Tracking Progress Towards Equitable Maternal and Child Health in Yunnan: A Systematic Assessment for the Health Programme for Poverty Alleviation in China during 2015-2020

OBJECTIVES: We present a systematic assessment in Yunnan, the main battlefield against poverty in China, to inform the impacts of the health programmes which aimed at preventing women and children from being trapped in or returning to poverty because of illness.

METHODS: We analysed national and Yunnan policy documents related to maternal and child health programmes for poverty alleviation during 2015-2020. We adapted the longitudinal comparative evaluation design and the difference-in-difference technique to assess the changes in disparities in maternal and child health system inputs, service coverage, and health outcomes between poor and non-poor areas, and out-of-pocket payments between poor and non-poor populations before and after 2017.

RESULTS: In total 12 policies and 15 programmes related to poverty alleviation for poor women and children in Yunnan were summarised. As a result of health system strengthening in Yunnan, the densities of licenced doctors, nurses, obstetricians, midwives, township health workers, and female village doctors had been increased substantially in poor areas. Although disparities existed in some of service coverage between poor and non-poor areas, the health programmes had narrowed the gaps in utilisation of facility birth, caesarean section, prenatal screening, and newborn screening across Yunnan. The out-of-pocket payments for inpatient care for serious illnesses among women and children with poverty registration had been considerably decreased to 10.0%. Paralleling the universal coverage, maternal deaths per 100,000 livebirths and child deaths per 1,000 livebirths had further declined in both poor and non-poor areas, and the impacts of health programmes on closing the gaps in child survivals across Yunnan were significant.

CONCLUSIONS: Remarkable progress in equitable maternal and child survival has been achieved in Yunnan. The practices in Yunnan have showed the Chinese model in ending poverty by strengthening health system and implementing universal coverage the firm commitment, determined leadership, detailed blueprint, and social participation.