Essential drugs policy in three rural counties in China: What does a complexity lens add?

Evaluation, in three provinces, of the introduction and impact of China’s National Essential Medicines Scheme

“…24 Although the main aim was to evaluate how the NEMS had affected various quantitative measures of health care, an important secondary goal was to explore how different locations were implementing a scheme for which only general principles had been outlined. 22 The collection of both quantitative and qualitative data has recently been recommended for health policy and systems research. 25,26 The analytical approach to be followed was established in advance (Appendix A, available at: http://www.12320.gov.cn/12320dt/show.…”

“…However, the official documents for this reform provide only guiding principles that encourage the local adaptation and piloting of the NEMS, 21,22 including the use of the National Essential Drugs List (now widely augmented 14,23 ) and strategies to compensate health-care providers for income lost as a result of the zeromark-up policy.…”

“…16 Although the NEMS has now been almost universally introduced, the effects of its introduction in rural China have not been widely investigated. In a recent evaluation, 22 China's NEMS was viewed as a dynamic process with multiple and unpredictable stakeholders interacting in a complex conceptual framework. In the present study, which was based on selected health facilities at the grassroots level, various methods were used to explore the implementation and financial and operational impact of the NEMS and to record the views of the healthcare providers and patients affected by it.…”

“…However, local governments should perhaps not be given too much responsibility for the detailed design and funding of the NEMS, as this could also threaten the NEMS' viability. 22 Until the link between drug sales and the incomes of health-care providers and facilities is broken, the full realization of the intended benefits of the NEMS will remain a great challenge. ■ …”

Constraints to applying systems thinking concepts in health systems: A regional perspective from surveying stakeholders in Eastern Mediterranean countries

“…apprehensions about job loss), conflicts in mandates and governing rules among organizations, and factors in academic environments that may limit adoption of systems approaches (1). Given the increased recognition of the importance and relevance of ST for strengthening health systems in LMICs in recent years, expressed by the 2009 WHO publication (5) and other recent publications on the topic (3,9,17,18), and using the EMR as a case study, this paper seeks to gain a better understanding of: 1) how ST concepts have been received and used by health systems stakeholders including policy-makers such as senior officials in the Ministry of Health (MoH), researchers and other stakeholders such as civil society groups and professional associations, particularly in LMICs in recent years; 2) what in their view are the key enablers and barriers that may support or hinder its wider adoption in health systems research and practice; and 3) what are the possible strategies to address the perceived constraints. Despite the diversity in countries of the region with regard to income, development, health and environmental conditions, most countries from the EMR are classified as LMICs.…”