The Rural Health Reforms of the 2000s
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of Y 65.5 billion to improve access to tap water in rural areas. Third, there was an effort to standardize the subnational CDCs. Finally, the possibility of free hospital delivery for all pregnant women was being actively discussed. To support and sustain these efforts, government substantially boosted public health spending. Following the SARS outbreak, the central government transferred approximately Y 1 billion (US$146 million) to help the western and middle provinces develop their public health systems. That increased nearly fourfold to Y 3.7 billion in 2004 (MOH 2005a). Altogether, a total of Y 10.9 billion was transferred across various levels of government for capital investment in the CDC system, as well as Y 11.4 billion for capital investment in health care facilities. China is mostly on track to achieve its public health targets. The 2010 goals for average life expectancy and MMR already have been met. Very likely that is also true for the 2010 infant and under-five mortality rates. For vaccinatable diseases, only diphtheria, pertussis, tetanus, and oral polio vaccine inoculations are lagging behind the 90 percent 2010 population coverage targets. Otherwise, coverage of the World Health Organization’s key EPI vaccines has reached the national target. Key 2010 disease prevention and control targets also have been achieved for HIV infections, DOTS detection, the cure rate for new smear-positive TB, and the hepatitis B virus (HBV) prevalence rate for children under five years of age. The overall HBV prevalence rate is close to the 2010 target of 7 percent. Targets that look less likely to be hit are tobacco control, rural water and sanitation, birth defect prevention, and iodine deficiency. Beyond the question of whether specific targets are being met, two further issues arise in assessing the status of public health. One is whether China is spending “enough” in this area. The frequently heard claim that the government had abandoned public health prior to recent injections of spending is certainly untrue. Over the period 1990–2003, government allocations to disease control and MCH institutes rose in step with overall government health expenditure—although not quite keeping pace with government expenditure across all sectors (figure 3.1). Increased government subsidies to public health institutions have been overlooked because they have been dwarfed by rising “business income,” so that the government share of institutions’ overall financing declined steadily during the period (figure 3.2). Moreover, international comparisons suggest that China’s spending on public health programs is not low by international standards. Comparative analysis poses difficult methodological problems (discussed briefly in