Governance function analysis of the Patriotic Health Movement in China

Abstract

BackgroundHealth system governance is critical to the operation of a country’s health system and its overall performance. This study analyzes the role of health system governance in driving health policy innovation and effective implementation.MethodsA retrospective review is applied to collect, analyze and synthesize information from publications and policy documents relevant to the implementation of a typical health policy, the Patriotic Health Movement.ResultsThe analysis of governance highlighted a number of features underpinning this policy. These included highest authority prioritizing health system development, specific health policies being prioritized within the national development agenda, strong political will to promote the policies drawing on the advantages of the highly hierarchal administrative system in China, and accumulating evidence from local experience to support policy making. It was also found that the formation of these governance practices and how they drove policy innovation and implementation were both closely related to the political and socio-economic contexts in China.ConclusionGiven that many low- and middle- income countries are strengthening their health systems aimed at UHC, this study demonstrates that along with drawing lessons from health policies or interventions, addressing factors in each governance domain is critical in adapting the policy design to other settings and the effective operation of policies in other settings.

Successes and challenges of health systems governance towards universal health coverage and global health security: a narrative review and synthesis of the literature

“…Cultivating bottom-up and top-down forms of accountability can strengthen the HSG to influence the quality and coverage of health services [ 85 ]. A top-down administrative approach helped to implement policy documentation/direction and was the most common measure for policy enforcement [ 86 ]. Promoting UHC for socially excluded populations helped to establish participatory spaces for policy dialogue and ensure accountability within the health systems [ 32 ].…”

Annual incidence and fatality rates of notifiable infectious diseases in southeast China from 1950 to 2022 and relationship to socioeconomic development

“…Several factors may help explain these decreases. The Patriotic Health Movement, launched in the 1950s, promoted sanitation and public health measures to eradicate vector-borne diseases through interventions such as immunisation, access to toilets and clean drinking water, and health education [14,15]. The immunisation campaign that began in the 1950s led to the eradication of smallpox from the country and the near-eradication of poliomyelitis, measles, ECM, pertussis, and Japanese encephalitis for different age groups [16].…”

“…By 1965, approximately 2500 epidemic prevention stations were operating across more than two-thirds of Chinese counties [14]. In parallel, the abovementioned Patriotic Health Movement mobilised local governments and communities to improve nutrition, sanitation, water quality, and control of infectious disease [14,15]. Between 1950 and 1952, over 512 million of the country's population of 600 million were vaccinated against smallpox, and the last smallpox outbreak in China occurred in 1960, already 20 years before it was eradicated globally.…”

China's COVID‐19 pandemic response: A first anniversary assessment

“…Throughout the Mao era (1949–1976), the Party used nationwide mass mobilization campaigns to create shared meanings and ensure its legitimacy as the ruling party (Perry, 2011 ; Whyte, 1993 ). Deng Xiaoping declared the era of mass mobilization over (O'Brien & Li, 1999 ; Perry, 2011 ; Whyte, 1993 ), however, the Chinese Party‐state never stopped using campaign methods to enlist mass participation to implement specific policies and manage crises (Kleinman & Watson, 2006 ; Mosher, 1983 ; Zhao et al, 2019 ). China's pandemic response included the 'patriotic health movement' ( aiguo weisheng yundong ; henceforth 'PHM'), which started in the 1950s and was institutionalized in the 1970s (Zhao et al, 2019 ).…”

“…The PHM represents a flexible and innovative health 'governance mechanism' (Zhao et al, 2019 ) that benefits from the Party‐state's highly hierarchical structure, particularly its ability to guide populations toward public health goals. The State Council prioritizes health agendas and pushes its implementation through the National Patriotic Health Movement Committee.…”