Situation Analysis for Health Policy in Guangxi Zhuang Autonomous Region of China in 2001

Preface

Health is a basic need and eternal pursuit, as well as a creation and foundation for making profits for people. The health course is an important part of social and economical development. Health work plays an important role, which cannot be substituted in protecting productivity and promoting modernization in China. Therefore, it is important guarantees on reaching the goal of letting people get affluent and enhancing the development of health services to improve the health and life quality of the people in Guangxi.

The Health Policy Study of Guangxi Zhuang Autonomous Region was made according to the requirement of WHO West Pacific Region and Ministry of Public Health. The authors analyzed the current situations and the existing problems of Guangxi health development by collecting the information and data inside and outside the health system, and put forward the policy suggestions on enhancing the development of Guangxi health work in the future to help the policy and decision-makers to have deeper understandings on this situation, to improve their scientific decision-making and to serve the economic development and social prosperity better in Guangxi.

Contents

Guangxi health policy study

The main problems in face of Guangxi health work

Great influence of population aging on economy and society

Acute, chronic infectious diseases and parasitic diseases – main factors affecting Guangxi population health in a certain period in the future

Chronic-non-infectious diseases and accidents – increasingly serious influences on economy and health

New health problems resulted from the economical development

Unsound health insurance mechanism

Weakened rural health work

Existing deeper problems in health care systems

Lower level of medicare

Policy suggestions

The golden rules of health development

Strengthen the leadership of government to health work

Establish the insurance mechanism that fits the social and economical level and promotes the health development

Strengthen the foundation construction of health and improve the overall level of Guangxi health work

Adjust health service system strategically

Establish the health management system that fits market economy

Persist in the policy of putting the stress on rural health work, prevention and mother and child healthcare (MCH), and traditional Chinese medicine

Improve the quality of medical and health workface

General situation of Guangxi health development

The level of people’s health

Health resources

Medical services in hospitals

Utilization of health services

Rural health work

Disease prevention and control

Traditional Chinese medicine and folk medicine

Mother and child healthcare

General situation of population, natural environment and social and economical development in Guangxi

Population and natural environment

Economical and social development

Guangxi health policy study

Since over twenty years of reform and opening the door to the outside world, Guangxi people, under the leadership of the Party Central Committee and State Council and Guangxi Provincial Government, have changed their ideology, grasped every new opportunity, and enhanced the foundation establishments so as to greatly improve their living conditions (for details, please see General situation of population, natural environment and social and economical development in Guangxi). The development of economy promoted the quick development of health work. Now three levels of medical and health service networks have been set up in urban and rural areas in Guangxi and supplying capability of health services have been further strengthened. Up to 2000, there have been 13,700 medical institutions with 85,400 ward beds and 158,700 medical and health staff, among whom 127,000 are doctors, nurses or technical personnel. Some diseases that seriously endangered people’s health have been brought under control or eliminated and the people’s health has obviously been improved. Compared with 1999, infant mortality rate dropped from 61.33‰ to 27.34‰, mortality rate of children under five years old dropped from 77.15‰ to 32.15‰, maternal mortality rate from 143.68/100,000 to 60.33/100,000. Life expectancy per capita went up from 41 years old before 1949 to 72.5 years old (for details, please see General situation of Guangxi health development). Guangxi health work has made a great contribution to the safeguard of social productivity, promotion of economical development and maintenance of social stability in Guangxi.
It is an important period from now on to 5-10 years for Guangxi to speed up its development and to build well-to-do society. Health work plays an important role, which cannot be substituted for in promoting the economical development and social progress. Therefore, it is an important task for the governments at all levels to speed up the development of health work and to improve the people’s health.

In the new century, the health work meets new challenges with the improvement of social and economical development, and the high living standards of the people, as well as the increase of population. The change of population dynamics and the increase of life expectation per capita bring aging problems of population and pressure on society and economy. Also a new task has been put forward to the health service system and service models. Varied, comprehensive and high quality health care services are needed with people enjoying well-to-do life and increasing knowledge of society toward health value. The transfer of disease moles, shortage of health investment, and poor quality of medical and health personnel at grass-root units cannot meet the increasing demand of people for medical and health care. Thus varied contradictions and problems arose from health transformation can be resolved by changing our conception, and reforming our health work.

The authors of this study put forward their suggestions on the policies of health development in the future on the bases of analysis of main problems Guangxi health work faced.

The main problems in face of Guangxi health work

Great influence of aging population on economy and society

According to the international practice, the proportion of more than 10% of people over 60 years old or 7% over 65 among the total population can be considered as population aging. The aging problem is an increasing global tendency.

The age structure of Guangxi population has changed greatly with the transformation of reproductive types of population. The proportion of population from 0 – 14 years old was 26.24% in the year 2000, which was higher than the average of China (22.89%), but was reduced 9.58% as compared to that in 1953. The proportion of population over 65 was 7.12%, higher than the average of China (6.96%). the proportion of population at/over 65 was increased totally 1.75% from 1964 to 1982, 1.7% from 1990-2000. the degree of population aging in rural areas (7.56%) was higher than that (6.0%) in towns. It was shown that the aging progress of Guangxi population has been quickening obviously, and rural and urban areas are all facing the challenge of population aging.

The population aging brings the following serious influences: 1.increasing economical burden of working population toward the increase of population proportion supported. 2. Heavy burden of the financial expenditure of government for the elderly such as the increase of social insurance, welfare, relief and services. 3. The increasing expenditure of medical and health care for the elderly and 4. Increasing needs for higher quality of medical and health services.

Acute, chronic infectious diseases and parasitic diseases – main factors affecting Guangxi population health in a certain period in the future

Guangxi, situated in the area of low latitude, is warm and rainy as alternately affected by warm and humid air current from the ocean and modified cold mass from the north all the year round. The hot and humid climate fits for the growth of insect vectors that cause high incidence of intestinal infectious diseases and food poisoning. Guangxi was a so-called miasmatic area historically. Thus the infectious and parasitic disease prevention and control is very arduous. Especially in recent years, some diseases as STD and TB that were once brought under control have come back again and have the tendency to spread. New disease as AIDS has occurred and prevails. A little slackness of infectious diseases control would cause the local outbreak and even the possibility of pandemic. According to the analysis on the composition of diseases in inpatients, the infectious and parasitic diseases ranks in the 9th place in cities, and 7th place in county level. It is estimated that in 10 years Guangxi is still in the alternant period of first and second health revolutions and acute, chronic diseases and parasitic diseases still threaten the health of Guangxi people. The disease control is facing much more serious situation.

1 Current situation of prevalence of major infectious diseases

33 out of 35 notifiable diseases in China have been reported or prevailed in Guangxi. 25 out of 26 A/B notifiable diseases were reported in Guangxi, mainly cholera, AIDS, TB, typhoid fever, hepatitis, STD, dysentery, malaria and so on. In 2000, 23 A/B infectious diseases were reported. The total morbidity rate was 231.17/100,000. Total mortality rate was 0.72 /100,000. Total fatality rate was 0.31%. In recent five years, the morbidity rate has had the tendency to increase according to the reports on infectious diseases. The main reasons are as follows: 1. The obviously reduced rate of missing reports because of the conducting of investigation on missing reports of infectious diseases and the strengthening of report management. 2. The increase of STD morbidity rate.

(1) Intestinal infectious diseases represented by Cholera and typhoid fever

Cholera

The epidemic trend and characteristics of cholera have been changed. Cholera not only prevailed in coastline areas but also broke out locally in inland areas.

Typhoid fever

In recent years, the epidemic of typhoid fever has had a tendency to increase. The morbidity rate was 6-13 /100,000 in Guangxi. The reasons that caused the epidemic were mainly the characteristic karst topography, poor environmental health condition in rural areas, unhealthy drinking water for residents and miscarriage of water resources in some water supplies.

(2) Hematogenic and sexual transmitted infectious diseases represented by hepatitis, AIDS and STD

Hepatitis

Since 1990’s, the cis-position of virus hepatitis has been put forward in the morbidity and mortality of various infectious diseases reported in Guangxi. In 1995-2000, hepatitis ranked in the anteposition of morbidity rate of infectious diseases reported. In 2000, the morbidity rate reached 52.71 /100,000 that was higher in rural areas than in towns. Guangxi is one of the provinces of high epidemic of hepatitis B. The carriage rate of hepatitis B virus in population was 13.03%. There are 1.6 million patients with hepatitis B and 6 million carriers of hepatitis B virus, which are higher than those of the average of the whole country.

There have been no drugs for the radical cure of hepatitis B. The most effective preventive measure is to inoculate children with hepatitis B vaccine. In Longan County, one of the high epidemic areas of liver cancer, neonates in rural areas have been inoculated with hepatitis B vaccine since 1987. This greatly reduced the HbsAG carriage rate in adolescents. The morbidity rate of hepatitis B also dropped by a big margin. The preventive results are satisfactory.

AIDS
The surveillance of AIDS began in 1986 in Guangxi and the first case of HIV infection was found in 1996 in Guangxi resident. The epidemic developed quickly and in the end of 2000, 2,146 cases of HIV infection and AIDS patients had been detected. But experts estimated that the actual cases of HIV infection would be 40,000. 63 counties and cities have been involved. HIV infection rate has surpassed 10% in drug users in some central cities and towns. The numbers of HIV infection reported ranked third in China.

The main causes that resulted in HIV/AIDS epidemic in Guangxi were sharing needles by IV drug users. But the infection number by sexual transmission has a tendency to increase. HIV infections were detected from drug users, underground prostitutes, STD patients, pregnant women, truckers, seamen, and spouse of HIV infection cases. At present, AIDS has been transmitted from high-risk groups to population. It will seriously affect the economical construction, social stability and the people’s health of Guangxi, if no effective control measures are immediately taken.

STD

STDs were eliminated in Guangxi in 1962 but prevailed again in 1982. The morbidity rate was increasing year by year. In 1995-1998, 25,000-30,000 cases were reported annually. The morbidity rate was 65/100,000. There were 32,700 and 30,400 reported cases in 1999 and 2000, respectively. The morbidity rates were 69.42 and 62.73 /100,000, respectively. Nearly all this reported cases were from public medical and health institutions. The actual cases are far more than this. STDs have spread from towns to rural areas and its high morbidity rate fostered the epidemic of AIDS.

(3) Respiratory infectious diseases presented by Measles and tuberculosis

Measles

Since EPI implementation to the end of 1990s, morbidity of Measles reported in Guangxi was put under control of 15 /100,000. Morbidity dropped 88% and mortality dropped 95% compared to those before EPI implementation. Measles is highly infectious and the vaccine is not capable of lifelong immunization. The success rate of immunization is not satisfactory due to the hot climate and inconvenient traffic of Guangxi. All this leads to the gathering of susceptible population in local areas and forming the high-risk population in Measles epidemic. Epidemic peak occurred in every 4-6 years. In 2000, there was an increase in Measles morbidity of 51.52% above that of the corresponding period of 1999. The epidemic was mainly local and the outbreak was small.

Tuberculosis

Tuberculosis once eliminated in china, prevails due to its biological characteristics and social influences. China has become one of 22 countries that bear heavy burdens of TB. TB epidemic is very grim in Guangxi. There were 20,460 new TB cases registered in 1999. TB epidemic ranks first in all infectious diseases. The numbers of death from TB is higher than the total of death from all the other infectious diseases. According to the fourth nationwide epidemiological survey on tuberculosis finished in June 2000, TB morbidity rate were 650 /100,000, increasing 39.49% as compared with 466 /100,000 in the third nationwide epidemiological survey on tuberculosis in 1990. The annual progressive increasing rate was 3.38%, of which infectious pulmonary tuberculosis was 127/100,000; increasing 11.40% than that in1990. On the basis of this estimation, there are 300,000 TB patients, of whom 60,000 are cases of infectious pulmonary tuberculosis, 75% being working groups from 15-54 years old. Cases of active pulmonary tuberculosis detected and treated account for 2% of the cases calculated statistically. Most of the infected cases are still among the health groups. If they are not given prompt treatment, they will infect more health population. TB has become one of the major diseases that restrict the economical and social development in rural areas, especially in poverty areas.

2 Parasitic diseases and endemic diseases

The infections of human parasitic diseases are as many as 24 kinds, mainly malaria, Clonorchiasis, intestinal nematodiasis, taeniasis, cysticercosis, and so on. The infection of intestinal nematodiasis is the most serious. The epidemic of Clonorchiasis was found in 52 counties/cities. The average infection rate was 19.7%. It is estimated that there be over 2 million people infected with Clonorchiasis. And this figure is still increasing. As residents in some parts of Guangxi have the customs to eat raw pickled meat, there also exist dangers of taeniasis, cysticercosis and trichiniasis.

Endemic fluorine poisoning and IDD are the main endemic diseases in Guangxi. Morbidity rate of endemic goiter was as high as 25.38% on the basis of the research data in early 1960s. Guangxi belongs to the medium epidemic area. IDD was detected in746 townships in 65 counties/cities, mainly distributed in mountain areas in north and west parts of Guangxi.

Epidemic of acute and chronic diseases have given heavy burdens to the country and family, affected the social stability and disturbed the economical development. Therefore, governments at all levels should attach great importance to this.

Chronic-non-infectious diseases and accidents – increasingly serious influences on both economy and health

In the last ten years, the models of epidemic and death have been changed as the result of quick pace of life, pressure from work, unreasonable diet structure, ill life styles brought by the economical development, progress of population ageing, industrialization. The increasing morbidity rates of chronic-non-infectious diseases such as cardio-cerebral vascular diseases, tumor and diabetes, mental diseases and accidents have become new social health problems.

Based on the data of sampling survey on the death causes of population in Guangxi in early 1990s, death from chronic-non-infectious diseases accounted for 35.78% among the number of death cases. The mortality rate of major chronic diseases had an increasing tendency in 1991-1996. 82,000 people died from cardio-cerebral vascular diseases and 34,700 from malignant tumors in 1996. Compared with those in 1991, the mortality increased 48.55% and 57.73%, respectively. In accordance with the sampling survey in two demonstration sites in Guangxi, in the last ten years in Liuzhou the mortality rate of cardio-cerebral vascular diseases reached as high as 150 /100,000. Case rate of hypertension was 4,200/100,000. Morbidity rate of tumors was 207.75/100,000. Case rate of diabetes was 2,400/100,000. In 1998, the morbidity rate of chronic diseases reached 46,700/100,000 in residents of Beihai. Case rate of hypertension was 28,000/100,000 in residents over 35. The sampling survey on health status showed that in 2000, case rate of hypertension was 22,000/100,000 in residents from 37-74 in Nanning. The case rate of major chronic diseases such as cardiac infarction, cerebral apoplexy, heart failure and chronic bronchitis, was 13,970/100,000. According to the data of Guilin City, the death rate from chronic diseases also had an increasing tendency.