NGOs and Health Policy in ChinaWord格式.docx

NGOs and Health Policy in ChinaWord格式.docx

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channellingfundingtoNGOstohelpwithHIV/AIDSrelated‘awarenesseducation,support,

andcare’（ThompsonandLu2006,p.32）.3ButarehealthsectorNGOswidespread?

And

howmuchinfluencedotheyhaveoverpolicy?

RecentworkonChineseNGOsinotherpolicyareashasshownthemtobeincreasinglyactive

andinfluential.Maargues,forexample,thatNGO‘actionshave…startedtoinfluence

governmentalpolicymakingandimplementation’（Ma2006,p.121）.Thisisespeciallysoin

relationtosocialandenvironmentalissueswherethecentralgovernmenthasencouraged

themtotakeonsomeworkformerlyhandledbythestate（Curley2002;

Howell2004;

Yang

2005）.SincetherehasbeensimilarrecentstateencouragementofNGOsinthehealthsector

1IwouldliketothankTheLeverhulmeTrustforfundingtheprojectthroughaLeverhulmeResearch

Fellowship,2006-2007.IwouldalsoliketothankXuYing,WangGuohuiandDanielHammondfor

theirveryvaluableresearchassistanceatvariousstagesofthisprojectaswellasthoseNGOmembers

whokindlyagreedtobeinterviewedbutwhoseidentitiescannotberevealedinthispaper.

2AndThompsonandLu（2006,p.36）suggestthata‘thirdwave’mightinvolveNGOsinthesphereof

environmentalhealthproblems.

3ThompsonandLu（2006）reportthatbothWuYi（Vice-PremierandthenMinisterofHealth）in

Spring2005）andGaoQiang（MinisterofHealth）onWorldAIDSday2005,havecalledforNGO

involvementinthefightagainstHIV/AIDS.

（seeaboveandPeople’sDaily,25June2004）,these,toomighthavebecomeactiveandbe

influencing（ortryingtoinfluence）policy.

Studiesofhealthpolicy-makinginadvancedindustrialiseddemocraciesusuallyseea

particulartypeofNGO,themedicalprofessionalorganisation,asapowerfulinfluence

（Moran1999;

Tuohy1999）.Associationsofmedicalprofessionalsoftenhaveatradeunionlike

role,representingmembersinterestsandnegotiatingontheirbehalfwithgovernments,

butalsosometimesmaintainingautonomythroughastrongprofessionalself-disciplinaryrole.

ForexampleintheUKtheBritishMedicalAssociationiseffectivelythetradeunionfor

doctors,whiletheRoyalCollegesrepresenttheinterestsofspecifichealthsectoremployees

（forexamplesurgeonsandnurses）.TheUK’sGeneralMedicalCouncilisanotherselfregulatory

bodyformedicalprofessionals.Itregistersdoctorsforpracticeandmaintainsits

owndisciplinaryproceduresformedicalmalpractice,includingstrikingpractitionersfromthe

medicalregister（Ham1992）.AlthoughinChina,theinfluenceofsuchorganisationswaned

inthe1950saftertheChineseCommunistPartytookpower,itasmayhavebeguntowax

againalongwiththoseofotherNGOsoverthelastdecade.Theseorganisationsinparticular

arethereforeworthstudying.

ThepaperisbasedonareviewofChinese（notinternational）healthsectorNGOsandindepth

studyofonegrassrootsorganisationandonegovernment-organisedNGO（GONGO）,

anorganisationofmedicalprofessionals.4Thecasestudiesuseacombinationofdocumentary

materials（policydocuments,organisations’constitutionsandotherdocuments）,organisation

websites,andinterviewswithNGOmembersandscholarsinChina,allcarriedoutin2006

and2007.5Ofcourseconclusionsbasedononlytwocasestudiescanonlybeindicativeand

arenotgeneralisabletoallhealthsectorNGOs.Furtherresearchisneededtodemonstrate

theirwiderapplicability.

ThelargestandfastestgrowinggroupofgrassrootshealthNGOsinChinaisactiveinthe

HIV/AIDSissuearea,andtherearerelativelyfewothers.Acrossissueareas,however,these

NGOsarenotonlybeginningtofillgapsinpublicsectorprovisionforsomeisolatedand

vulnerablesocialgroups,butarealsolobbyingforpolicychangeontheirbehalf.Sincetheir

capacitiesandchannelsforinfluencingpolicyremainlimited,theyusearangeofinformal

4Theprojectonwhichthispaperisbasedisstudyinginsomedepthalargernumberoforganisations,

butdata-gatheringandanalysisofothersisnotyetcomplete.

5Interviewshavebeenanonymisedtoprotectinterviewees’identities

channels,includingpersonalconnectionstoCPPCCorNPCrepresentativesanddoctors,and

themedia,aswellaspersistinginusingformalchannelssuchaswritingtoMinistersand

localgovernmentofficials.However,theirpersonalconnectionsarepoor（whencompared

withGONGOs）,theiruseofthemediacanleadtoproblemswiththeparty-state,andformal

channelsoftenelicitlittleresponse.Theythereforehavelimitedoptionsattheirdisposal.

Sincepersonalconnectionsarepotentiallythemosteffectivewayofreachingpolicymakers,

grassrootsNGOsperhapshavemorepolicyimpactatlocallevel.

ResearchinotherpolicyareashasindicatedthatsomeGONGOs（includingso-called‘mass

organisations’thathaveparticularlyclosetiestotheparty-state）,havedevelopedindependent

policystances（Howell2000）.Ifind,however,thatmanyhealthsectorGONGOsremain

closelyconnectedtotheMinistryofHealth,havefewdiscerniblydistinctpolicypositions,

andaremainlyvehiclesforpolicyimplementation.Notably,medicalprofessional

organisations—thosethatyoumightfromcomparativeexperienceexpecttodevelopsome

autonomy—haveapparentlyfailedtodevelopanindependentstanceevenoverthecritical

issueofprofessionalself-regulation.Overall,theroleofNGOsislimitedinhealthbya

powerfulMinistryofHealth,eventhoughitseemsunabletoregulateprofessionalsand

deliverawiderangeofserviceseffectively.

NGOsandtheirrolesinChina

BasedonMartens,IdefineNGOsas‘independentsocietalorganisationswhoseprimaryaim

istopromotecommongoalsatthenationalorinternationallevel’（Martens2002,p.285）.Ido

not,however,include,asshedoes,therequirementthattheybe‘formal’,withanemployed

staff.AsIshalldiscussbelow,inChinamanygrassrootsNGOsthatfulfilotherpartsofher

definitionarenotabletooperateformallybecausetheparty-statelimitstheirdevelopment

preventingthemfromformallyregisteringandopeningcorporatebankaccounts.Following

otherswritingonNGOs,‘civilsocietyorganisations’or‘societalorganisations’（shehui

tuanti）inChina（Cooper2006;

Yang2005）,IdoincludeGONGOs,thatissocietal

organisationswithclosetiestotheChineseparty-state,sincetheyareformallyindependent.

TheexistingliteratureonChineseNGOshasshownthemtohaveawiderangeofroles.6

Whilesomehaveonlyasinglemainactivity,forexample,servicedelivery,othersmay

simultaneouslysustainmultipleroles.AtleastsevenNGOpolicy-relatedrolesoractivity

typeshavebeenidentifiedintheexistingliterature.First,thereis‘selfhelp’orservice

delivery/provisionthatfillsagapinstatepolicyandprovision,forexamplerunningschools

formentallyhandicappedormigrantchildren（Kwong2004;

Leung1994）,orservicedelivery

thatisundertakenforgovernmentandisaformofpolicyimplementation（Ma2006）.Second,

someNGOsdisseminateorcoordinatepolicy（Howell2004）.Third,theycanprovidetraining

forofficialsandothers—oftentoimprovepolicyimplementation（Cooper2006;

Howell

2004）.Fourth,NGOssometimesdisseminateresearchornewmodelsforinterventionsthat

thenshapepolicy（Howell2004）.Fifth,theycanrespondtogovernmentconsultationsor

othergovernmentinvitationsforpolicyinput（Howell2004）.Sixth,theycanmediatedisputes

orprovidelegalassistanceforindividuals（Cooper2006）.Seventh,theycandirectlylobbyor

conduct‘advocacy’activitiesthatrangefromtheuseofpersonalconnections,notablythose

withCPPCCmembers,writingreportsorletterstorelevantgovernmentofficessettingout

recommendations,and‘awareness-raising’,oftenthroughthemedia（ChenandLiao2005;

Cooper2006;

Ma2006）.Thefirstfiverolesarenon-confrontationalandgenerally

unthreateningtothestateeventhoughtheymayinvolveindirectattemptstoinfluencepolicy.

Thelattertwocanbemorecontentiousandpotentiallychallengepolicydecisions,pointto

lackofpolicy,orhighlightproblemswithexistingpolicies.

HealthsectorNGOs:

thegrassroots-GONGOdistinction

Thispaperdistinguishesprimarilybetween‘grassroots’NGOsandGONGOs.Grassroots

NGOsarethosethathavebeenestablishedvoluntarilyandspontaneouslybyindividualsor

groupsofpeopleandwithouttheinvolvementofgovernment.Theyareusuallyrelatively

smallintermsofpersonnelandadministrationandhaverelativelyfewresources.Theymay

beregisteredas‘societalorganisations’（shehuituanti）,andthereforebeformallynot-forprofit.

Butsomearenotregisteredatallbecausetheyhavefailedtosecureasponsoring

departmentwithintheparty-stateadministrationordonotfulfiltherequirementsfor