Table 3

A summary of BHSP interventions’ integration into China’s health system

Intervention and the integration	Evidence and examples
Various ideas and values were introduced and institutionalised at the national level or in project areas to promote health equity.	According to subnational respondents, the idea of ‘A1. County Health Resource Plans’ took root for some managerial and policy-making officials in project provinces and counties. According to respondents, the project’s approach of government contracting health services was successfully implemented nationwide and accepted to promote government accountability in the health sector since 2009. According to published literature32 and respondents, the project advocated the balance of hard versus soft infrastructure* and demand-side versus supply-side investments†, which were routinised in project provinces and counties and included in the discourse of national healthcare system reform in 2009.
Some interventions informed China’s rural health system reforms and were adapted accordingly in national and provincial policies.	According to respondents, ‘B2. Priority health interventions’ tailored to local needs in the project were assumed by provincial public health services and standardised through the National Equalization of Basic Public Health Services initiated in 2009, in addition to other major public health service initiatives. According to project documents,53 57 58 published literature,32 33 and respondents, the project ‘C1. Cooperative Medical Scheme’ and ‘C2. Medical Financial Assistance Scheme’ were modified to support experimental phases of the New Rural Cooperative Medical Scheme (NCMS) and Rural Medical Assistance (MA). NCMS and MA were launched in 2003 by the national government.
The enhanced health facilities, well-crafted guidelines and protocols, trained human resources and other improvements in health service delivery have boosted the availability and quality of healthcare services, notably in project counties, and have furnished instructive insights for China’s rural health system reforms.	According to respondents, ‘A2. Upgrading township health facilities’ improved the infrastructure and equipment of the township health centres in the project counties, providing valuable lessons for post-project provincial programmes and national primary healthcare facility development. According to respondents, ‘A3. Improving management information system’ and ‘B1. Improving health service delivery’ were routinised in project counties’ health services; B1 provided valuable references for the development of national essential drug lists, guidelines for standard clinical protocols, the development of human resources for health, and public hospital reforms—all as parts of the national healthcare system reform in 2009.

*During the interviews, it was observed that the terms “hard infrastructure” (yingjian jianshe) and “soft infrastructure” (ruanjian jianshe) were used locally. Specifically, hard infrastructure refers to physical infrastructure such as health facility construction and equipment upgrading, while soft infrastructure refers to personnel training, institutional building, organisational development, policy experimentation and other non-physical aspects of infrastructure development. The collected data revealed that there was a common tendency towards inefficient investment in hard infrastructure over soft infrastructure in China during the 1990s.
†'Demand-side investment’ (xufang touru) and ‘supply-side investment’ (gongfang touru) were noted as local concepts during the interviews. Demand-side investment adopts a people-centred approach that prioritises improving health services accessibility and expanding medical insurance coverage. Supply-side investment, on the other hand, focuses on enhancing the capacity of health services provision such as health facility upgrading and training for health workforce’s technical skills. The respondents indicated that the lack of emphasis on demand-side investment had been identified as a crucial bottleneck in China’s rural health system during the inception of the BHSP.
BHSP, Basic Health Services Project.