China, People's Republic of : Strengthening Public Health Institutions Building Project

Health / Disease control of communicable disease - Health system development

The project will support the People's Republic of China (PRC) in implementing its Healthy China 2030 to improve the quality and services of the health care system; and its Fourteenth Five-Year Plan, 2021-2025 by implementing health system strengthening. The project is aligned with the Asian Development Bank's (ADB) Strategy 2030, accelerating progress in gender equality, strengthening governance and institutional capacity, and fostering regional cooperation and integration; as well as the country partnership strategy for the PRC, 2021-2025 which aims at strengthening national and regional health security under strategic priority 3. It also supports the United Nations Sustainable Development Goal on promoting healthy lives and well-being.

Close consultation with the World Health Organization (WHO) has informed proposed activities and guided adherence to international best practices and standards to advance core capacities for public health. The project is in harmony with sector support of development partners such as the World Bank and Asian Infrastructure Investment Bank.

Strategic context. The proposed project introduces a transformational approach to address gaps by strengthening public health institutional capacity in the PRC. The PRC has experienced rapid economic growth in the past decades enabling more than 850 million people to escape poverty. These achievements allowed investments in the health sector that resulted in near universal health coverage, improved equity and access, reduced child and maternal mortality, lower incidence of infectious disease, and improvement in health outcomes and life expectancy. The government continues to prioritize the health sector. The plan for Healthy China 2030, established in 2016, identifies health as a fundamental prerequisite for social and economic development. It focuses on disease prevention as well as a holistic well-being approach with core indicators including strengthening health security and improving health services. Healthy China 2030, is in line with the health reforms under the PRC's Fourteenth Five-Year Plan, 2021-2025 which prioritizes health system development.

Public health system limitations. While health system development has progressed, the PRC is now faced with increasingly complex health challenges. This includes an overreliance on hospital-centric curative care to the detriment of cost-effective preventive medicine, gaps in the quality of health care particularly in rural areas leading to overburdened urban hospitals, and a rapidly increasing elderly population requiring specialized services. Despite the relatively advanced development of the PRC's health system, the coronavirus disease (COVID-19) pandemic highlights obstacles and development needs in government-led public health systems. The quality of service from health care providers is inadequate, and education and qualification levels among professionals in public health are low. Gaps in legislative frameworks and fragmented public health systems are another challenge. Additionally, weak coordination among health institutions and inefficient referral systems hamper the goals of achieving people-centered, integrated, and cost-effective care to meet the goals of the Healthy China 2030.

Lessons learned. The rapid spread of COVID-19 in the PRC underscored the inability of the hospital system, particularly community and secondary hospitals, to effectively respond to large-scale public health emergencies. Weak coordination between public health agencies, technology and equipment unsuited to rapid detection of infectious diseases, slow response and reporting, insufficient facilities for surge capacity, and limited skills in core public health knowledge highlighted the health system's inability to meet the challenges of future epidemics and hazards in the PRC. In its current state, the public health system's capacity to effectively prevent and contain future public health threats remains uncertain. The post-COVID-19 pandemic recovery period provides a valuable opportunity to strengthen the country's preparedness for emerging infectious diseases (EIDs) and other possible public health threats and apply best practices to better protect against future health hazards. This can be best achieved using a multipronged, all-embracing approach which combines public health institutional capacity building aligned with latest needs, policies, and hardware that are fit-for-purpose and world-class training capacity.

Transformational approaches. Tackling public health hazards using innovative transdisciplinary approaches across different sectors - human health, animal health, agriculture, and environment (known as One Health) - as well as holistic and evidence-based methods to prevent diseases that include mental well-being, wellness, and disease prevention (rather than cure) are a transformational approach that can be used alongside curative, hospital-based medicine to improve health outcomes. Rapid response reporting mechanisms linked to national systems using digital health technologies supported by modern health management policies and frameworks are essential for effective systems. Reducing barriers for women's participation in the public health workforce provides additional benefits. In the context of an upper middle-income developing member country, such as the PRC with a developed health system, a transformational impact requires a strategic and comprehensive approach which reinforces the public health network.

Public health ecosystem. Assessments on the PRC public health systems highlight weak links between responsible agencies, lack of well-trained staff, outdated operational plans and response systems, and poor public health prevention and response. To address these gaps, the project will support the PRC in the development of a complex interconnected network, or ecosystem, through strategic investments in key pillars of public health systems. The project proposes a high impact and transformational approach, comprised of development of public health institutional capacity and policies; upgrading of strategic public health emergency and training facilities with surge capacity; and improvement of talent building and capabilities as well as international exchange. In accordance with the PRC's aim to develop regional centers of public health excellence as demonstration models in economically underdeveloped areas, the project will support Guangxi Zhuang Autonomous Region (GZAR), Guizhou Province, and Shaanxi Province. The proposed project sites were selected on the basis of a wide geographical distribution and commitments to interventions emphasizing public health impact and affordable health care, development of institutional capacity, and international cooperation activities.

Health and well-being of residents protected, promoted, and restored

Capacity for early warning, risk reduction, and management of health security risks strengthened

Prevention and control of major communicable diseases strengthened

Quality of public health services improved

Public health institutional capacity and policies developed

Effective public health ecosystem established

Training excellence and international cooperation capability enhanced