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Two years ago in Shanghai, an infant girl with a heart defect was abandoned in the shadow of the luxurious Four Seasons hotel, possibly because her migrant worker parents could not afford her medical care.
That child’s plight cast a sharp light on one of the biggest social problems facing China’s new political leaders: how to improve healthcare for tens of millions of migrant workers who live in desperate poverty amid the conspicuous consumption of its biggest cities.
The abandoned infant, who now lives in an orphanage after her heart repair was paid for by the local government, is one of 230m migrants who have boosted urbanisation to the point where last year, for the first time, more Chinese lived in cities than in the countryside. In Shanghai alone, she is one of nearly 10m migrants who make up 40 per cent of the population – and whose numbers are forecast to rise to 14m, or half the city’s population, by the end of the decade.
Helping those new migrants integrate into a city that is not their home – and where their lack of a residents’ permit, or hukou, still makes it harder for them to get education and healthcare – is the mission of the GSK New Citizen Health Care project, funded by GlaxoSmithKline, the drug company, and operated by the Xintu Centre for Community Health Promotion, a local non-governmental organisation (NGO) that specialises in public health education.
In Sanlin town, a crowded urban community of 100,000 migrants in Shanghai’s Pudong district, the GSK project has built one of four community centres, complete with air-conditioned playroom, classrooms and lecture rooms, provided rent-free by the local government. The project has been such a hit with local residents that GSK is planning to open a similar centre in Beijing next year.
At the macro level, the Chinese government has made healthcare reform a top priority, fully aware that as their standard of living rises, people’s willingness to tolerate the country’s antiquated healthcare delivery system is fading. In 2009, Beijing set itself the ambitious goal of providing universal access to effective, safe and low-cost healthcare by 2020. Since then, it has extended some form of health insurance to 95 per cent of the population, says a recent report, “Healthcare in China: ‘Entering uncharted waters’”, from McKinsey, the consultancy.
But when it comes to the micro level – the level of daily life in a migrant community such as Sanlin – the picture is much less rosy. In theory, for example, migrants to Shanghai have the same healthcare rights as those who hold Shanghai hukou. “But without health insurance, the services are too expensive,” says Guo Xiaomu, director of Xintu.
Migrants may have some form of health insurance, but most can only use it in their province of origin. The central government is working hard to improve the portability of health insurance across provincial borders, but there is a long way to go before that becomes reality. Even provinces that allow insurance portability often make it so difficult to claim that in practice reimbursement is impossible.
In Shanghai, where the best hospitals have some world-class equipment and practitioners, the local government provides some healthcare services free for poor residents, including migrants, and foreign and local charities fund many healthcare services, including free operations, for instance to repair the heart defect that prompted the abandonment of the migrant infant. “But it’s not as simple as knowing about a free service,” says Guo. “You may have the right in theory, but first you have to know that you have it – which most migrants don’t. And then you need various certifications in order to get it.”
Most migrants “don’t have the resources to go through the whole process”, she says, adding that implementation is the problem, not policy. The GSK project does not try to provide the medical care that migrant workers and their families are lacking. Rather, it tries to prevent them getting sick, by offering basic preventive education on topics such as sanitation, childhood nutrition and childhood diseases. From its annual budget of Rmb1m ($160,320), it provides a mix of services, even beyond its public health focus: recent workshops have been held covering such areas as preventing hand, foot and mouth disease, but also on domestic violence, and how to use Skype and shop safely online.
Guo says local governments are watching her projects to learn how they can be extended to other communities. But while other NGOs provide help to migrant schools, the GSK project seems to be one of the few in China to focus on migrant healthcare.
Reform of Chinese healthcare has only just begun: projects such as this could blaze a trail others will follow.
Additional reporting by Yan Zhang