DEVELOPMENT-CHINA: SARS Exposes Weaknesses of Health System

By IPS Correspondents Reprint | | Print |

Analysis - By Antoaneta Bezlova

BEIJING, Apr 18 2003 (IPS) - When China’s newly inaugurated leaders pledged last month to devote their energy to helping the poor and downtrodden, little did they know that they would run straight into a challenge that would test this commitment.

This is because of the fast-spreading atypical pneumonia, called Severe Acute Respiratory Syndrome (SARS), which is not only active in China and in many countries around the world, but is suspected to have originated in the country.

But beyond the growing worries about what some fear may have the potential to be a global pandemic, SARS has brought to public attention one carefully concealed failure of China’s development over the past two decades – the regression of its rural health care, largely overshadowed by the glare of the country’s remarkable economic achievements.

In truth, this boom has left hundreds of millions of peasants in the Chinese countryside without even basic preventive care – something they enjoyed in the old days of socialism.

After the government withdrew from the role of being the free provider of medical services in the early 1980s, when its market-opening measures were stepped up, the worst affected by this shift have been public health services – preventive care, disease surveillance and medical control.

In rural China, the collapse of public health care has been a disaster waiting to happen.

The current health crisis might well turn out to be a time bomb that would inflame dormant social tensions in the long-neglected countryside.

SARS has officially killed at least 65 people and infected 1,445 people in China, which now has nearly half of the world’s cases. Outside of Guangdong, Beijing and Shanghai, SARS already has spread to southern Guangxi and Hunan provinces, to Sichuan in the west and Shanxi in the north.

Two more far-flung provinces, Inner Mongolia and Ningxia, reported this week that they too had an outbreak.

A visiting team of World Health Organisation (WHO) experts that did their investigations in Guangdong, southern China, where the first case emerged in November, reported that it had "found an urgent need to improve surveillance in the countryside to head off new outbreak in rural areas”.

"The team observed that many of China’s poorer provinces may not have adequate resources, facilities, an equipment to cope with outbreaks of SARS, and underscored that Guangdong’s capacity was (actually) exceptional among China’s provinces," the report said.

Hospitals in Guangdong, one of China’s wealthiest coastal provinces, are among the most modern in the country, but have nevertheless came under enormous strain due to the outbreak.

WHO experts admit they have scant information about the level of preparedness and scope of the epidemic in most of China. "We do not know what is going on outside Guangdong," said David Heymann, WHO’s head of communicable diseases.

Experts fear that far away from central government control, hospitals in some regions might turn away patients with SARS who are unable to pay for their treatment. "No hospital should refuse treatment to people infected with SARS," read the headline on front page of ‘Beijing Youth Daily’ newspaper this week.

Echoing fears about how well poor provinces could handle a full-fledged health crisis, Communist Party chief Hu Jintao warned that if mishandled, the SARS epidemic could jeopardise not only social stability but also China’s overall economic development.

The emergency meeting of the Standing Committee of the Communist Party’s Politburo, held on Thursday, follows two other SARS-related meetings convened by Premier Wen Jiabao.

A matter that has been taboo for months, SARS and its impact on China’s future has become the most formidable challenge the country’s leaders, who assumed their positions in the last months, are facing as they try to seek legitimacy for their rule.

There are plenty of reasons to worry. Rural residents account for more than 70 percent of China’s 1.3 billion population, but receive just 20 percent of public spending on health. Urban residents also enjoy disproportionate access to hospital beds and trained medical personnel.

This week Beijing, earmarked 18 more hospitals to those three already designated as infectious-disease hospitals to deal with SARS patients. It was not clear why so many hospitals were needed when official statistics claim only 37 people in Beijing have been affected by SARS, and only four have died.

But even if Beijing has grossly underreported the scope of epidemic, as feared by many specialists here, the capital’s preparedness for emergency situations mirrors a growing disparity in health care between the developed coastal and urban areas and poorer inland regions.

The collapse of China’s rural communes in the late 1970s and early 1980s brought to an end an era of free preventive health care and universal medical treatment.

Under the collective system, 90 percent of the rural population was provided with free health services. Today only 10 percent of rural residents are insured, leaving some 700 million Chinese having to pay out-of-pocket for all of their health expenses.

The Chinese government has effectively relinquished all responsibility for health care in rural areas, leaving local governments to fend for themselves. Many regions in China’s poorest and under-developed regions have been unable to finance public health programmes on their own.

As a routine, financing for rural clinics come partly from local governments and partly from their own revenues. To increase revenues, clinics are charging fees for injections, antibiotics and intravenous drips, disregarding less costly treatment.

As a consequence, the neglect of preventive care in favour of more profitable curative treatments has led to a precipitous rise in infectious diseases and epidemics. Tuberculosis and neo-natal tetanus kill more than 200,000 children in China every year, and hepatitis, tuberculosis and AIDS are spreading rapidly.

SARS is only the newest health threat to befall China’s neglected countryside.

And even as Premier Wen Jiabao says that the situation is now "grave", the "golden week" labour holiday on May 1 – which would see millions of Chinese head for trains, planes and cars to visit their families and tour regional resorts remains on schedule.

The government is still encouraging people to travel and spend, and live up to the country’s growth targets, although this will also ensure a greater risk of the disease spreading throughout China.