China enacts draconian curbs on foreign healthcare NGOs

by MICHAEL WOODHEAD
When a Chinese minister says a new arrangement is a "win-win situation" you know have lost. And so it is with China's new NGO Management Law, which is in effect a piece of highly restrictive legislation that will drastically curtail the activities of foreign health and medical NGOs, put them under the direct control of relevant ministries and subject them to tight monitoring and suppression by the Public Security Bureau. 

In what seem to be a parallel with the widespread crackdown on civil and legal rights with the mass arrest of lawyers, Xi Jinping has launched an aggressive campaign to strike against the increasing activities of health NGOs. Many of the activities of groups such as Oxfam and Project Hope may seem relatively inocuous to westerners - but programs focused on poverty alleviation, disability awareness, environmental health and promoting reproductive health, and offering health services to minorities are a highly sensitive subject for China's supposedly Communist administration. You only have to look at the crackdown on HIV organisations to see how the authorities react to any imaginary threat to their authority or the questioning of it.

Perhaps the authorities fear the so called "Third Sector" groups will undermine their legitimacy by highlighting the failures of the government to provide basic services. Or perhaps they are just paranoid, with ministers already on record as saying that NGO claims about "Big Society" are an underhand way of bringing about social revolution - a kind of Velvet Revolution in scrubs.

Whatever the reasons, the new conditions are harsh. The new law for regulating NGOs specifies that

• At least 50% of staff must be local Chinese, 
• All NGOs must register and gain permission for all programs in advance, 
• NGOs must put themselves under the control of the relevant health ministry and departments.
• Programs will only be permitted if they are in line with Chinese government policies. 
• NGOs must also clear all their activities with the PSB and make all their documents and staff subject to instant inspection and ongoing monitoring.

Of course, this is not how the NGO Management Law has been reported in official media. On the contrary, it has been described as a measure that finally recognises the high value of NGO work and seeks to bolster the status of such efforts. The Chinese government said the new law it would provide better management "and strive to provide more convenience and service, better environment and security."

A meeting held to launch the new regulations was told that China "welcomed long-term friendly exchanges and cooperation, and that foreign NGOs brought China international capital, advanced technology and management experience, and their activities were conducive to the development of Chinese science and technology, people's livelihood, welfare and other aspects of business."

However, it was notable that the launch meeting was chaired by Minister of Public Security Guo Shengkun rather than ministers responsible health or development. Guo said that China placed great importance on the work of health NGOs and wanted to further encourage them.

Nevertheless, the security chief also warned that NGOs must strictly obey Chinese laws and regulations, and the new NGO regulation was needed to ensure that NGO programs were conducted according to their stated purpose and "in an orderly manner" - that's Chinese official speak for not doing anything that is vaguely beyond government control.

Another speaker more pointedly warned against NGO "trickery", using the Chinese idiom of "displaying a sheep's head but selling dog meat" (“挂羊头卖狗肉”)

However NGO representatives and diplomats especially from the EU have strongly criticised the wide ranging and oppressive conditions in the new law. They say health NGOs already find it difficult to operate in China and the new law will make it even harder. The law curtails almost all the rights and functions of NGOs and their staff, and makes them subject to vague but sweeping and draconian powers of the PSB and ministries.

An EU representative said the new laws will impose an excessively heavy burden in terms of administrative, financial and personnel requirements on NGOs and greatly increase operating costs of the organizations, making their China programs unviable.

The meeting heard that there were about 1000 NGOs with long term programs in China and as many as 7000 with short term or one off aid programs. How they will be affected by the new measures remains to be seen.

Tuberculosis in China - the good news and the bad news

by Michael Woodhead
China has succeeded in more than halving its tuberculosis prevalence with a major campaign launched in the 1990s, according to a new report from the Chinese Ministry of Health.
The campaign produced dramatic reductions in tuberculosis because it shifted treatment out of hospitals and into the community via public health centre TB dispensaries, according to an article published in The Lancet this week.
The report assesses the impact of China's tuberculosis control program based on the directly observed treatment, short-course [DOTS] strategy which was scaled up to cover half the population during the 1990s, and to the entire population after 2000.
Between 1990 and 2009 the prevalence of tuberculosis fell from 170 cases to 59 cases per 100 000 population. The decreases were attributable to the program because declines were only seen in areas where it was operating in the 1990s. The reduction in tuberculosis was greater after 2000 than the 90s (57% vs 19%), with 70% of the total reduction in tuberculosis seen in the last decade.
The proportion treated by the public health system using the DOTS strategy increased from 15% of cases in 2000 to 66% of cases in 2010.
The health ministry said China had shown that it was possible to achieve ambitious targets in reducing tuberculosis, which had not been achieved in other developing countries. However, despite this success, China still had an estimated 1 million new tuberculosis cases in 2010.
China now faces the problems of a widening urban-rural gap in tuberculosis prevalence and tuberculosis not being picked up in hospitals. Also, further reductions in tuberculosis prevalence are likely to be less impressive because the DOTS program is more effective in reducing the prevalence of tuberculosis in known cases than in new cases, and the number of known cases is now low.
Therefore other control efforts in addition to the DOTS strategy need to be implemented, the report authors say.
Another problem is that the cost of treating tuberculosis is becoming prohibitively expensive for patients due to hospital profiteering, according to another report released this week. The study by Chinese and international researchers found that many patients are being treated at hospitals with second-line drugs when they should have been treated with first-line drugs in community TB dispensaries. The reason for this seems to be because hospitals want to retain patients to make more profits, the researchers surmised.
The study also found that patients faced crippling costs for treatment despite China's supposedly free TB treatment policy and despite most patients being covered by medical insurance. Insurance coverage for outpatient care generally reimbursed only a small percentage of fees and the free TB treatment policy does not cover costs on auxiliary examinations, drugs and hospitalisation, the report notes.
"A large proportion of patients borrowed money for TB care, and incurred catastrophic expenditure due to TB care," the researchers said.

What's in the budget for health? Highlights from China's NPC budget announcements

by Michael Woodhead
Unlike political parties in the west, China's ruling Communist Party does not have to publish an election manifesto with budget commitments or account for where it has allocated its budget spending. However, following the recent National People's Congress meeting in Beijing, the Party has released some 'budget statements'. They're pretty vague and there isn't anyone or any agency to check on the figures, but this is what they had to say about health:

The background:

1. Spending on medical and health care last year amounted to 259 billion yuan, 99.4% of the budgeted figure and a 26.4% increase.

2. We raised government subsidies for the new rural cooperative medical care system and basic medical insurance for nonworking urban residents to 280 yuan per person per year.

3. Most provincial-level administrative areas unveiled plans to introduce serious illness insurance for their rural and nonworking urban residents.

4. We increased the standard of funding for basic public health services to 30 yuan per person per year, and continued to support major public health service projects.

5. We made steady progress in the pilot reform of county-level public hospitals and the comprehensive reform of community medical and health care centers, and launched a pilot program for posting general practitioners in such institutions.

6. We moved ahead with developing a system for providing assistance in dealing with medical emergencies.

What's next?

- First, we must facilitate the reform of the medical and health care systems. In line with the requirements for each year's work set forth in the plan for deepening the reform of the medical and health care systems during the Twelfth Five-Year Plan period, we will increase government subsidies for the new rural cooperative medical care system and basic medical insurance for nonworking urban residents from 280 yuan to 320 yuan per person per year and accordingly increase the annual individual contribution from 70 to 90 yuan per person.

- We will more quickly push ahead the work of insuring rural and nonworking urban residents against serious illnesses to further reduce their burden of medical expenses.

- We will increase input in medical assistance in urban and rural areas, expand access to such assistance, and provide assistance to those suffering from serious mental illness.

- We will increase financial input in public health, continue to implement basic and major public health services projects, and raise annual per capita spending on basic public health services to 35 yuan.

- We will continue with the trials on comprehensive reform in county-level public hospitals, and develop better policies of subsidizing community medical and health care centers to motivate them and their staff to enhance their services in terms of both quantity and quality.

But wait, there's more:

* We will abolish the practice of compensating for low medical service charges with high drug prices, adjust the prices of medical care and drugs, and create a mechanism for running hospitals by nongovernmental capital.

* We will consolidate and improve the system of using basic medicines and the new mechanisms for operating community-level clinics.

* We will improve the system of tiered medical services, strengthen training of general practitioners, and allow doctors to work in more than one medical institution so that people have easy access to quality medical services.

* We will build harmonious relations between doctors and patients.

* We will improve our capacity to prevent and treat major communicable and chronic diseases and occupational and endemic diseases. The government subsidy for basic public health services will be increased to 35 yuan per person.

* We will support the development of traditional Chinese medicine and the traditional medicine of ethnic minorities.

* We will unwaveringly adhere to the basic state policy of family planning and will implement the policy that allows married couples to have two children if one parent is a single child.

* We must resolutely press ahead with medical reform and work out a Chinese solution to this global problem so that the Chinese people can enjoy a happier and healthier life.

So there you have it ....

Health ministry to merge with Family Planning Commission

China plans to set up a national health and family planning commission through merging the existing Health Ministry with the National Population and Family Planning Commission, according to a report delivered by State Councilor Ma Kai to the annual session of the country's top legislature on Sunday.
The integration of the two ministerial-level departments aims to better uphold the basic national policy of family planning, improve medical care service, and deepen the institutional reform of medical care and public health, says the report on the State Council institutional reform and transformation of government functions.
It also aims to optimize the resources allocation of medical care and public health as well as family planning services, improve the health of the people including the newborns, the report says.
The proposed national health and family planning commission will be responsible for planning the resources allocation of medical care and public health as well as family planning services, establishing basic medicine system, forming China's family planning policy, and supervising, administering the services of public health, medical care and family planning, the report says.
The functions of studying and drawing up population development strategy and population policy of the existing National Population and Family Planning Commission will be transferred to the existing National Development and Reform Commission, the report says.
The existing State Administration of Traditional Chinese Medicine, currently affiliated with the Health Ministry, will be administered by the proposed national health and family planning commission, the report says.
After the reform, China will adhere to and improve the family planning policy, the report says.
Source: Xinhua

Free emergency medical treatment to be provided for the poor

China will set up funds to subsidize emergency medical fees incurred by the poor and patients whose identities are unclear, the State Council said in a guideline issued Friday.
The move came amid the government's efforts to help patients whose inability to pay medical bills has resulted in hospitals ignoring them or refusing treatment.
The funds will be used to cover emergency medical treatments for acute illnesses or serious injuries among the poor and patients whose identities have not been confirmed, said Sun Zhigang, director of the health reform office of the State Council.
However, it is not yet clear who would qualify for such financial assistance. Sun said specific criteria to determine whether a patient qualifies need to be worked out by governments and medical institutions based on local conditions.
The Ministry of Health will lead efforts to determine which illnesses and injuries can be covered, as well as develop compensation standards, according to the guideline, which did not include a timeline.
Provincial and prefecture-level governments are required to set up such funds, which will be jointly financed by government revenue and public donations, the guideline says.
The funds, described by the State Council as an important guarantee for establishing an emergency assistance system in China, will be operated by provincial and prefecture-level government health departments.
The health departments will be supervised by a special committee of legislators, political advisors, medical experts, donors and media representatives.
Expenditures will also be subject to public supervision, according to the guideline.
Source: Xinhua

Now for the hard part: reforming city hospitals

China's ongoing medical reform has already entered its most difficult stage, Minister of Health Chen Zhu has said.
He made the remarks at the launch of the China-World Health Organization Country Cooperation Strategy 2013-15.
The strategy outlines a medium-term framework for cooperation between the Chinese government and the WHO to improve the health and well-being of Chinese people.
"By 2015, when all county-level hospitals are reformed, the program will be expanded to large city hospitals, which will be very difficult," Chen said.
As China has nearly achieved universal healthcare by covering about 95 percent of the population under some form of health insurance, reforms to public hospitals will be on top of the working agenda, he said.
The essence of the reform is to cut public hospitals' financial dependence on drug sales, a mechanism that easily results in excessive examinations and prescriptions, health policy experts said.
Zhang Liming, deputy director of the WHO collaborating center for primary healthcare in Shanghai, said the reform is aimed at improving public access to affordable medical care at public hospitals.
"Public hospitals should serve as a base providing essential healthcare to the people rather than a profiting institution," he said.
However, finding a proper way to compensate them is crucial, Zhang pointed out, proposing government support.
According to Chen, by the end of the year, about half of the nation's county-level public hospitals will be reformed and for that, the government would largely subsidize their operation.
At present, 70 percent of the nation's population, mainly farmers, get medical care at county-level hospitals, the Ministry of Health said.
Given that county-level hospitals are relatively small and totally subject to the control of health administrations, "they were chosen as the starting point of the reform", explained Wu Ming, assistant director of the Peking University's Health Science Center.
"The reform will surely reach large hospitals in cities by 2015 when all county-level ones finish it," Chen vowed, urging more support from large hospitals for the reform.
As sporadic experiments, several major hospitals in cities such as Beijing and Shenzhen launched the reform in July, previous reports said.
Under the pilot program, the long-established 15 percent markup on drugs was scrapped while the fees for seeing the doctor were raised.
"That's more like a restructuring to the insurance payment pattern," Zhang explained.
In fact, the government didn't pay extra for the change, he added.
"The annual revenue of large hospitals usually amounts to hundreds of millions yuan, and that's impossible for the government to absorb," he said.
Huang Jiefu, vice-minister of health, said the success of China's medical reform lies in medics' hands, thus it's important to find ways to compensate their potential losses and encourage their enthusiasm for work.
Source: People's Daily

New rules for rational antibiotic use in China

by Xiao Yonghong and Li Lanjuan
On Aug 1, 2012, China formally implemented a decree issued by its Ministry of Health on administrative regulations for clinical use of antibacterial agents. This ruling defines all aspects of antibiotic use in hospitals, including selection, procurement, prescription, use, monitoring, and legal responsibility, and is the strictest regulation yet for antibiotic management in China. The major purpose of the new regulations is to ensure rational use of antimicrobial agents.
China has extensively reformed its health-care system, which is expected to ultimately give all citizens access to basic medical care. To achieve this aim, the current profit-orientated philosophy in public hospitals should be completely abandoned, and administration of drugs, including antimicrobial agents, should be rationalised. Irrational long-term use of antibiotics allowed by current hospital managements strategies in China has generated antibiotic-resistant bacterial strains, despite the health-care authority releasing several sets of guidelines during the past 10 years to promote rational use, including principles for clinical use of antibiotics (2004), a national formulary (2008), and guides for hospital drug therapeutic committee (2002). Bacterial resistance is now a major problem in China.
In a national survey, 60% of isolates of some species were drug resistant, including meticillin-resistant Staphylococcus aureus, extended-spectrum β-lactamase-producing Escherichia coli, quinolone-resistant E coli, and carbapenem-resistant Pseudomonas aeruginosa, and Acinetobacter baumannii.  Rational use of antimicrobial agents and the implementation of other methods to prevent resistance from worsening have become crucial.
The recently introduced regulations for antibiotic use incorporate the internationally accepted notion of antimicrobial stewardship, and include some administrative requirements tailored to the Chinese health-care system. The regulations also include specific instructions for leaders of medical institutions who are responsible for the rational administration of antimicrobial agents, for establishing an effective antibacterial drug-management system, and for forming a working group composed of infectious disease physicians, pharmacists, microbiologists, and managers. Medical institutions must ensure that antibiotics are classified as non-restricted, restricted, or special-grade. Physicians and pharmacists need specific training in antibiotic prescription before they are granted different levels of prescribing privileges depending on their professional title. The health-care authority will set administrative goals for institutions, review of antibacterial drug prescriptions, regularly publish information about antibacterial drug use in hospitals, commend physicians who closely follow the regulations, and impose penalties on medical staff who violate them.
The regulations also encourage medical institutions to explore alternative strategies to improve the rational use of antibacterial drugs, such as diverse antibiotic use, active intervention for antibiotic use, implementation of clinical guidelines, and hospital infection control. At the same time, pharmaceutical companies should implement a standardised drug-promotion procedure and stop attempting to increase drug sales for economic incentives. Medical institutions need to regularly report the use of antibacterial drugs to the health-care authority. To improve the administration of antibiotics, institutions that seriously or persistently violate the regulations will be appropriately penalised by the authority, by means such as downgrading the hospital to a lower level of classification, and dismissing the leaders of the institutes involved. Medical staff who seriously violate the regulations could lose permission to prescribe antibacterial drugs, have their professional qualification revoked, or even be prosecuted if their actions have serious consequences.
To promote the implementation of these regulations, in 2011 the Chinese Ministry of Health initiated a 3 year campaign with a special task force in antibiotic management. By strict implementation of these regulations and the introduction of legal penalties, the rational use of antibiotics in public medical institutions can be enforced quickly and efficiently. Although these steps are appropriate to reduce antibiotic use in the current Chinese health-care system, long-term management of the strategies needs more planning and the establishment of a sustainable back-up system such as antibiotic stewardship professionals, guidelines, ongoing staff training, and procedures for identifying illegal practice. Unfortunately, antibiotic sales in high-street pharmacies are not within the legal jurisdiction of the regulation.
Source: Lancet Infectious Diseases

Ministry of Health clarifies that 'bulk billing' free treatment scheme will only be a pilot

China’s Ministry of Health denied a statement that a medical payment system that allowed patients to pay after treatment will be introduced nationwide, but confirmed that the system was encouraged to promote in pilot regions.
The pilot system reveals a change in China’s medical payment system – hospitals will pay the fees under related policies for patients first and settle the accounts with the medical insurance then.
Earlier, state-run China Central Television reported that the ministry will introduce the system of “Pay after Treatment” in hospitals across the country this year.
But Jiao Yahui, head of the ministry’s medical management division, said on Tuesday that the system will only be promoted in some qualified pilot regions.
Under the new system, patients, especially those suffering extreme conditions, will receive treatment first. Hospitals will pay the fees for them first and repay by medical insurance later. After the treatment, patients will only pay the part that is not included in the medical insurance.
Currently, most Chinese citizens must pay their bills and apply for a reimbursement covered by medical insurance, usually more than 70 percent of the total treatment fees, Xinhua News Agency reported.
Jiao said the “Pay after Treatment” system was first tested in a hospital in Beijing in 2009. Now more than 20 provincial regions are carrying out the pilot programs in local hospitals, Xinhua said.
Jiao said the new system will not be adopted nationwide in the short term due to an immature social credit system and insufficient medical insurance in the country.
Some patients may "disappear" without paying treatment fees after leaving hospital, which has created risks for the hospitals, according to Jiao. Hospitals will not be able to get the money back if patients don’t buy any medical insurance, Xinhua said.
But in coastal wealthy regions, hospitals won’t face such risk. Medical insurance departments, instead of hospitals, will pay in advance for patients who have bought medical insurance, the 21st Century Business Herald reported.
An unnamed director with the medical insurance department of a major hospital in Shanghai told the paper on Tuesday that the department will allocate one twelfths of the annual amount of medical insurance to the hospital every month and the money can totally cover what patients need.
The paper said the above system of payment in advance by medical insurance department can support the “Pay after Treatment” medical payment system. But it hasn’t introduced in most regions of middle and west China.
Zhu Hengpeng, head of the Center for Public Policy with the Institute of Economics of Chinese Academy of Social Sciences, believes that the reform of medical payment system is just a technical matter, what matters the most is the reform of the medical service supply system, the paper reported.
Currently in China, public hospitals have monopolized the medical service, it’s hard for the new payment system to work, Zhu said.
Source: Morning Whistle

China to train 60,000 GP teachers

The Chinese government will train 60,000 general practitioner (GP) teachers by 2015, according to a circular published by the Ministry of Health on Wednesday.
A GP is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and all sexes.
Jointly issued by the Ministry of Health, the Ministry of Education, the Ministry of Finance and the State Administration of Traditional Chinese Medicine, the circular says candidates for GP training will be classified into three categories: core GP teachers, clinical GP teachers and grassroots GP teachers.
According to the circular, training will last no less than two months and focus on clinical GP teachers and grassroots GP teachers, with the goal of training 6,000 core GP teachers.
The circular stipulates that clinical GP teachers should have a bachelor's degree or above and be qualified as an attending doctor or above. Grassroots GP teachers are expected to have finished junior college and be experienced in clinical practice and public health service.
The Ministry of Health will set up a database of core GP teachers, while provinces nationwide will establish their own databases of GP teachers, the circular said.
Source: EastDay

Ministry of Health revises list of occupational diseases

The Ministry of Health (MOH) on Tuesday began soliciting public opinions on its revised list of ailments considered occupational diseases.
The catalogue of diseases occurring as a result of work and which may therefore be given special consideration under insurance has been newly amended to include AIDS contracted by medical staff through exposure at work.
The revised regulation includes 130 kinds of occupational diseases and adds 17 work-related illnesses to the list. However, chlordimeform toxicosis has been removed from the list as manufacture and use of the chemical that causes it has been prohibited, according to the MOH.
The amendment also classifies occupational diseases into 10 categories, which specifies work-related lung diseases and other respiratory illnesses as one major category.
Of the newly added ailments, five are related to lung diseases caused by metal powder, erionite, double chlorine methyl ether and other materials.
For lack of necessary protection, pneumoconiosis is a major occupational disease in China, especially among miners.
Statistics from Daaiqingchen.org (eliminating pneumoconiosis with love), a charitable foundation established to help treat migrant workers who have developed the disease, show that about 6 million rural Chinese are affected by the disease.
Source: CRI

Flu season expected to peak in next few weeks

The flu season that started in China's northern provinces in December is expected to peak with infections in the next few weeks, a health ministry spokesman said Thursday.
Ministry of Health spokesman Deng Haihua said despite the expected peak infection levels will not reach that of previous years.
One of the reasons is that no variation has occurred to the prevailing flu virus strains, the spokesman said at a regular press conference.
He said a total of 360 cases of A/H1N1 flu were reported across China between Dec. 1 and Jan. 6. They included two deaths in Beijing.
Citing experts' observations, the official added that A/H1N1 flu has become a seasonal one in the country's northern areas.
Between April and December 2012, a total of 45 flu outbreaks were reported across China, with more than 10 flu cases in each outbreak. Of the 45 flu outbreaks, 29 are of A/H3N2, three are type B, and three are A/H1N1.
Monitoring and statistics from March onwards showed that in Beijing and Shandong Province, where there was an increase of A/H1N1 flu cases, A/H1N1 has been the predominant strain of flu virus, the spokesman said.
Source: Peoples Daily

There can be no real health reform without political reform

by Yanzhong Huang, Senior Fellow for Global Health
In April 2012, the director of the State Council Health Care Reform Office announced that targets set in the three-year plan for China's health-care reform had been accomplished on schedule.
There is no denying that the reform has led to expanded health insurance coverage and increased provision of public health services—it has also contributed to the strengthening of grassroots healthcare institutions. However, there has been at best mixed success in reforming the essential drug system. The past year was supposed to be a year of deepening health-care reform. The government selected about 300 pilot counties and cities for reforming public hospitals, which is considered the most important component of healthcare reform. It also announced plans to raise the reimbursement level for catastrophic illness to more than 50 percent, which is an important step toward reducing the share of out-of-pocket payments to 30 percent by 2015. Despite this, the reform has not fundamentally solved the problem of access and affordability. The officially stated 95 percent coverage rate contradicts the fact that more than 200 million migrant workers are actually not covered in China. Meanwhile, disintegrating business ethics and lack of regulatory capabilities have made food safety an unpredicted concern in China.
Driven by the need to maintain legitimacy and to stimulate domestic consumption, the new Chinese leadership is expected to commit to the building a social safety net in the coming years. For health-care reform to succeed, the new leaders have to demonstrate significant progress in reforming the public hospitals and make health care more affordable. In the absence of fundamental changes in public hospitals' financing and management structures, health-care costs will likely continue to increase rapidly. This could be exacerbated by population aging and the growing burden of chronic noncommunicable diseases (NCDs). Today, more than 80 percent of the mortality in China is attributed to NCDs, which is significantly higher than the world average (63 percent). So far, the government has not adopted a proactive approach to addressing NCDs and their risk factors (e.g., tobacco use). Sustained government funding for the healthcare sector is also threatened by local public financing problems. Local governments, which provide the lion's share of government health spending, still do not have the incentives and capabilities to effectively implement important reform measures. A fundamental overhaul of China's health sector therefore entails reforming China's archaic political system.
Read more: Council on Foreign Relations

Government requires mental health education for schools

New guidelines require psychological counselling be made available in all Chinese schools

China's Ministry of Education on Monday urged more efforts to provide qualified mental health education and services to students in primary and middle schools.
Local education authorities and schools should strictly implement a newly revised guideline on mental health education, according to a circular published on the ministry's website on Monday.
The circular stresses systematic arrangements for mental health-related curriculum and accessible in-school psychological counseling. It also pledged to include mental health education in the overall evaluation of a school's performance.
In-school counseling should be strengthened in order to prevent and resolve students' mental health issues, says the circular.
It also highlights the guideline's requirement that each school should have at least one mental health teacher.
The guideline also introduces an examination procedure for all textbooks to be used in mental health classes from the spring semester of next year.
A previous version of the guideline was adopted in 2002.
In 2010, China's total enrollment at regular primary schools and junior secondary schools was 152.2 million, according to the ministry.
Source: Shanghai Daily

Ambulances will get priority, Ministry of Health decrees

Traffic must give priority to ambulances, Ministry of Health says, but laws must wait two years

Following the death of a patient in a traffic jam on December 7, the Ministry of Health (MOH) and Beijing Health Bureau have announced new regulations to ease ambulances' passage through traffic in emergency cases.
The ambulance was only able to move 3km in 40 minutes.
Public opinion on the MOH Pre-hospital Emergency Medical Treatment was already solicited in October and November of 2011 and will soon be released as a ministerial edict, said the ministry's spokesperson Deng Haihua at a press conference held in Beijing on Wednesday.
The fifth draft of the Beijing Emergency Treatment Medical Service Regulation, which began to be discussed in 2007, has been handed over to the local legislative body, the Beijing News reported on Thursday.
The Beijing regulations will be published within two years, according to reports.
 They will stipulate that ambulances have traffic priority in emergency treatment and while transferring patients in critical condition.
Other drivers that refuse to give way to ambulances will be punished and be held legally accountable if the patients die, Legal Mirror reported Thursday.
Traffic jams are a common obstacle for city ambulances, with drivers complaining that fewer than half of all vehicles give way to them.
According to the statistics from the Beijing Emergency Medical Center, the average speed of ambulances in urban areas is less than 40 kilometers per hour during the daytime when they transfer patients, said the Beijing News.
According to the updated version of the Law of the People's Republic of China on Road Traffic Safety, implemented in 2011, ambulances have priority and can't be limited by driving routes, speed, directions and traffic lights.
However, some Beijing residents argued that the punishment for cars who block ambulances would be difficult to confirm.
After collecting public opinions, law makers in Beijing will consider whether ambulances should be exempt from penalties if they scrape or collide with other cars during emergency treatment, said the Beijing News. 
Laws alone cannot solve all the traffic problems confronted by ambulances, Li Jianren, director of the emergency center, told the Global Times on Thursday.
"Tragedies won't happen if people obey traffic rules and respect others' lives," he said during a phone interview.
Source: Global Times

Health minister to lead a permitted non-Communist political party

Health Minister Chen Zhu now heads the Chinese Peasants and Workers Democratic Party

Minister of Health Chen Zhu was elected chairman of the Central Committee of the Chinese Peasants and Workers Democratic Party (CPWDP) on Monday.
The decision was announced after the CPWDP, a non-communist political party with about 125,600 members, concluded its five-day 15th National Congress on the same day.
Chen, 59, a French-trained scientist, was appointed as the country's minister of health in June 2007 when he had no political party affiliation.
The CPWDP was founded in August 1930 in Shanghai and mainly comprises leading intellectuals in the fields of health care, population resources and ecological protection.
It is one of eight non-communist parties in China that participate in state affairs under the leadership of the Communist Party of China (CPC).
Source: Global Times

Hospital says "Yes Minister" to perform liver transplant

Professor Huang Jiefu, China's Vice Minister of Health, performing a liver transplant operation

On November 21, 2012, when Professor Huang Jiefu, Vice Minister of the Ministry of Health, was attending the Chinese Hospital Association Conference in Guangzhou, he was informed that there was going to be a DCD (Organ Donation After Cardiac Death) transplant operation in Lingnan Hospital of The Third Affiliated Hospital of Sun Yat-sen University. 
On hearing this, Huang decided to brave the rain and perform that liver transplant operation personally. He commented that this very operation was his support of the innovative reform taking place in Guangdong's public hospitals where the state-owned central hospitals shall gradually expand their services to the grassroots level. He also considered it as a practice of the appeal for voluntary organ donation after death, proposed by the Red Cross Society of China and the Ministry of Health together.
   "It is a real coincidence that I come across this operation.” A woman in her fifties passed away that morning. Based on her own willing and her family’s consent, her organs would be donated to a liver transplant recipient, two kidney transplant recipients, and two cornea transplant recipients. Before stepping into the operating room, Huang readily accepted the interview. He extended his reverence to the voluntary donor by concluding: "One life passed away, but it ended up saving another three. It will also help another two to see the world again. This very devotion is filled with lofty spirit.”
Huang entered the operating theatre around 10 o’clock and got himself prepared for the surgery. After preparation, Huang cooperated well with the team led by Professor Chen Guihua at the Transplant Center of the Third Affiliated Hospital of Sun Yat-sen University. The surgery finished up in success in the afternoon.
   "I pledged to perform an operation personally when the hospital becomes well developed at the launching ceremony. That is why I came here today to honor that promise.” “The Eighteenth National Congress of the Communist Party of China emphasized that we must provide our people with high quality medical services to ensure their happiness and offer the best treatment to the patients in need. This is our responsibility.” Huang made an analogy that if we could not establish a public organ donation system in China, the transplant operations would become “water without the source”. The cause of organ transplant demands wide understanding and support from the public. The concerted effort made by our people can pave the way for the sustainable development of organ transplant cause in China. Huang said: "Chinese culture advocates love, harmony, devotion, sympathy and saving life. Showing the glory of human nature, the tradition will be inherited and carried forward.”
It is learned that, there are already a large number of potential donors who are willing to donate their organs after death. Since the Ministry of Health and the Red Cross Society of China initiated the pilot project on March 2nd, 2010, the 38 pilot stations have received 465 cases of organ donation. Among them, Guangzhou station is the most exceptional one, with an incredible number of 126 cases.
   On the 8th of last October, when Lingnan Hospital in Luogang District was officially handed over to The Third Affiliated Hospital of Sun Yat-sen University, Huang Jiefu also attended its launching ceremony. He extolled this move as “a superb example of China’s public hospital reform”. "The Luogang Government built the houses, and Sun Yat-sen University provided the medical expertise and technology. They collaborated and helped the locals solve their health issues”, he remarked.   
   Today when Vice Minister Huang Jiefu heard that the daily number of outpatient services has reached 1,300 persons per day and more than 70% of the 500 hospital beds are being used on average, he further approved this reform by adding:”So far, it is the best mode of expanding public services to the grassroots level which is currently advocated by the party group of the Ministry of Health.”
Source: Sun Yat-Sen University

AIDS-related deaths up by 9% in China

The number of new cases of HIV in China has increased by almost 13% this year

China's health authority announced on Wednesday that 17,740 AIDS-related deaths were reported in the country from January to October, a year-on-year increase of 8.6 percent.
As those living with HIV have become AIDS patients over time,AIDS-related deaths are on the rise, according to the Ministry of Health (MOH).
The MOH said the latest figures show that 34,157 new cases of AIDS were reported in China in the ten-month period, up by 12.7 percent year-on-year.
HIV rates have risen among people aged 15 to 24 and those over 50.
From January to October, 16,131 new cases of HIV infections among citizens over 50 were reported, marking a year-on-year increase of 20.2 percent.
There were also 9,514 new cases of HIV reported among young people aged 15 to 24, up 12.8 percent year on year, according to figures from the MOH.
The MOH said the HIV/AIDS epidemic is rampant in some locations and among certain groups of people.
In total, China reported 492,191 cases of HIV/AIDS by the end of October, including 68,802 new cases this year, according to the MOH.
Sexual transmission has become the primary channel of HIV/AIDS spreading. Sex between men registered a sharp increase, said the MOH.
Out of the new cases of HIV within the ten month period, 84.9 percent contracted the virus through sexual intercourse.
According to China's AIDS Action Plan for the 12th Five-Year Program period (2011-2015) published by the State Council, or China's Cabinet, in February, the country aims to decrease AIDS fatalities by 30 percent by 2015, and new cases by 25 percent as compared to 2010.
Since the end of 2003, the Chinese government has carried out the policy "four frees, one care" for people living with HIV/AIDS. This includes free blood tests for those with HIV, free education for orphans of AIDS patients, free consultation and screening tests, and free antiretroviral therapy for pregnant women.
Read more: Eastday

Health minister performs liver transplant - but some question his qualifications

Professor Huang Jiefu is a transplant surgeon as well as China's deputy health minister

by Michael Woodhead

China's deputy health minister Professor Huang Jiefu was wearing his surgeon's hat when performed a liver transplant in Guangzhou this week - but some cynics have questioned his qualification to do so.
The health minister, who is a transplant surgeon by training, performed a liver transplant from a 50-year old woman at Lingnan Hospital, Sun Yat-sen University Third Affiliated Hospital, to highlight China's new organ donations pilot
The 66-year old deputy minister like to keep his hand in as a transplant tsurgein and is never far away from the operating table, performing an average of two operations a week at the Beijing Union Medical College Hospital .
Professor Huang paid tribute to the deceased woman and her family for donating the organs saying: "this death saved three lives and in addition also allows two people to see with corneal transplants, which is a great thing."
Professor Huang has the vision that China can build a sustainable ethical and national organ donation transplant system. He lead the way in setting up the Chinese Human Organ Transplant Ordinance promulgated in May 2007, and has been open in admitting to the international community to the fact that China had been using organs from executed prisoners as a major source of transplants - but now wants to change that.
"Since the donor organ pilot, organ transplant regulations have achieved significant progress in Guangdong and voluntary organ donations next year may exceed the number of death row inmates organ. Of course, we do not opposed to the death row inmates voluntary contributions. "
However, after the publicity over the latest transplant procedures by the minister some Chinese citizens took to microblogging sites such as Weibo to question whether he was fully licensed and qualified to do so, and questioning how he could be both a senior government minister and "moonlighting" as a practicing clinician.
Professor Huang responded with good humour to allegations that he was an "illegal doctor".
"I have been licensed as a doctor since I graduated from medical school, I wrote China's national textbook on liver transplants, I do liver transplant teaching videos, and I am also been recognised by medical organisations in Australia and in the United States. Being a practising surgeon is the most important thing in the world to me - how could I not have a medical license in this country? " 　　In response to the accusations of  "moonlighting" argument, Professor Huang responded that although he is a Ministry of Health official, his most fundamental role is still as a doctor, "The media calls me Minister Huang, but I actually prefer the title of Professor Huang. The priority in my life and career has always been to help and treat the patient, and I have always had career satisfaction and pride through the surgery I do with my hands, seeing patients to restore health."
Read more: Jiankan Bao

Code of Conduct for health practitioners released by Ministry of Health

Code of practice covers practitioners such as doctors, nurses and pharmacists

by Michael Woodhead
A new national "code of conduct" for medical standards and ethics for medical institutions and health practitioners has been issued and must be "strictly followed", the Ministry of Health has announced.
The code of conduct covers doctors nurses, pharmacists and other health practitioners as well as medical institutions and organisations under the Ministry of Health, the State Food and Drug Administration and the State Administration of Traditional Chinese Medicine.
The ten part code of conduct sets out basic standards such as emphasising adherence to medical ethics and national laws. It defines the role of health practitioners as having a people-oriented practice, adhering to a philosophy of healing the sick, and preventing and curing diseases. Practitioners are also required to be humanitarian, rational, sincere and and act in the spirit of medicine to provide patient-centred health services for the people.
The code also requires practitioners and health organisations to respect the patient's right to informed consent and privacy, safeguard the legitimate rights and interests of the patients and to respect the rights of patients where they may face discrimination because of race, religion, disability or socioeconomic status.
The code of conduct also stipulates the practitioners and health organisations must not seek to take advantage of patients through bribes, soliciting donations or rewards, nor should they engage in profiteering, fraud  or abuse of medical insurance. Practitioners and institutions must also avoid conflicts of interests when providing medical services and products and should advertise and promote their services and products in an ethical way.
It is also required that health practitioners be regularly evaluated to ensure they are maintaining good standards. Practitioners who violate the norms of medical institutions, may be criticised and educated, suspended or dismissed, depending on the seriousness of the infringement. Serious cases of negligence or malpractice may need to be investigated and death with in accordance with the disciplinary rules and case investigation and handling procedures.
The code has been disseminated to all provinces and organisations and will come into effect immediately.
Read more: Ministry of Health

Health minister pledges equality in treatment for HIV-positive Chinese

Health minister Chen Zhu has called for proper treatment for people with HIV

by Shan Juan and Wang Qingyun
Hospitals designated to treat HIV/AIDS will be upgraded to protect the rights of patients and ensure better healthcare services, Minister of Health Chen Zhu pledged on Thursday.
He was speaking at a ceremony to mark the end of the China-Australia Health and HIV/AIDS Facility, a joint project, and after Vice-Premier Li Keqiang on Wednesday called for proper medical treatment for people who have HIV or AIDS.
Li contacted the ministry after learning of a recent case in which a 25-year-old HIV carrier ― identified as Xiaofeng ― was denied cancer treatment in Tianjin due to his condition, and only secured treatment at another facility after hiding his status.
"The Health Ministry will improve services at designated hospitals to better help people with HIV/AIDS beyond just treating them," Chen told China Daily. "We'll also improve working conditions for medical workers."
Thanks to anti-retroviral treatment, patients can now live much longer and may need treatment for other medical conditions, he said. Because their immune system may be weakened, patients with HIV/AIDS could be susceptible to other illnesses.
Each city on the mainland has at least one designated hospital to carry out anti-retroviral and HIV/AIDS related treatment, said Wu Zunyou, director of the National Center for AIDS and Sexually Transmitted Diseases Control and Prevention.
Zhao Yan, deputy director of the center's AIDS treatment and care division, said: "However, many of them, particularly those specializing in infectious diseases, are not competent enough to treat other diseases like cancer or eye conditions."
Meng Lin, a member of the China Alliance of People Living with HIV/AIDS, said: "It's just makeshift measures to meet other medical demands at designated hospitals".
Meng, an AIDS patient in Beijing, suffered kidney problems as a side effect of anti-retroviral drugs in August.
"I first went to a designated hospital specializing in treating infections, but they couldn't treat kidney disease at all," he said. "I just want to go to the right hospital, where my disease can be treated properly."
He added that he was rejected numerous times while seeking medical services at non-designated hospitals. "I was denied even in non-surgery cases," he said.
Meng admitted that he used to hide his status from doctors to get treatment. "I have no way out. Lie or die."
China issued a regulation on HIV/AIDS prevention and treatment in 2006. It stipulates that no hospital can deny treatment on grounds of a patient being HIV-positive.
So far, no hospital has ever been penalized by health authorities for such a violation, according to Meng. "We just hope the laws and regulations are well enforced," he added.
Health Minister Chen called for more kindness and less discrimination.
Also, Wu Zunyou urged tougher punishment for medical institutions, which turned their back on sufferers.
In another development, the health bureau in Tianjin announced Thursday that it is holding staff workers in the Cancer Institute and Hospital of Tianjin Medical University accountable for refusing to conduct lung cancer surgery on Xiaofeng.
The bureau also investigated the hospital that did the surgery on Xiaofeng to make sure that all procedures, including sterilization and disposal, were properly followed.
The bureau said such incidents must not happen again, and all hospitals in the city should ensure HIV carriers get treatment. Also, it requires HIV carriers to fully disclose their medical condition to doctors.
China has 780,000 people living with HIV/AIDS on the mainland, according to official estimates.
Read more: China Daily