Table 1

Summary of the Basic Health Services Project

Focus	Rural health system strengthening
Duration	1998–2007*
Actual/latest estimate of financing (USD millions)†	World Bank International Development Association credit	98.42
	UK DFID grant	66.6
	Other donors’ grant	3.504
	Chinese subnational counterpart funds	37.51
	Total	206.034
Geographical and population coverage	The project targeted around 43 million people in 97 poverty-stricken counties out of around 660 counties across 10 provinces/municipalities (Qinghai, Henan, Guizhou, Gansu, Anhui, Shanxi, Chongqing, Ningxia, Shaanxi and Sichuan).
Bottlenecks for the project to tackle	Affordability of health services decreased due to multiple factors, such as the collapsed old cooperative medical scheme, health facility marketisation, excessive drug prescriptions and high service fees and diagnostic test costs. Health service delivery quality, efficiency and effectiveness were poor, reflecting untrained, unsupervised staff and infrastructure investment not aligned with population planning. Rural populations in poverty faced barriers to health services access.
Project components	Improving planning, management and health infrastructure A1. County health resource plans Health planning training and workshops; (ii) progress reviews and site visits; and (iii) technical support to prepare annual work plans. A2. Upgrading township health facilities Reestablishing and equipping about 1000 township health centres and central township hospitals based on revised service functions and standards. A3. Improving management information system Improving the collection and use of information for planning and monitoring health programmes and the project through (i) improvements to the reporting system; and (ii) surveys. Improving health service quality and effectiveness B1. Improving health service delivery Establishing effective supervision and referral relationships between health system levels; implementing standard case management and infection control protocols and X-ray safety; and piloting essential drug lists to reduce dangerous and unnecessary prescribing. B2. Priority health interventions Improving coverage and utilisation of selected cost-effective interventions, targeting important health problems in project counties. Increasing affordability of health services C1. Cooperative Medical Scheme (CMS) Helping townships to establish risk-sharing schemes. Funds were for startup costs (eg, baseline analysis, scheme design, community mobilisation, management capacity and seed funds). C2. Medical Financial Assistance Scheme (MFA) Establishing an MFA scheme in participating townships, as a means to reimburse service providers in partial payment for health services and inpatient care for the poorest five per cent of households. Project coordination and support

Source: Project Appraisal Document, Implementation Completion and Results Report, and the China-led final report of the project, with authors’ amendments.
*The project duration was originally 1998–2005 in the project design, but it was extended to 2007. According to the Implementation Completion and Results Report, “the closing date was extended 2 years to allow the implementation momentum to be sustained and project objectives to be met more fully” (see Page 6, World Bank Group. Implementation Completion and Results Report on a credit of SDR 63.0 million for the People’s Republic of China for a Basic Health Services Project [Internet]. Washington, D.C: World Bank Group; 2008. Report No.: ICR512). According to respondents, the reason for the extension was that the committed funds supported by the donors were not used up, especially in the case of less predictable interventions for institutional changes. Little information was about why the project was extended to 2007 not others. Additionally, the World Bank initiated a rural health project from 2008 to 2014, continuing building on the work developed in the BHSP (see Page 7, World Bank Group. Implementation Completion and Results Report (IBRD-75510 TF-92893) on a Loan in the Amount of US$50 Million to the People’s Republic of China for a Rural Health Project [Internet]. Washington, D.C: World Bank Group; 2014. Report No.: ICR2967).
†The funding statistics are inconsistent across project documents. The statistics in this table were extracted from Page 28, the Implementation Completion and Results Report of this project. In the final report published by the Chinese counterpart, the statistics (in USD millions) are: 85 from World Bank International Development Association credit; around 42 (21 GBP) from UK; 4.19 from other donors; and 43.78 from the Chinese subnational counterpart funds. DFID supported the BHSP through a Health 8 Support Project (H8SP), with grants allowing more focus on ‘software’ expenses (eg., those for increasing flexibility of County Health Resource Plans, establishing expert panels, research and compensating transaction costs) as the Chinese government had internal constraints on the use of credit funds. Other donors supported the BHSP through small grants for innovation, experimentation and project implementation strengthening. The costs varied each year as the progresses of different components differed. For example, the Implementation Completion and Results Report revealed that by the end of 2004, with the township health facility program largely completed, the project increased its focus on capacity and institutional building. However, we have not found exact statistics on annual cost.