1. 1 Dr. Zhu CHEN Minister of Health, China (8 July 2009, Geneva) Health-related MDGs in China 1

2. 2 Context 1. Development of China 2. MDGs on Health in China 3. Experiences in Achieving MDGs on Health 4. Challenges 5. Health Care Reform in China 6. Ways Ahead 2

3. 1. Development of China 3

4. Social and Economic Growth Source: National Bureau of Statistics of China and Human Development Report 2007/2008 Trends in Human Development Index (HDI) and per capita GDP (RMB), 1978-2008 4

5. Poverty Reduction Comparisons in no. of people living in poverty and poverty incidence rate 5

6. Health care systems has developed in positive ways Many communicable diseases have either been wiped out or brought under control The health of the Chinese populace has improved considerably Health and Health Care Chinas average life expectancy (years), 1981-2005 Source: Health Statistics yearbook of China 2008 6

7. 2. MDGs on Health in China 7

8. MDG 4 - Reduce Child Mortality Chinas Under-5 Mortality Rate () Goal Real 8

9. MDG 5 –Improve Maternal Health Chinas Maternal Mortality Rate (1/100 000) Goal Real 9

10. The spread of AIDS is slowing down MDG 6 - Combat AIDS, Malaria and Other Diseases 10

11. DOTS coverage for TB has reached 100% MDG 6 - Combat AIDS, Malaria and Other Diseases 11

12. Reported Incidence Rate of Malaria stays at a low level malaria free incidence < 1/ 100000 incidence >1/100000 incidence > 10/100000 incidence >100/100000 Malaria distribution in China MDG 6 - Combat AIDS, Malaria and Other Diseases 12

13. Emergency Response System has been strengthened MDG 6 – Combat AIDS, Malaria and Other Diseases State Council Ministry of Health Provincial Government Provincial Health Bureau City Government City Health Bureau County Government County Health Bureau Emergency surveillance institute Medical institutes and relevant units Emergency surveillance institute Medical institutes and relevant units 2 hours ASAP 2 hours 1 hour 13

14. Prevention and Control Strategy Contain imported cases Contain imported cases Prevent domestic transmission Prevent domestic transmission Prepare for Second Wave Prepare for Second Wave Reduce secondary cases Reduce secondary cases Prevent community transmission Prevent community transmission Treat severe cases Treat severe cases Prepare for epidemic changes Prepare for epidemic changes Gradual transition Strategies are adjusted in time according to the characteristics of different development stages of the epidemic 14

15. Achievements Effectively slowed down the import, spread and prevalence of the disease in China. Gained precious time to prepare for more serious potential epidemic, improve stockpiling of vaccines and drugs, etc. Helped building a favorable environment for China to recover from the global financial crisis as early as possible. Contributed to lowering the global peak of the first wave of Influenza A(H1N1). 15

16. Lab testing training for ASEAN countries. International exchanges and assistance ASEAN plus three Health Ministers (China, Japan, Korea) Special Meeting on influenza A(H1N1) 16 Meeting between Health Ministers of China and Mexico during the 62th WHA, 2009

17. 3. Experiences in Achieving MDGs on Health 17

18. .Uphold people-oriented principle, and put peoples health and life safety at priority.Start from national reality, and follow the rules of healthcare development 18

19. .Focus on prevention, and establish a medical insurance system covering both residents at rural and city areas, which should also center on disease prevention and primary health care Coverage rate of New Rural Cooperative Medical Scheme 19

20. . International Cooperation WHO, UNICEF, UNFPO, UNDP, WORLD BANK GAVI, GLOBAL FUND, UNITAID US, DFID, AUSAID, EC, JICA, ADB Gates Foundation, Clinton Foundation Merck Foundation, Project HOPE South-South Cooperation 20

21. 4. Challenges 21

22. Unbalanced Development & Health Inequity hospital beds Number of rural and urban hospital beds per 1000 people medical personnel Number of medical personnel per 1000 people hospitalized delivery rate Average hospitalized delivery rate in cities and types of regions 22

23. Ageing & Disease Pattern annual increase rates (%) of elderly populati International comparison of average annual increase rates (%) of elderly populations 23

24. Tendency of Death Pattern, China, 1954-1998 Others Injuries & poisoning Non-communicable diseases Communicable, maternal and child diseases Ageing & Disease Pattern 24

25. Urbanization & Migrant Population MMRs of permanent residents and floating population in 2005 (1/100000) 25

26. 5. Health Care Reform in China 5. Health Care Reform in China 26

27. Health Reform Plan Objective To ensure universal coverage of essential health care Service delivery system Primary Health Care System (public health and essential health services) Tertiary Services System (acute and catastrophic services ) Social protection system Free PHC by governments facility Social Medical Insurance (Essential Medical Insurance + Cooperative Medical Scheme) Commercial medical insurance Strategies Health Law: Health right Role of governments Statutory governments inputs; Accountability To assure hospital social objective Health administration on system reform 27

28. Five key tasks for 2008-2010 28. Improve grassroots medical and health service system To expedite the construction of urban and rural grassroots medical health institutions for extensive coverage. To improve finance mechanism, by pooling finance departments at various levels to ensure the input for development of grassroots health institutions and staff salaries. To separate income and expenses in finance and sell drugs at zero gap. To strengthen the training of grassroots medical workers, general practitioners, in particular. And establish mechanisms for evaluation and incentive. To gradually establish classified medical service and two-way referral system.

29. Five key tasks for 2008-2010 29. Make primary public health service equal accessibility for the people To strengthen construction of specialized public health institutions to better serve for public health. To reform personnel distribution system, implement competition for all the posts and job accountability, and enhance performance evaluation. To improve finance mechanism for public health institutions by 100% budget management, formulate basic public health service projects, and allocate relevant amount of subsidies based on the population of service recipients. To provide urban and rural residents with primary public health services including disease prevention and control, planned immunization, maternal and child health care and health education, etc. To implement national key public health projects, and control major diseases and risk factors.

30. Five key tasks for 2008-2010 30.Expedite the construction of basic medical insurance system To cover basic medical insurance system in an all-round way, and ensure the participation rate of basic medical insurance scheme for urban and rural residents to reach 90% or higher. Basic Medical Insurance System for Urban EmployeesBasic Medical Insurance System for Urban Employees Basic Medical Insurance System for Urban ResidentsBasic Medical Insurance System for Urban Residents New Rural Cooperative Medical Care SchemeNew Rural Cooperative Medical Care Scheme To raise the percentage of medical costs for hospitalization in insurance, and incorporate outpatient fees of common diseases and frequent diseases into medicare reimbursement. To resolve the insurance for university students, people employed flexibly, retirees from bankrupt state-owned enterprises, retirees and workers of ill-functioning companies, and farmer-turned workers. To appropriately address medical insurance for migrant population. To improve the urban and rural medical relief system.

31. Five key tasks for 2008-2010 31. Establish national system of essential medicine To scientifically determine the categories and quantities of essential drugs, and give access to around 700 categories of drugs. To implement bid system for fixed site manufacturing, and direct and extensive distribution of essential drugs. To enhance supervision over essential drugs. Medical and health institutions must equip and prioritize essential drugs, and grassroots medical organizations will prescribe 100% essential drugs. To promulgate and implement prescription collection for essential drugs and guidelines for treatment, and boost the drug prescription level. All of the essential drugs will be included in the basic medical insurance reimbursement catalog, and the reimbursement ratio will be much higher than non-essential drugs. Essential drugs will be priced by the state, and their prices will be controlled within reasonable range.

32. Five key tasks for 2008-2010 32. Promote reform pilot projects in public hospitals To scientifically determine the amount, scale and layout of public hospitals. To increase government input, improve finance mechanism and grant special subsidy to public health services provided by public hospitals. To eliminate the policy of drug price addition by adding charge for pharmaceutical services and investment. To reasonably adjust the prices for medical services, reflecting the value of medical services. To explore legal representative governance structure in public hospitals, and establish president administration system. To reform the mechanism of personnel distribution, all medical workers will be employed by contract terms, and the salary system will combine position and performance. Enhance cost evaluation and control. To improve internal management, regulate medical practice and optimize service flow.

33. inequities Devoted to the inequities in income, social insurance, medical services and education international cooperation Actively involved in international cooperation, and make contributions to the realization of MDGs in the world inequities Devoted to the inequities in income, social insurance, medical services and education international cooperation Actively involved in international cooperation, and make contributions to the realization of MDGs in the world 6. Ways Ahead 33

34. THANK YOU FOR YOUR ATTENTION THANK YOU FOR YOUR ATTENTION 34