China's health system performance

Liu, Yuanli; Rao, K. Ramachandra; Wu, Jing; Gakidou, Emmanuela

doi:10.1016/s0140-6736(08)61362-8

Cited by 159 publications

(147 citation statements)

References 17 publications

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“…There is evidence that the gap in maternal mortality between migrant and resident women is increasing, 16 and little is known about mortality among women with pregnancies outside the family planning system. 38 Income-related inequalities in institutional births increased in rural areas between 1993 and 2003, 39 and inequities between individual women may remain an issue, especially in rural China. The MCMS sample is large, and its quality control is extremely thorough, but a critical assessment of data quality is nevertheless warranted.…”

Section: Discussionmentioning

confidence: 99%

Socio‐economic disparities in maternal mortality in China between 1996 and 2006

Feng

Zhu

Zhang

et al. 2010

BJOG

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Objective China's economic reforms have raised concerns over rising inequalities in maternal mortality, but it is not known whether the gap across socio-economic regions has increased over time.Design A population-based, longitudinal, ecological correlation study.Setting China.Sample Records from the National Maternal and Child Mortality Surveillance System between 1996 and 2006.Methods We report levels, causes and timing of maternal deaths, and examine crude and adjusted time trends in the overall and cause-specific maternal mortality ratio in five socio-economic regions (using Poisson regression). We examine whether socioeconomic disparities have widened over time using concentration curves.Main outcome measures All-causes and cause-specific maternal mortality ratios.Results Maternal mortality (MMR) declined by 6% per year (yearly rate ratio, RR, 0.94; 95% CI 0.93-0.96). The decline was most pronounced in the wealthiest rural type-I counties (RR 0.89; 95% CI 0.85-0.93), and in the poorest rural type-IV counties (RR 0.90; 95% CI 0.82-1.00). There were declines in almost all causes of maternal death. Postpartum haemorrhage (PPH) was by far the leading cause of maternal death (32%, 997/3164). The decline in MMR was largely explained by the increased uptake of institutional births. Concentration curves suggest that wealthrelated regional inequalities did not increase over time.Conclusions China's extraordinary economic growth has not adversely affected disparities in MMR across socio-economic regions over time, but poor rural women remain at disproportionate risk. Other emerging economies can learn from China's focus on the supply and quality of maternity services along with more general health systems strengthening.Keywords China, MDG 5, MMR, socio-economic disparities, time trends.Please cite this paper as: Feng X, Zhu J, Zhang L, Song L, Hipgrave D, Guo S, Ronsmans C, Guo Y, Yang Q. Socio-economic disparities in maternal mortality in China between 1996. BJOG 2010117:1527-1536. IntroductionThe Safe Motherhood Conference held in Nairobi 30 years ago put reduction of maternal mortality on the global health agenda. 1,2 Global campaigns focussing on this issue have accelerated, particularly since the fifth Millennium Development Goal (MDG 5) targeted a reduction in the maternal mortality ratio (MMR) by three-quarters between 1990 and 2015. (www.un.org/millenniumgoals/maternal.shtml.) 3 However, notwithstanding recent evidence, 4 progress has in general been slow. 5 China has the largest population in the world, and maternal deaths in 1990 comprised almost 4% of the world's total. 6 Progress in reducing maternal mortality in China has been impressive; 4,7-10 the MMR decreased from 95 deaths per 100 000 livebirths in 1990 to 45 deaths in 2005, 11,12 a remarkable success given the size and diversity of the country. However, economic reforms have raised Epidemiology concerns over rising inequalities, particularly in poorer regions and among rural migrants in urban settings. [13][14][15][16] Government financing as a p...

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Section: Discussionmentioning

confidence: 99%

Socio‐economic disparities in maternal mortality in China between 1996 and 2006

Feng

Zhu

Zhang

et al. 2010

BJOG

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“…in Mexico and China). 19,20 Despite this difficulty with measurability, the concept of effective coverage is useful for orienting health policy. When combined with financial protection, it enables a more precise specification of UHC: it is system-wide effective coverage combined with universal financial protection.…”

Section: Policy and Practicementioning

confidence: 99%

Health financing for universal coverage and health system performance: concepts and implications for policy

Kutzin

2013

Bull. World Health Organ.

392

306

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“…health facilities has increased in recent years 21 but has not reached 100% yet. Our finding that testing capacity at hygiene stations is limited is consistent with the findings of other studies in China.…”

Section: Researchmentioning

confidence: 99%