Impact of new health care reform on enabling environment for children’s health in China: An interrupted time-series study

Abstract

Background Creating an enabling environment (EE) can help foster the development and health of children. The Chinese government implemented a new health care reform (NHR) in 2009 in a move to promote an EE for health. The purpose of this study was to evaluate the impact of the NHR on EE for children’s health. Methods An interrupted time-series analysis was used to evaluate the changes in the EE before and after 2009 in China. This study analysed the EE through five quantitative indicators, including policy element coverage rate (PECR), service meeting with children’s needs rate (SMCNR), multisector participation rate (MPR), and accountability mechanism clarity rate (AMCR), based on the content analysis of available public policy documents (updated as of 2019) from 31 provinces in mainland China, and the number of health care personnel of maternity and child care centres per 10 000 population (HP per 10 000 population), based on the 2002–2019 China Health Statistical Yearbook and China Statistical Yearbook. Results The average values of PECR, SMCNR, and MPR increased rapidly to 90.96%, 82.46%, and 81.31%, respectively, in 2019, representing a higher value compared to the AMCR (7.38%). The NHR promoted the EE, in which HP per 10 000 population showed the fastest increase (β 1 = 0.03, P < 0.01; β 3 = 0.10, P < 0.01), followed by SMCNR (β 1 = 0.94, P < 0.01; β 3 = 1.83, P < 0.01), AMCR (β 1 = 0.13, P < 0.01; β 3 = 0.24, P = 0.14), MPR (β 1 = 1.35, P < 0.01; β 3 = 2.47, P < 0.01) and PECR (β 1 = 1.43, P < 0.01; β 3 = 1.47, P < 0.01). Conclusions The NHR has a positive impact on the EE, especially on the human resources and service provision for children. Efforts should be intensified to improve the clarity of the accountability mechanism of the health-related sectors.

Research on the Experience of Influencing Elements and the Strategy Model of Children’s Outpatient Medical Services under the Guidance of Design Thinking

“…In 2018, the Shanghai Municipal Health Commission issued the "Guiding Opinions on Further Improving Pediatric Specialized Medical Services" [74]. This opinion proposes to optimize the allocation of medical resources, improve the quality and level of medical services, and provide more convenient and efficient medical services for children [72,75,76]. In addition, the Shanghai municipal government has also increased funding and support for pediatric medical services to promote the improvement and upgrading of pediatric medical services [9].…”

Promotive and Preventive Efforts of Health Workers in Reducing Stunting: A Scoping Review

“…Nutrition education aimed at mothers to increase exclusive breastfeeding, healthy complementary food, immunization of infants and children, and treatment of diarrhea in infants is programmed and advocated using a multilevel approach involving health workers (Sartika et al, 2021). In addition, there is support from the government which has implemented a nutrition program for children and provides nutritional food supplement packages containing protein, vitamins, and minerals every day for every child aged 6-24 months and provides education on child nutrition (Huangfu et al, 2022) The inhibiting factors are explained in the article [7]. Providing education about nutrition and reproductive health to pregnant women, continuous monitoring and evaluation by health workers, such as midwives, nutritionists, health workers, or other health practitioners, is necessary to ensure that the nutrition education program and reproductive health runs optimally and continues until the child is 2 years old (Permatasari et al, 2021).…”