Policy experimentation and innovation as a response to complexity in China’s management of health reforms

Abstract

There are increasing criticisms of dominant models for scaling up health systems in developing countries and a recognition that approaches are needed that better take into account the complexity of health interventions. Since Reform and Opening in the late 1970s, Chinese government has managed complex, rapid and intersecting reforms across many policy areas. As with reforms in other policy areas, reform of the health system has been through a process of trial and error. There is increasing understanding of the importance of policy experimentation and innovation in many of China’s reforms; this article argues that these processes have been important in rebuilding China’s health system. While China’s current system still has many problems, progress is being made in developing a functioning system able to ensure broad population access. The article analyses Chinese thinking on policy experimentation and innovation and their use in management of complex reforms. It argues that China’s management of reform allows space for policy tailoring and innovation by sub-national governments under a broad agreement over the ends of reform, and that shared understandings of policy innovation, alongside informational infrastructures for the systemic propagation and codification of useful practices, provide a framework for managing change in complex environments and under conditions of uncertainty in which ‘what works’ is not knowable in advance. The article situates China’s use of experimentation and innovation in management of health system reform in relation to recent literature which applies complex systems thinking to global health, and concludes that there are lessons to be learnt from China’s approaches to managing complexity in development of health systems for the benefit of the poor.

China's policy experimentation on long‐term care insurance: Implications for access

“…Under the umbrella of “experimentation,” the central government encourages subnational governments to carry out pilot programs for exploring novel policy options and solving problems through a process of trial and error. Lessons learned from the pilot programs will help the central government find an appropriate policy with contextual fit nationwide . Hence, 15 pioneer cities were selected for implementing LTCI pilots, instead of a direct start with a national scheme.…”

Understanding China’s growing involvement in global health and managing processes of change

“…localities to test alternative approaches for establishing some form of rural health insurance before implementing a nation-wide reform in 2009 that included rural health insurance [1,2]. Analysts point out functional similarities between Chinese approaches to experimentation as a component of the management of rapid change and approaches now being recommended by the global development community [4,6].…”

“…Alongside highprofile commitments such as financing the construction of the Africa Centre for Disease Control and Prevention (CDC) and their five regional sub-centres (and staff secondments to the CDC) [41], support for several direct interventions overseas, 3 and programmes such as the Brightness Project [45], many less prominent initiatives are underway. Examples include the continued support by the Chinese CDC for public health strengthening in Sierra Leone, a range of new bilateral cooperation agreements, 4 diversification of the functions of Chinese medical teams, supporting Chinese emergency medical teams to get WHO-prequalification, and support for joint external evaluations in several Asian countries. 5 The National Health and Family Planning Commission Belt and Road Health Cooperation Plan issued in 2015 [37] provides a snapshot of the breadth of activity underway, including commercial activity, health assistance, infectious disease control and health security, primarily framed as 'cooperation' rather than 'assistance'.…”

“…The strategy implemented between 2013 and 2018 involved: 3 Notable examples are pilot projects in Tanzania, Myanmar and Ethiopia supported through the GHSP (see GHSP project completion review [42]), a Sino-Australian collaboration on building capacity for malaria control in Papua New Guinea [43], and a malaria eradication initiative in Comoros [44]. 4 Examples include agreements such as the Sino-Czech 2017-2020 health cooperation plan [46], announcement of health as a priority in collaboration with the Lao PDR [47], and support to development of public health institutes in Myanmar and Cambodia. 5 A list of JEE mission reports for the WPRO region is available here.…”

“…It brings together two sources of data. The first is a series of analyses by this paper's authors of China's approach to the management of change in its own health system [1][2][3][4]. The second is a review of documents and a number of interviews undertaken as part of an evaluation of the UK Department for International Development-funded China-UK Global Health Support Programme (GHSP).…”