Nyamweya is a Kenyan scholar who has done many years of research on a diversity of topics
Poor healthcare is one of the major public service challenges that are currently facing China. Although China is globally viewed as a rising economic power, the country’s healthcare is developing at an alarmingly slower rate. According to Balding (2020), hindrances such as low levels of human capital have negatively impacted the delivery of high quality and effective medical care to patients. This implies that although China performs fairly in sectors such as construction, a considerable number of its healthcare sector is performing poorly. The author also indicates that unlike in the United States where there are about 1,500 people per general practitioner, China has only one practitioner per 23,000 people (The World Bank, 2021). Consequently, the availability of limited health practitioners has negatively impacted the delivery of public health solutions. In a research conducted by Balding (2020), human capital deficiency is one of the key factors that have negatively impacted the ability of the healthcare sector towards offering quality health care. Sun et al. (2021) also explain that the Government of China is seeking ways to prioritize on curbing the deficiencies in China’s human capital. Poor health is a major deficiency in the country. Therefore, to handle the healthcare challenge, the Chinese healthcare reform is inclined towards providing citizens with universal and equitable access to quality healthcare.
A study by Li et al., (2020) is of the view that the Chinese government has substantially increased financial investment and established favorable policies in a bid to strengthen the country’s primary healthcare system. Currently, one of its main responsibilities entails the prevention and management of chronic diseases including hypertension and the emergent viral diseases such as coronavirus. According to Sun et al. (2021), the large-scale transmission of the coronavirus has not only raised alarm but also exposed the weak capacity of community hospitals in China. This weakness results from factors such as incompetent doctors and limited ability for virus testing. Additionally, the unavailability of medical resources has resulted in thousands of patients being sent home for isolation, and hence exposing other members to the disease (Huang & Zhao, 2020). In an effort to minimize the rate of infection, most physical hospitals in China have been postponed and outpatient appointments cancelled. Resultantly, most of the mitigation measures have majorly affected the routine of medical services for the public. According to Zhou, Guo, & Liu (2020), the health status of the rural poor in China is quite pessimistic in that 51.63% attribute their poverty to illnesses of household members. The researchers also assert that Noncommunicable diseases (NCDs) are currently identified as the major threat to the rural poor in China. In this case, China’s government has a role to play in implementing strategies that mitigate the poverty level in rural areas in a bid to improve the health status of the rural poor.
Notably Li et al. (2020), assert that there is a widespread gap in the quality of primary health care, and the Chinese government is working towards minimizing this gap. The currently existing gap has resulted in suboptimal population health. Furthermore, the recent outbreak of coronavirus disease in 2019 led to public managers and other health practitioners to emphasize on the significant role of primary health care (PHC) in monitoring and preventing the COVID-19 disease. Public managers within the Chinese healthcare organisation are trying to identify some of the shortfalls within the primary health-care system. Some of the most commonly identified short falls include lack of training opportunities for practitioners and poor integration between clinical care and the public health service and other health sectors. According to Li et al. (2020), public managers also understand that when it comes to China one of the main obstacles towards accessing quality health care is financial barriers. Although the Chinese government has made large-scale infrastructural investments when it comes to accessing healthcare, evidence shows that a significant number of residents minimise the use of medical services due to financial reasons. Overall, understanding the root cause of poor health in China enables public mangers to seek ways of eradicating the challenge.
The Creation of networks by Public Managers to address Poor Healthcare in China
With the intention of solving the poor health crisis in China public managers have brainstormed and worked towards implementation of the most effective strategies for improving the primary healthcare system. Precisely, managers within the healthcare sector have emphasized on the importance of creating networks within and outside the health sector as way of addressing the challenge of poor healthcare. Accordingly, Cunningham et al. (2020) indicate that health professional networks have become a key element for improving healthcare quality as well as safety. Chinese public health managers admit that although the hospital sector has been consolidating in many markets, a large percentage of health institutions operate within the same networks or systems. Furthermore, most of these managers admit that lack of clinical integration amongst healthcare partners can hinder China from solving the ongoing health crisis. When addressing the issue of poor health one of the public health managers in China pointed that the existence of a poorly designed healthcare system in China has hindered health institutions from offering quality healthcare to patients (Lu et al., 2021). The management team within the healthcare organization is aware of the fact that overcoming the complexity of the health networks in China can help in curbing the challenge of poor health (Bovaird, Löffler, & Löffler, 2003). In this case, public mangers are seeking ways to use networks in improving healthcare in China.
To maximise on the usage of networks, public managers have delegated the formation of partnership between public and private health sectors in China. According to Holden (2009), public-private partnerships have become one of the major forms of reforms in both the lower and middle-income countries. Most public managers within the Chinese health sector are emphasizing on the creation of collaborations, especially between the private and public sector. Most importantly, the Chinese government has stepped up to promote Public Private Partnerships (PPPs) in a bid to enhance healthcare provision (Field & Peck, 2003). Public managers have insisted on the establishment of PPPs such that in 2014, the Budget Law of the People’s Republic of China has facilitated long-term PPP projects (PWC, 2016). For instance, Beijing New Century International Children’s Hospital has started optimising on how to utilise hospital resources through (PPPs) (Wang et al., 2018). The formation of these partnerships has led to creation of networks between the private and public sectors. According to public manager, the goal of creating partnerships is to help facilitate the best quality of healthcare to patients in China. The public mangers in China maintain that partnerships are effective networks that will guide institutions on how to use resources efficiently in a bid to serve patients better.
Additionally, public managers have advocated for seeking ways to eliminate the complexity of governance networks since it hinders them from attaining effective governance and management. Most importantly, most of the managers believe that maintaining transparency on how finances are used or roles shared can help in ensuring resources are available and adequate for offering the best healthcare services. Accordingly, Bovaird, Löffler, & Löffler (2003) indicate that public managers are being pressured to mobilize resources from multiple sources. This complexity should be managed by a dedicated team of partners within the Chinese healthcare sector. In a bid to improve the healthcare system, public managers are making sure that Chinese citizens become part of the stakeholders and are directly involved in public service delivery, especially in the health sector. Involving citizens will entail considering them during the formation of policies. To maintain the level of transparency within these networks, public managers within different health institutions in China ensure they are open on how resources are used to offer healthcare to patients. Most of these mangers are also open on explaining the factors that trigger the decisions adopted on the usage of resources (Douglas & Meijer, 2016). Most of these decisions are expected to meet the expectations of citizens so that they can determine if the government prioritises on public health.
In addition, public managers are also seeking ways to obtain an empowered team that can help manage the existing networks in healthcare. Particularly, public managers have delegated on ways to enhance staff competencies and capacity, since they are involved in the direct care of patients. As indicated earlier, poor training of healthcare professionals has largely contributed to poor health crisis in China. Although the need to boost competency is a recent development, the public management team has already developed a professional network of staff working on health system. This team has also established a network in China intended to foster both formal and informal communication. According to Alanazi, Nicholson, & Thomas (2017), most healthcare institutions focus on increasing the capacity and skill of staff members to make sure they are equipped will to handle health-related policy issues. Some of the activities that public healthcare managers in China have introduced include training seminars and cross-cluster groups.
There are certain benefits and limitations associated with the adoption of networks in China’s public healthcare services. For instance, the formation of networks and partnerships by public managers has positively impacted how healthcare services are delivered. Precisely, introducing private-public partnerships (PPPs) has led to the efficient use of resources set aside for providing healthcare (Chew & Vohra, 2018). Creation of partnerships has given the private sector a wider platform for offering healthcare services on a level that cannot be attained by the public sector. Data gathered by Globe Newswire (2019) indicates that by February 2019, China had established 21,165 private hospitals, which accounted for 63.9% of the total number of hospitals. Evidently, different players in the healthcare sector are now collaborating in order to adopt modern approaches that utilise digitalisation. As a result, the Government of China is encouraging healthcare institutions to create joint ventures and engage collaborations in order to create the best healthcare platform for Chinese citizens. Overall, it is the role of the Government of China and elected public healthcare managers to ensure these PPPS emphasize on people-focused care.
Additionally, most of the formed PPPs have emphasized on maintaining transparency, and this has help in enhancing accountability within the health sector. For instance, managers of these Chinese PPPs have begun updating citizens about the progress of the government in the provision of healthcare services. As noted by Mader, Vitters, & Obbagy (2018), managers are also known for maintaining transparency with the citizens by informing them how finances are used. This level of transparency has ensured the proper utilisation of resources set aside for offering healthcare services. Accordingly, Hughes (2003) argues that transparency and accountability help in enhancing collaboration as well as partnerships amongst different players in the healthcare sector. Consequently, the level of collaboration in China has risen since healthcare organisations are now able to trust each other, especially when their common goal is to offer quality healthcare. Public health institutions and the Chinese government should maintain transparency since lack of transparency can lead to corruption and mismanagement of funds set aside for facilitating healthcare.
Thirdly, boosting the capacity and skills of staff members within the formed healthcare networks has led to the creation of an empowered and dedicated team. As pointed out earlier, lack of training opportunities for health practitioners has been one of the major short falls within the primary health care sectors in China. To curb this challenge, Jin et al. (2019) indicate that a healthcare reform named “Equalization of Basic Public Health Program” was established in China to help improve the knowledge and skills of the primary health workforce. Introducing such seminars and training programs for health practitioners has gone a long way in equipping them with the necessary skills for handling arising issues in healthcare. Overall enhancing the competencies and capacity of the staff will go a long way in improving healthcare in China since they are involved in direct care of patients. Public managers within the health sector are encouraging the Government of China to set aside adequate funds for managing the training programs. It is imperative to have trained and experienced practitioners who can help manage the complex networks in public healthcare services.
Although the introduction of networks in public healthcare services has successfully enhanced quality healthcare, there are still problems associated with the process. For instance, despite the creation of public-private partnerships (PPPs) helping to improve healthcare, significant risk has been transferred from the Chinese government to the private sector. The chances of incurring more risks discourages private health care providers from creating partnerships with organizations in the public sector. Since China’s private sector is known for offering the best healthcare services, some PPPs projects such as Beijing New Century International Children’s Hospital hinder them from maximizing their potential in delivering high quality services (Wang et al., 2018). Lack of transparency amongst the partners has also contributed to mismanagement of funds set aside for offering public health services. Therefore, public managers in China have role to improve the governance of public-private partnerships.
Another major problem has been associated with inefficient funds for facilitating the creation of and management of networks in public health services. The government of China has had to increase its funding to the various health institutions, and this has minimized the resources available to the rural poor. For instance, Kamal et al. (2020) point out that per capita basis, the Chinese Government has increased health spending by over 31-fold in the last 40 years. The above assessment report indicates that the health status of the rural poor is quite poor, and poverty is the main contributing factor to illness amongst the household members (Zhou, Guo, & Liu, 2020). Poverty is partly caused by networks, especially when there lacks transparency and public managers mismanaged resources. Moreover, a considerable amount of capital has been used to establish and manage training programs for the health practitioner. Evidently, effective management of complex networks is quite expensive and it leads for the China Government incurring huge costs.
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