NGOs and Health Policy in ChinaWord格式.docx

1、channelling funding to NGOs to help with HIV/AIDS related awareness education, support,and care （Thompson and Lu 2006, p. 32）.3 But are health sector NGOs widespread? Andhow much influence do they have over policy?Recent work on Chinese NGOs in other policy areas has shown them to be increasingly ac

2、tiveand influential. Ma argues, for example, that NGO actions have started to influencegovernmental policy making and implementation （Ma 2006, p. 121）. This is especially so inrelation to social and environmental issues where the central government has encouragedthem to take on some work formerly ha

3、ndled by the state （Curley 2002; Howell 2004; Yang2005）. Since there has been similar recent state encouragement of NGOs in the health sector1 I would like to thank The Leverhulme Trust for funding the project through a Leverhulme ResearchFellowship, 2006-2007. I would also like to thank Xu Ying, Wa

4、ng Guohui and Daniel Hammond fortheir very valuable research assistance at various stages of this project as well as those NGO memberswho kindly agreed to be interviewed but whose identities cannot be revealed in this paper.2 And Thompson and Lu （2006, p. 36） suggest that a third wave might involve

5、NGOs in the sphere ofenvironmental health problems.3 Thompson and Lu （2006） report that both Wu Yi （Vice-Premier and then Minister of Health） inSpring 2005） and Gao Qiang （Minister of Health） on World AIDS day 2005, have called for NGOinvolvement in the fight against HIV/AIDS.（see above and Peoples

6、Daily, 25 June 2004）, these, too might have become active and beinfluencing （or trying to influence） policy.Studies of health policy-making in advanced industrialised democracies usually see aparticular type of NGO, the medical professional organisation, as a powerful influence（Moran 1999; Tuohy 199

7、9）. Associations of medical professionals often have a trade unionlikerole, representing members interests and negotiating on their behalf with governments,but also sometimes maintaining autonomy through a strong professional self-disciplinary role.For example in the UK the British Medical Associati

8、on is effectively the trade union fordoctors, while the Royal Colleges represent the interests of specific health sector employees（for example surgeons and nurses）. The UKs General Medical Council is another selfregulatorybody for medical professionals. It registers doctors for practice and maintain

9、s itsown disciplinary procedures for medical malpractice, including striking practitioners from themedical register （Ham 1992）. Although in China, the influence of such organisations wanedin the 1950s after the Chinese Communist Party took power, it as may have begun to waxagain along with those of

10、other NGOs over the last decade. These organisations in particularare therefore worth studying.The paper is based on a review of Chinese （not international） health sector NGOs and indepthstudy of one grassroots organisation and one government-organised NGO （GONGO）,an organisation of medical professi

11、onals.4 The case studies use a combination of documentarymaterials （policy documents, organisations constitutions and other documents）, organisationwebsites, and interviews with NGO members and scholars in China, all carried out in 2006and 2007.5 Of course conclusions based on only two case studies

12、can only be indicative andare not generalisable to all health sector NGOs. Further research is needed to demonstratetheir wider applicability.The largest and fastest growing group of grassroots health NGOs in China is active in theHIV/AIDS issue area, and there are relatively few others. Across issu

13、e areas, however, theseNGOs are not only beginning to fill gaps in public sector provision for some isolated andvulnerable social groups, but are also lobbying for policy change on their behalf. Since theircapacities and channels for influencing policy remain limited, they use a range of informal4 T

14、he project on which this paper is based is studying in some depth a larger number of organisations,but data-gathering and analysis of others is not yet complete.5 Interviews have been anonymised to protect interviewees identitieschannels, including personal connections to CPPCC or NPC representative

15、s and doctors, andthe media, as well as persisting in using formal channels such as writing to Ministers andlocal government officials. However, their personal connections are poor （when comparedwith GONGOs）, their use of the media can lead to problems with the party-state, and formalchannels often

16、elicit little response. They therefore have limited options at their disposal.Since personal connections are potentially the most effective way of reaching policy makers,grassroots NGOs perhaps have more policy impact at local level.Research in other policy areas has indicated that some GONGOs （incl

17、uding so-called massorganisations that have particularly close ties to the party-state）, have developed independentpolicy stances （Howell 2000）. I find, however, that many health sector GONGOs remainclosely connected to the Ministry of Health, have few discernibly distinct policy positions,and are m

18、ainly vehicles for policy implementation. Notably, medical professionalorganisationsthose that you might from comparative experience expect to develop someautonomyhave apparently failed to develop an independent stance even over the criticalissue of professional self-regulation. Overall, the role of

19、 NGOs is limited in health by apowerful Ministry of Health, even though it seems unable to regulate professionals anddeliver a wide range of services effectively.NGOs and their roles in ChinaBased on Martens, I define NGOs as independent societal organisations whose primary aimis to promote common g

20、oals at the national or international level （Martens 2002, p. 285）. I donot, however, include, as she does, the requirement that they be formal, with an employedstaff. As I shall discuss below, in China many grassroots NGOs that fulfil other parts of herdefinition are not able to operate formally be

21、cause the party-state limits their developmentpreventing them from formally registering and opening corporate bank accounts. Followingothers writing on NGOs, civil society organisations or societal organisations （shehuituanti） in China （Cooper 2006; Yang 2005）, I do include GONGOs, that is societalo

22、rganisations with close ties to the Chinese party-state, since they are formally independent.The existing literature on Chinese NGOs has shown them to have a wide range of roles.6While some have only a single main activity, for example, service delivery, others maysimultaneously sustain multiple rol

23、es. At least seven NGO policy-related roles or activitytypes have been identified in the existing literature. First, there is self help or servicedelivery/provision that fills a gap in state policy and provision, for example running schoolsfor mentally handicapped or migrant children （Kwong 2004; Le

24、ung 1994）, or service deliverythat is undertaken for government and is a form of policy implementation （Ma 2006）. Second,some NGOs disseminate or coordinate policy （Howell 2004）. Third, they can provide trainingfor officials and othersoften to improve policy implementation （Cooper 2006; Howell2004）.

25、 Fourth, NGOs sometimes disseminate research or new models for interventions thatthen shape policy （Howell 2004）. Fifth, they can respond to government consultations orother government invitations for policy input （Howell 2004）. Sixth, they can mediate disputesor provide legal assistance for individ

26、uals （Cooper 2006）. Seventh, they can directly lobby orconduct advocacy activities that range from the use of personal connections, notably thosewith CPPCC members, writing reports or letters to relevant government offices setting outrecommendations, and awareness-raising, often through the media （C

27、hen and Liao 2005;Cooper 2006; Ma 2006）. The first five roles are non-confrontational and generallyunthreatening to the state even though they may involve indirect attempts to influence policy.The latter two can be more contentious and potentially challenge policy decisions, point tolack of policy,

28、or highlight problems with existing policies.Health sector NGOs: the grassroots-GONGO distinctionThis paper distinguishes primarily between grassroots NGOs and GONGOs. GrassrootsNGOs are those that have been established voluntarily and spontaneously by individuals orgroups of people and without the

29、involvement of government. They are usually relativelysmall in terms of personnel and administration and have relatively few resources. They maybe registered as societal organisations （shehui tuanti）, and therefore be formally not-forprofit.But some are not registered at all because they have failed to secure a sponsoringdepartment within the party-state administration or do not fulfil the requirements for