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Providing Primary / Reproductive Health Services in Asian Urban Areas with Attention to Vulnerable Populations, Especially Women and Girls

Section Two - Nine AUICK Associate City (AAC) Reports

8. Weihai, China


Historical Background

Methodology

Collected Data


Mr. Sun Pingyi 

Professor, Shandong University Weihai Branch; Former Advisor, Weihai Environmental Protection Agency (Participant of AUICK First 2006 and First 2007 Workshops) 
Ms. Peng Xia 
Vice Director, Weihai Women’s Federation (Participant of AUICK Second 2007 Workshop)

Weihai Map

I. Historical Background

Weihai is located on the eastern tip of the Shandong Peninsula of China, opposite the Liaodong Peninsula, the Korean Peninsula and the Japanese Islands across the sea. Weihai has a history of over 600 years. It had been a small frontier town till the 1980s, with a population of less than 70,000. 

In 1987, Weihai was founded as a prefecture level city. Three lower level cities are under its jurisdiction; the total area is 5,436 square kilometers, with a population of 2.47 million. 

Before family planning was introduced to Weihai in the early 1970s, the birth rate, the death rate, the Infant Mortality Rate (IMR), the Maternal Mortality Rate (MMR) and the Child Mortality Rate (CHMR) were higher, and the reproductive health service was poor. After family planning was introduced to Weihai, the government and families paid much more attention to reproductive health, and the birth rate, and child, infant and maternal mortality rates decreased sharply. Detailed data is shown in Table 1, Table 2 and Figure 1. 

Weihai General DataWeihai Mortality RatesWeihai Mortality Rates Chart

II. Methodology

During July, August and September, 2010, according the outline of AUICK Research Project: “Providing Primary/Reproductive Health Services in Asian Urban Areas with Attention to Vulnerable Populations, especially Women and Girls”, the work team in Weihai has interviewed the Mayor of Weihai, Mr. Sun Shutao, the Vice Mayor in charge of the public health service, Mr. Liang Liang, the Director of Weihai Health Bureau, Mr. Lv Xiaodong, the Vice Director of Weihai Health Bureau, Mr. Li Donglin, the Director of Weihai Association of Family Planning, Mr. Liu Qingsheng; the Director of Weihai Red Cross, Mr. Cong Weidong, and investigated the No. 1 Weihai Hospital and the No. 2 Weihai Hospital which provide reproductive health services. At the same time, the work team collected the information about reproductive health services in Weihai City, Shandong Province and China from government statistics, published study reports and websites. After careful analysis and discussions, they completed this report. 

III. Collected Data

Views of Urban Administrators and Non-Governmental Organization (NGO) Service Providers 

1. What are considered the most important RH issues and conditions? List respondents views to probe: 

a) HIV/AIDS 
b) Sexually Transmitted Diseases (STDs) 
c) Family planning for health of mothers 
d) Family planning for/ against population growth 
e) Infertility 
f) Safe motherhood 

Most of the informants interviewed consider the most important RH issue is d) Family planning against population growth. This is because although from the viewpoint of Weihai, the registered population is stable, from the viewpoint of the whole of China, with the largest population in the world, the population growth rate is still high, and population growth control is still a tough task for the government. In recent years, Weihai as a coastal open city enjoys most of the preferential policies and a unique location, as well as an economy and urban construction that have developed very fast, and that have attracted more and more immigrant workers. How to make sure the family planning policies are carried out by the immigrant workers and how to provide adequate reproductive health services to them? These issues are becoming very important for Weihai municipal administrators. 

Some informants interviewed from the health care service sector are more concerned over sexually transmitted diseases, especially HIV/AIDS, because most of the immigrant workers are young, they are in high desire for sex partners and their sanitation condition is poor, so they can easily be infected by sexually transmitted diseases. HIV/AIDS has a long potential period and the knowledge of the immigrant workers is limited, so it is more dangerous for them. 

2. Overall, how is the level of the city’s reproductive health condition? 

a) Excellent 
b) Very good but could be improved 
c) Needs more improvement 
d) Seriously low and needs much improvement. 

Most of the informants interviewed consider the city’s reproductive health condition is b) Very good but could be improved. The following table and figure show the doctors and beds in the hospitals of Weihai. 

Doctors and Beds in Weihai HospitalsDoctors and Beds in Weihai Hospitals Chart

From Table 3 and Figure 2, it can be seen that from 1970 to 2008, numbers of doctors and beds in hospitals of Weihai increased by 709.2% and 820.1%, respectively. Over the same period, the registered population only increased by 18%. That means health care conditions in Weihai have been improved very much, but the quality of equipment and doctors stills needs to be improved. 

3. Overall what priority does the city give to RH services? 

a) The Very highest 
b) High 
c) Moderate: the problem is not serious 
d) Low: the problem is basically solved and procedures are routine 
e) Low: the problem is still very serious but due to other competing demands 
f) Low: due to lack of political support or commitment 

Most of the informants interviewed consider the city gives b) High priority to reproductive health services. This is because from the viewpoint of the family, most of the families only have one chance to give birth, and the child’s fate can decide the fate of the whole family. So the mother and infant’s health is the top priority of the family. From the viewpoint of the administrators, meeting the demand of the public is their duty. If there is inadequate service or mistakes, that will raise a severe social and public instability problem, and will be difficult to deal with. 

4. Overall how do you feel about the resources available for RH services? 

a) Fully adequate 
b) Quite good 
c) Somewhat deficient 
d) Woefully deficient. 

Most of the informants interviewed consider that the resources available for RH services are b) Quite good. Now in Weihai, there are 90 hospitals, 78 community based health care service stations in the urban area, and 124 village based health care service stations in the rural area. In 2008, 97.8% of pregnant women enjoyed the health care service system free of charge; and 96.2% of children under three years old enjoyed the health care service system free of charge. (Weihai Yearbook 2009) 

5. What are the specific needs of the city to improve its RH services? 

Most of the informants interviewed consider that the city’s RH services are less than adequate, and that more is needed in funds, equipment and facilities. Though in recent years, the government has paid much attention to health care services, especially the RH services, and the conditions of health care services have been improved very much. Compared with developed countries though, conditions are still far behind, mostly in funds, equipment and facilities. The main source of the funds is the government. As China is a developing country, the government has too much to be done; it cannot allocate enough money to improve health care conditions. Because of the inadequate funds, equipment cannot be updated frequently, and facilities cannot be improved along with the demand on health care services. 

6. What is the size of the city’s slum or below poverty level ($2 per day) population in 2000 (in actual number or % of total population), 2005 and 2010; and any future projection: 2020 or 2025? 

In 2008, the standard of poverty in Weihai was 330 RMB/month per person for urbanites, which equals about $1.6 per day; and 1,200 RMB/year per person for the villagers, which equals $0.48 per day. According to this standard, there were 1,808 persons, about 0.15% of the registered urban population, below the poverty level in the urban area; there were 32,300 persons, about 2.5% of the rural population, below the poverty level in the rural area. All the population below the poverty level received the government’s subsidies to reach the poverty level. In 2008, Weihai Government allocated 25.352 million RMB to the poor population (Weihai Yearbook 2009). 

There is no prediction for the poor population in the future. 

7. To what extent are city RH/ Family Planning (FP) services available to the slum dwellers? Are any factors impeding this availability? How could it be increased? (Please provide a rough percentage estimate and then discuss conditions) 

In China, especially in the eastern coastal cities, because of the strict urban planning and immigrant administration, usually you cannot see obverse slums in the urban areas. There are some registered residents living under the poverty level, but they are spread in almost all the district and buildings, mixed with other residents, and they enjoy the government’s subsidies for their living costs. 

The problem the city administrators are facing now in China is the immigrants, which will be discussed in question 9. 

8. Are there special programs to increase RH services to slum dwellers? Is so, please describe them, especially in terms of the following

a) staff size and categories designated (e.g. MDs, nurses, midwives etc.) 
b) special features 
c) size of budget 

The answer is the same as that given to question 7. 

9. What is the estimated size of the city’s new immigrant population (the new floating population) in 2000, 2005 and 2010? Are there any future projections for 2020 or 2025? Will reproductive health services be sufficient for these projected populations? 

In 2000, Weihai conducted the 5th population investigation. According to this investigation, the total immigrant population in Weihai is 0.45 million (www.statswh.gov.cn). This figure includes all people who have not received the qualification of registered residents, and it does not matter how long they have stayed in Weihai. 

In 2010, in the Weihai Statistical Communique 2009, the government began to report the permanent population in Weihai, which includes both the registered residents and immigrants that have stayed in Weihai for more than 6 months. In 2009, the registered population in Weihai was 2.53 million, and the permanent population in Weihai was 2.82 million, which means 0.29 million immigrants permanently staying in Weihai (www.statswh.gov.cn). Compared with the 5th population investigation in 2000, it does not mean the immigrant population in Weihai is decreasing. The permanent population does not include the immigrants who have stayed in Weihai for less than 6 months. 

There is no prediction for the immigrant population in the future, but as a fast developing coastal city, we can say the new immigrant population will increase gradually. 

Reproductive health services now of course cannot meet the demand for the predicted population. But along with the development of the city, the reproductive health services will also be improved. The immigrants bring some burden to the city, but more importantly, they bring the new productivity to the city; they are power of the city’s development. 

10. To what extent are city RH services regularly available to the migrants? Does this represent a problem for the city? Are there any special health and social programs to deal with this new floating population? What kinds of programs are necessary? 

The conception regarding immigrants is much different from 20 years ago. Before the 1980s, under planning the economic system, the urban residents enjoyed a lot of subsidies from the city government. More people meant more cost, so the cities’ administrators saw immigrants as a burden, and tried to control their inflow. Now, after the economic reform, most of the services provided to cities’ residents follow economic rules; city governments do not need to subsidize much for ordinary residents, and they have turned their focus onto vulnerable groups. And now the characteristics of immigrants have also changed, as most of them are young and have a good education, so city administrators see the immigrants as the power of development, and try to attract them. Generally speaking, in Weihai now, most of the RH services available to the registered residents are also available to the immigrants. But because the income of the immigrant workers is lower than that of the registered residents on average, some of the services are unaffordable to them. 

In 2006, Weihai Government issued a direction to improve the health of women and children. In this direction, the government put the health care of women and children into the social and economic development plan, and established a city, town and community (village) women and children health care network, free of charge for pre-marriage examination, subsidized to poor women and children for their health care. The funds come from Weihai City Government and local governments. 

11. What is the breakdown of the total budget for RH services in terms of the following: 

a) Percentage of costs covered by city government 
b) Percentage of costs covered by national government 
c) Percentage of costs covered by other sources (e.g. donors etc.)? 

There is no statistical data for the RH service budget available in Weihai. In 2008, the total budget of Weihai Municipal Government was 12,222.41 million RMB, 474.84 million of which was allocated to health care, which is about 3.9% of the total. 

Objective RH Services Data 

1.Table 4 shows the dynamic change in health care conditions of Weihai 

Weihai Basic Statistics of Health InstitutionsWeihai Basic Statistics of Health Institutions (Continued)

2. Programs related to reproductive health services in Weihai in recent years: 

1). Family planning program 

The conception of the family planning program now in Weihai is to control the quantity, improve the quality, balance the structure and increase the living standard of the population. Through education, policy encouragement and improvement to the social insurance system, reproductive behavior of families changed from high in density and number earlier, to scattered and fewer, later. In the last 10 years, 99% of families follow the family planning policy, and 97% of new couples marry later and give birth later. In 2008, the average age of newly married couples was 25.35, and 69.8% of women only had one baby.

2). Health insurance program 

Five years ago in most parts of China, only the permanent workers had health insurance, which farmers and jobless urban residents did not have. In the last five years, Weihai City launched a health insurance program for farmers and jobless urban residents. Farmers pay 100 RMB, to which the government subsidizes 80 RMB, and jobless urban older residents pay 180 RMB, to which the government subsidizes 120 RMB. Then, most of their hospital costs will be paid for by health insurance funds. Now the health insurance program covers 98.8% of farmers and urban residents. 

3). AIDS prevention. 

Weihai has established 18 AIDS laboratories and 12 AIDS counseling stations, and provides free-of-charge services for AIDS prevention. In 2008, 90,000 examinations were conducted, and a case report and follow-up reached 100% of persons. In a public survey, 87.5% of urbanites, 78.6% of farmers, 92.8% of students, and 70.1% of immigrant workers have knowledge on AIDS. 

4). Vaccination program. 

There are 85 vaccination rooms in Weihai, which provide free-of-charge services for children. Now the vaccination rate has reached 99%. Polio, chincough, diphtheria, lockjaw, B-cephalitis, and cerebrospinal meningitis have reached zero status. 

5). Pre-marriage examination program. 

The city government covers the cost of 90 RMB for each new couple, to let them take pre-marriage examinations. In 2008, 13,000 new couples underwent the examination, 89.4% of all married new couples.

Weihai Objective RH Services Data

Weihai Objective RH Services Data (Continued)

CONTENTS

Top

Foreword

Section One

The New Urban Challenge for Primary and Reproductive Health Care

Executive Summary

1. Background: Urban Growth and Urban Primary / Reproductive Health (RH) Services

2. An AUICK Research Project Report

3. Regional Findings

4. Individual City Findings

5. Summary and Implications

Section Two

Providing Primary / Reproductive Health Services in Asian Urban Areas with Attention to Vulnerable Populations, Especially Women and Girls:

Nine AUICK Associate City (AAC) Reports

6. Kuantan, Malaysia

7. Khon Kaen, Thailand

8. Weihai, China

9. Surabaya, Indonesia

10. Olongapo, Philippines

11. Chennai, India

12. Faisalabad, Pakistan

13. Danang, Vietnam

14. Chittagong, Bangladesh

Annex I.
Research Instrument: AUICK Research Project Outline

Annex II.
AUICK Research Project Participants


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