Capacity-building for pastoral hospitlas in Xinjiang

After breakdown of cooperative medical schemes and community-financed health care, health issues in rural areas are increasingly becoming an issue of high priority in Northeast Asia. This joint study of the universities of Vienna and Shihezi (AR Xinjiang, PR China) is - assessing health needs of nomadic and seminomadic pastoralists and the structure and scope of health care delivery in pastoral hospitals in a health status and risk factor survey with quantitative and qualitative methods. - exploring ways for better health care provision in the pastoral hospitals (muye yiyuan) of the Xinjiang Uygur Autonomous Region in China in a case study in Xinyuan county. - developing culture- and geographic-sensitive health scenarios for better health care provision and explores their transferability to other pastoral regions of post-collectivist societies in Northeast Asia. - exploring forms of governance in rural health care in the villages The central hypothesis is that improvements in health care delivery are sustainable when they are consequently community- and settings-oriented in the meaning of fitting into the existing structure and responding to local needs and customs. Using a transdisciplinary and participatory methodology this joint project will activate and transform existing coping and management resources for sustainable self-organization in pastoral hospitals.

The project on Capacity Building for Rural Health Care in Northeast Asia: Perspectives for Pastoral Hospitals in Xinjiang, China was conducted by experts of Chinese Studies at the Department of East Asian Studies at the University of Vienna and experts from the Department of Public Health at the Medical School of Shihezi University in Xinjiang, PRC. As an exception from the rule, it was permitted to do field research among the minority group of Kasaks in a region close to the border to Kazakhstan formerly not opened to visitors from outside China. The methodology the team applied was a combination of quantitative and qualitative research using an actor-centered approach. The aim of the project consisted of analyzing the resources for capacity building and the perceptions of three stakeholder groups (patients, health staff, health administrators) of the current situation of health care in the area. During its first field trip, the team conducted a survey among 457 households of Kazak herders living on the Nalati Agewuzan summer pasture at an altitude of 2500 m above the sea. It was assisted by a group of 10 students of Kazak background of Shihezi University`s medical school. The survey showed a much higher incidence of illnesses among the herders than among the general population in the valleys. In response to the provincial government as well as the government of Xinyuan county asking for policy advise concerning the possible upgrading of health care service for the herders, the next step of the project implied an in depth study of the health care facilities in the area. The current implementation of a three-tiered health care system located at the county, township and village levels does not address the needs of a semi-nomadic population. The system is both too distanced from their pastures and too expensive for the herders. The research team`s advice aimed at shortening the distance between health providers and health care users. It implied community oriented mobile hospitals both inexpensive and effective. However, the local administrators did not take any actions to implement the plan. Instead they complied with national health policies in order to use central funds rather than local money. The new hospitals they built are non-mobile and therefore cannot cater to the needs of semi-nomadic herders. As part of the friendly cooperation between Vienna, Shihezi and Xinyuan County the team was given access to data on the implementation process of the New Rural Cooperative Medical Scheme introduced to the area since 2006 which provided many important insights about this important new policy promulgated by the central government and implemented in the rural areas of the PRC. Simultaneously, it was able to observe and learn about the symbiotic relationship between health scientists and health administrators in the PRC. In order to gain legitimacy, the party organizations as well as administrators at the local level rely on an evidence based policy approach the evidence of which is presented by health scientists. Health scientists understand themselves as a bridge between the needs of the population which they try to explore and the ideas of local administrators which have to comply both with local needs and central demands.