Advancing the application of systems thinking in health: managing rural China health system development in complex and dynamic contexts

Background: This paper explores the evolution of schemes for rural finance in China as a case study of the long and complex process of health system development. It argues that the evolution of these schemes has been the outcome of the response of a large number of agents to a rapidly changing context and of efforts by the government to influence this adaptation process and achieve public health goals. Methods:The study draws on several sources of data including a review of official policy documents and academic papers and in-depth interviews with key policy actors at national level and at a sample of localities. Results: The study identifies three major transition points associated with changes in broad development strategy and demonstrates how the adaptation of large numbers of actors to these contextual changes had a major impact on the performance of the health system. Further, it documents how the Ministry of Health viewed its role as both an advocate for the interests of health facilities and health workers and as the agency responsible for ensuring that government health system objectives were met. It is argued that a major reason for the resilience of the health system and its ability to adapt to rapid economic and institutional change was the ability of the Ministry to provide overall strategy leadership. Additionally, it postulates that a number of interest groups have emerged, which now also seek to influence the pathway of health system development. Conclusions: This history illustrates the complex and political nature of the management of health system development and reform. The paper concludes that governments will need to increase their capacity to analyze the health sector as a complex system and to manage change processes.UKaid: DFI

The prospects for China's food security and imports: Will China starve the world via imports?

China's food supply and demand have significant implications for both China's own national food security and that of the world. This study reviews China's food security prospects and their implications, focusing on international trade in the coming decade. The results show that China's policies for ensuring food security will be enhanced and China will move to sustainable agriculture. Most studies anticipate that China will increase its food and feed imports in the coming decade. China's overall food self-sufficiency is likely to fall from 94.5% in 2015 to around 91% by 2025. The greatest increases in imports are likely to be soybean, maize, sugar, and dairy products. However, within the production capacity of the major exporting countries and of many food-importing developing countries, China's additional imports of 3 to 5% of its total food consumption in the coming decade are unlikely to threaten global food security. Indeed, the projected imports of feed and several foods could provide opportunities for many exporting countries to expand their production and save global resources