The health policy process and key determinants: China case studies

Health policy processes in developing countries are less robust than is desirable. The China study of SBA, ARH and DV policy focused to understand the cause of the Know-Do gap, to explore the complex interplay between different influences on the policy process, and to examine the key determinants in the policy process.

In the context of globalization, China economic reform and social transition, the domestic policy paradigm has being changed from “economic centered” to the "people focused". The issue of maternal health care and women right protection were then prioritized. The policy process of three cases were initiated by specific policy problems such as high MMR, emerging adolescent reproductive health problem and domestic violence against women.

The agenda settings were driven by the new political philosophy and availability of both international and national evidences. However, the different policy issues led to different policy processes: government dominated process for SBA, donor driven process for ARH and formal legislation process for DV.

Four themes of health system, human resources, service delivery and civil society were considered both individually and in an integrated way in the processes. A variety of evidence such as research evidence, statistical data and local pilot experiences were used. A number of actors were involved in the policy processes. Among these actors, government leadership and coordination were crucial for achieving policy goals. The CSO especially women’s federation played an important role in terms of advocacy, mobilization and involving policy making. All the above determinants created an enabling environment within which policy could be developed and then smoothly implemented.

Two lessons were learned from China case studies. Political commitment is the key determinant for a sustainable policy. Supervision and evaluation were important mechanism ensuring proper policy development.