Public Disclosure Authorized The World Bank Hainan Health Sector Reform Project (P171064) Rapid Poverty and Social Impact Assessment Public Disclosure Authorized Public Disclosure Authorized Hainan health commission December 2019 Public Disclosure Authorized 0 Contents 1 Background ...................................................................................................................................................... 3 1.1 Project Overview ................................................................................................................................ 3 1.2 Components ........................................................................................................................................ 3 1.3 Purpose ............................................................................................................................................... 4 1.4 Methods ............................................................................................................................................... 4 2 Socioeconomic Profile of Hainan Province ................................................................................................. 5 2.1 Population and Distribution ............................................................................................................... 5 2.2 Economic Situation ............................................................................................................................ 6 2.3 Health and Medical Care .................................................................................................................. 6 3 Stakeholder Needs ......................................................................................................................................... 7 3.1 Stakeholder Identification .................................................................................................................. 7 3.2 Stakeholder Attitudes and Needs .................................................................................................... 8 3.3 Social Benefits of the Project ........................................................................................................... 9 4 Project Impacts on Poor People ................................................................................................................. 10 4.1 Poor People of Hainan Province .................................................................................................... 10 4.2 Medical Services of Poor People ................................................................................................... 10 4.3 Project Impacts on Poor People .................................................................................................... 13 5 Project Impacts on Migrant Population ...................................................................................................... 14 5.1 Current Situation of Migrant Population .............................................................................................. 14 5.2 Health and Medical Care of Migrant Population ................................................................................ 14 5.3 Project Impacts on Migrant Population ............................................................................................... 15 6 Project Impacts on Women ........................................................................................................................... 16 6.1 Women’s Health Status ......................................................................................................................... 16 6.2 Use of Primary Healthcare by Women ................................................................................................ 16 6.3 Women’s Health Program ..................................................................................................................... 17 6.4 Project Impacts on Women ................................................................................................................... 17 7 Project Impacts on Minority Population ....................................................................................................... 19 7.1 Minority Population ................................................................................................................................. 19 7.2 Health and Medical Care of Minority Population ............................................................................... 20 7.3 Minority Health Program ........................................................................................................................ 20 7.4 Project Impacts on Minority Population ............................................................................................... 20 8 Conclusions and Suggestions ...................................................................................................................... 22 8.1 Conclusions ............................................................................................................................................. 22 8.1.1 The Project is beneficial to all stakeholders and does not exclude vulnerable groups. ... 22 8.1.2 Migrant population will not occupy local residents’ medical resources. .............................. 23 8.2 Suggestions ............................................................................................................................................. 24 Appendix 1 Statistics of Workforce of Township Health Centers in Hainan Province and Sample Cities / Counties ................................................................................................................................................................. 27 Appendix 2 Summary of Stakeholder FGDs ..................................................................................................... 27 Appendix 3 Flowchart of Priority Medical Care for Registered Poor Patients ............................................. 29 Appendix 4 Fieldwork Photos.............................................................................................................................. 30 Table 2-1 Population Statistics of Hainan Province (2017)....................................................................... 5 Table 3-1 Primary Stakeholders .................................................................................................................... 7 Table 3-2 Analysis of Stakeholder Attitudes and Needs ............................................................................ 8 Table 4-1 Summary of Health Poverty Alleviation in Hainan Province.................................................. 11 Table 7-1 Populations and Features of Main Ethnic Minorities in Hainan Province ........................... 19 Figure 4-3 Green Channel for Medical Care of Poor Patients……………………………………. 12 Abbreviations EAC - Ethnic Affairs Commission FDT - Family Doctor Team FGD - Focus Group Discussion HC - Health Commission HHDRC - Hainan Health Development Research Center HHSA - Hainan Healthcare Security Administration HPHC - Hainan Provincial Health Commission HSA - Healthcare Security Administration PAO - Poverty Alleviation Office PHC - Primary Healthcare PMO - Project Management Office SEP - Stakeholder Engagement Plan WF - Women’s Federation Units Currency unit = Yuan (CNY) USD1.00 = CNY6 1 hectare = 15 mu 1 Background 1.1 Project Overview The overall goal of the Hainan Health Sector Reform Project (HHSRP) is to strengthen the quality of primary health care (PHC) services and efficiency of the health system. Focusing on primary health care (the foundation for people-centered integrated care), the Project takes an integrated health system approach to deliver improved health outcomes for the people of Hainan. Recognizing that there is no silver bullet to achieve this goal, the project adopts a two-pronged approach: 1） The project supports the strengthening of primary care delivery system to address several key gaps that plague the health system in Hainan, including: a) poor preventive and promotive care, particularly in the context of the rising incidence of NCDs and an ageing population; b) the routine bypassing of PHC facilities in favor of hospital care; c) the declining quality of PHC, largely due to a lack of rigorously applied standards of service quality and shortage of appropriately qualified human resources; and d) inefficiencies in financing that disproportionately affect service utilization and health outcomes of the poor and most vulnerable. The central focus for PHC strengthening will be (i) to build health sector stewardship of People Centered Integrated Care (PCIC) through better integration of different levels of care and alignment of public health functions such as disease surveillance and emergency response with PHC service delivery; and (ii) to improve the performance of Family Doctor Teams (FDTs) operating in township health clinics, village clinics and community health centers through targeted strengthening of front-line service delivery , rigorous measurement of performance outputs and outcomes, supportive supervision and targeted incentives driving forward a strong/high capacity PHC system that is delivered through team-based approaches and responds efficiently to population health needs. 2）This is supported with deeper institutional, human resource, and information technology reform to create a sustainable and efficient service delivery system. At the operational level this will mean