. A study is being carried out in order to obtain more understanding of the spread of venereal diseases and to emphasise the link with HIV/AIDS.
- Yunnan, Zhaotong Prefecture - Yiliang county
Start: June 1999
Target group: The most vulnerable population groups in the above areas.
Activities: Inventorying of the most vulnerable areas and population groups, with the aim of helping them to prepare for the threatened epidemics and natural disasters. The project is being carried out in close collaboration with the local authorities.
- Yunnan, Kunming en Yuxi, KaiYuan en HeKou counties
Start: March 2000
Target group: The population of the above areas, health workers in particular.
Activities: An HIV/AIDS awareness campaign is being developed in collaboration with the Yunnan AIDS Bureau. Posters and flyers are being distributed and the campaign is being supported by a travelling information exhibition. The campaign is concentrating on condom use in particular, since public advertising for condoms in China is otherwise officially forbidden.