Publication: Stakeholder Participation Targets the Rural Poor : China Basic Health Project
Loading...
Date
2001-03
ISSN
Published
2001-03
Author(s)
Editor(s)
Abstract
The past 20 years have witnessed a growing disparity in health status indicators between urban and rural populations in China. The economic and social reforms that have accelerated the growth in GDP and personal income levels of the urban population have not trickled down to the rural areas. Declining government support of public health programs and the collapse of community financing of health services have meant that health services in poor rural areas have deteriorated in general. Services have declined in coverage, quality, efficiency, utilization, and financial viability. To address this disparity, the World Bank-supported Basic Health Project in China introduced a systematic but rapid process of consultation and feedback among selected beneficiary communities. The project was prepared using guidelines prepared by national and international experts. The social assessment confirmed impressions gained from less structured consultations and provided additional support for project design. Stakeholder involvement was extensive, including consultations with governmental departments of planning, finance, poverty alleviation, personnel, and education, as well as civil society groups such as the All China Women's Federation and the Red Cross. Field visits included focus group discussions with local government representatives, village officials, and householders. The rural poor, including minority nationalities, figured prominently in such consultations. This note concludes that responsive social development has its risks. Even in such an innovative and comprehensive project, maintaining a balance between improvement of health facilities versus population-based health care remains a challenge. Without adequate technical support and supervision, or without adequate funds in the county poverty fund to reimburse health care providers for their services given to the poor, this balance could ultimately break down and erode the lines of communication and trust established by the project.
Link to Data Set
Citation
“Kuehnast, Kathleen. 2001. Stakeholder Participation Targets the Rural Poor : China Basic Health Project. Social Development Notes; No. 53. © World Bank. http://hdl.handle.net/10986/11392 License: CC BY 3.0 IGO.”
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication Decreasing Social Inequities through Decentralization : Morocco Social Priorities 1-Health Project(World Bank, Washington, DC, 2001-03)The Morocco Social Priorities Program incorporates three complementary projects, one of which is the Basic Health Project. These projects are being implemented simultaneously in the 14 poorest provinces, in which 27 percent of the total population and 43 percent of the rural population live. The overall objectives of the Social Priorities Project are to assist the government to implement its strategy to increase access of the poor to basic social services, enhance social protection, and create new opportunities for the poor to participate in economically productive activities. Social Development best practices were recognized as: the multi-dimensional approach to poverty reduction aimed at enhancing opportunities, capabilities, empowerment, and security of the poor; Participatory processes in implementation; organizational and institutional decentralization; and ongoing monitoring and evaluation of social development outcomes by the government and community.Publication Empowering the Poor through Decentralization : Brazil Rural Poverty Alleviation Program(World Bank, Washington, DC, 2001-03)The Rural Poverty Alleviation Program in Northeast Brazil uses an integrated approach to social and economic analysis in tackling poverty at the community level. Key to the success of this program is the use of economic and social indicators to monitor changes in the community. The reform process encourages the empowerment of the poor and the development of social capital. Those who formerly were socially excluded are now directly involved in institutional development at the local level. Such community-oriented projects encourage new alliances and enable the development of more innovative ways to improve the lives of the rural poor. The components of success in this project are: Community-based empowerment, poverty-targeting mechanisms, decentralization of fiscal and investment decision making from Federal to state and local governments, stakeholder participation, technical assistance and training for beneficiaries, transparency of funding process, an integrated monitoring and evaluation system, and technical assistance and training for beneficiaries, and supervision quality enhanced through a highly effective Management Information System.Publication Learning from the Past : India Uttar Pradesh Sodic Lands Reclamation Project(World Bank, Washington, DC, 2001-03)India's Uttar Pradesh Sodic Lands Reclamation Project has two objectives. First, it seeks to reverse the decline of productivity through sustainable reclamation of sodic lands. Second, it is intended to prevent additional increases in sodicity through strengthening local institutions and enabling effective management of such programs with strong beneficiary participation and nongovernmental organization (NGO) support. This objective contributes to the alleviation of poverty of families managing sodic lands. Social Development best practices elements were identified as using: multi-dimensional approach to poverty reduction aimed at enhancing opportunities, capabilities, empowerment, and security of the poor; institutionalized mechanisms for participation and decentralized implementation; and ongoing monitoring and evaluation of social development outcomes by the government and community. Lessons learned focused on establishing the correct sequence of project activities is a key ingredient of success. In this case, the sequence involved first establishing property rights and land titling, then creating organizations of the poor, and then providing technical solutions and resources for implementation. Transparency and participatory problem-solving by stakeholders builds ownership. Investment in organizational development and local capacity building lays the groundwork for decentralized management by beneficiaries.Publication Kosovo : Poverty Assessment, Promoting Opportunity, Security, and Participation for All(Washington, DC, 2005-06)Despite considerable progress with reconstruction in Kosovo, the challenge of poverty reduction remains enormous for years to come. The recent growth performance has been driven by a post-conflict boom financed by official development aid flows, but has not led to significant job creation opportunities, and its sustainability is unlikely without a clarification of Kosovo's political status, and the maintenance of peace and security. While recent growth (and consumption inequality) have most likely led to a reduction in poverty (between 2000 and 2003), yet, some 37 percent of the population is estimated to live in poverty according to the 2002/03 Household Budget Survey (HBS) data. The report seeks to contribute to the on-going policy dialogue on poverty reduction in Kosovo, and to support the formulation of public policy. The report outlines the many dimensions of poverty in Kosovo, where income poverty appears widespread, and is found to affect disproportionately children, the elderly, female headed households, the disabled, non-Serb ethnic minorities, the unemployed, and precarious job holders. Unemployment is in direct correlation with income poverty, but, while educational and health outcomes are still low, social cohesion is fragile, which may undermine the sustainability of economic growth, and reduce the impact of growth on poverty reduction. This strategy is articulated around the following five main goals: 1) promoting income opportunities; 2) raising education and health capabilities; 3) reducing vulnerability to income and non-income poverty; 4) empowering disadvantaged groups; and, 5) promoting a poverty dialogue. However, this strategy would need to take into account the context of tight fiscal constraints, in which public programs need to be developed. Moreover, to maximize the impact on poverty reduction, the links between growth and job creation need to be enhanced. This would require improved investment climate, and trade arrangements, in addition to advisory services provision to small farmers, in light of the intense competition they are facing due to subsidized agricultural imports.Publication Innovative Approaches to Microfinance in Post-Conflict Situations : Bosnia Local Initiatives Project(World Bank, Washington, DC, 2001-03)Over the past five years, the World Bank has developed useful post-conflict strategies that better meet the unique needs of war-torn countries. The Local Initiatives Project (LIP) in Bosnia presents a new standard of responsive social development in the Bank. While it demonstrates the need to use traditional project cycle practices, it also brings into focus many innovative approaches that may be considered in non-conflict settings as well, especially when pilot projects are used effectively. Post-conflict countries must deal with a great number of problems in short order. But such difficult predicaments also can yield important opportunities that should not be overlooked. The Bosnia Local Initiatives Project was able to cope with the problems and take advantage of the rapidly changing economic terrain. One advantage of the LIP was that the task manager (TM) was based in the field. The TM was able to track changes in attitudes and behavior of government officials and take advantage of opportunities for adaptive learning to redesign the project and create sustainable institutions. Because the economic and political arenas in a post-conflict country are fluid, having a task manager on the ground who was aware of both the local and national situations proved very useful. Extensive beneficiary and stakeholder involvement at design and implementation phases enabled the project to benefit from local leadership, experimentation, diversity, and mutual learning. Through the training components, alliances were also built among nongovernmental organization (NGO) partners, so that when it came time to downsize the original 17 NGOs to 5, a constructive process ensued that focused on the long-term success of the country's microcredit goals versus the NGOs' short-term ambitions. Transforming a pilot project into a national project required intensive stakeholder involvement at both the local and national levels. These types of coalitions for change need time to grow, but also need to see positive results as a way of mobilizing action for change. The use of a pilot project to initiate and test a national project enabled the team to work productively and quickly outside the bureaucracy of a skeptical government until the success of the pilot project was evident.
Users also downloaded
Showing related downloaded files
Publication Economic Recovery(World Bank, Washington, DC, 2021-04-06)World Bank Group President David Malpass spoke about the world facing major challenges, including COVID, climate change, rising poverty and inequality and growing fragility and violence in many countries. He highlighted vaccines, working closely with Gavi, WHO, and UNICEF, the World Bank has conducted over one hundred capacity assessments, many even more before vaccines were available. The World Bank Group worked to achieve a debt service suspension initiative and increased transparency in debt contracts at developing countries. The World Bank Group is finalizing a new climate change action plan, which includes a big step up in financing, building on their record climate financing over the past two years. He noted big challenges to bring all together to achieve GRID: green, resilient, and inclusive development. Janet Yellen, U.S. Secretary of the Treasury, mentioned focusing on vulnerable people during the pandemic. Kristalina Georgieva, Managing Director of the International Monetary Fund, focused on giving everyone a fair shot during a sustainable recovery. All three commented on the importance of tackling climate change.Publication The Journey Ahead(Washington, DC: World Bank, 2024-10-31)The Journey Ahead: Supporting Successful Migration in Europe and Central Asia provides an in-depth analysis of international migration in Europe and Central Asia (ECA) and the implications for policy making. By identifying challenges and opportunities associated with migration in the region, it aims to inform a more nuanced, evidencebased debate on the costs and benefits of cross-border mobility. Using data-driven insights and new analysis, the report shows that migration has been an engine of prosperity and has helped address some of ECA’s demographic and socioeconomic disparities. Yet, migration’s full economic potential remains untapped. The report identifies multiple barriers keeping migration from achieving its full potential. Crucially, it argues that policies in both origin and destination countries can help maximize the development impacts of migration and effectively manage the economic, social, and political costs. Drawing from a wide range of literature, country experiences, and novel analysis, The Journey Ahead presents actionable policy options to enhance the benefits of migration for destination and origin countries and migrants themselves. Some measures can be taken unilaterally by countries, whereas others require close bilateral or regional coordination. The recommendations are tailored to different types of migration— forced displacement as well as high-skilled and low-skilled economic migration—and from the perspectives of both sending and receiving countries. This report serves as a comprehensive resource for governments, development partners, and other stakeholders throughout Europe and Central Asia, where the richness and diversity of migration experiences provide valuable insights for policy makers in other regions of the world.Publication South Asia Development Update, April 2024: Jobs for Resilience(Washington, DC: World Bank, 2024-04-02)South Asia is expected to continue to be the fastest-growing emerging market and developing economy (EMDE) region over the next two years. This is largely thanks to robust growth in India, but growth is also expected to pick up in most other South Asian economies. However, growth in the near-term is more reliant on the public sector than elsewhere, whereas private investment, in particular, continues to be weak. Efforts to rein in elevated debt, borrowing costs, and fiscal deficits may eventually weigh on growth and limit governments' ability to respond to increasingly frequent climate shocks. Yet, the provision of public goods is among the most effective strategies for climate adaptation. This is especially the case for households and farms, which tend to rely on shifting their efforts to non-agricultural jobs. These strategies are less effective forms of climate adaptation, in part because opportunities to move out of agriculture are limited by the region’s below-average employment ratios in the non-agricultural sector and for women. Because employment growth is falling short of working-age population growth, the region fails to fully capitalize on its demographic dividend. Vibrant, competitive firms are key to unlocking the demographic dividend, robust private investment, and workers’ ability to move out of agriculture. A range of policies could spur firm growth, including improved business climates and institutions, the removal of financial sector restrictions, and greater openness to trade and capital flows.Publication Media and Messages for Nutrition and Health(World Bank, Washington, DC, 2020-06)The Lao People’s Democratic Republic (Lao PDR) has experienced rapid and significant economic growth over the past decade. However, poor nutritional outcomes remain a concern. Rates of childhood undernutrition are particularly high in remote, rural, and upland areas. Media have the potential to play an important role in shaping health and nutrition–related behaviors and practices as well as in promoting sociocultural and economic development that might contribute to improved nutritional outcomes. This report presents the results of a media audit (MA) that was conducted to inform the development and production of mass media advocacy and communication strategies and materials with a focus on maternal and child health and nutrition that would reach the most people from the poorest communities in northern Lao PDR. Making more people aware of useful information, essential services and products and influencing them to use these effectively is the ultimate goal of mass media campaigns, and the MA measures the potential effectiveness of media efforts to reach this goal. The effectiveness of communication channels to deliver health and nutrition messages to target beneficiaries to ensure maximum reach and uptake can be viewed in terms of preferences, satisfaction, and trust. Overall, the four most accessed media channels for receiving information among communities in the study areas were village announcements, mobile phones, television, and out-of-home (OOH) media. Of the accessed media channels, the top three most preferred channels were village announcements (40 percent), television (26 percent), and mobile phones (19 percent). In terms of trust, village announcements were the most trusted source of information (64 percent), followed by mobile phones (14 percent) and television (11 percent). Hence of all the media channels, village announcements are the most preferred, have the most satisfied users, and are the most trusted source of information in study communities from four provinces in Lao PDR with some of the highest burden of childhood undernutrition.Publication Remarks at the United Nations Biodiversity Conference(World Bank, Washington, DC, 2021-10-12)World Bank Group President David Malpass discussed biodiversity and climate change being closely interlinked, with terrestrial and marine ecosystems serving as critically important carbon sinks. At the same time climate change acts as a direct driver of biodiversity and ecosystem services loss. The World Bank has financed biodiversity conservation around the world, including over 116 million hectares of Marine and Coastal Protected Areas, 10 million hectares of Terrestrial Protected Areas, and over 300 protected habitats, biological buffer zones and reserves. The COVID pandemic, biodiversity loss, climate change are all reminders of how connected we are. The recovery from this pandemic is an opportunity to put in place more effective policies, institutions, and resources to address biodiversity loss.