Institute of Development Studies

This practice paper is one of a series, in which development practitioners reflect on their own experiences. Its aim is to contribute to efforts to understand China’s successful management of very rapid change and development. It explores the relationship between central and local governments in the implementation of change and the role of partnerships between the Chinese government and international and bilateral organisations. It focuses on the health sector, which has experienced major challenges in adapting to the many changes associated with the transition to a market economy. By the mid-1990s, policymakers had recognised the need to address these challenges, but they did not have a clear understanding of a practical way forward. One government strategy to build this understanding was to collaborate with the World Bank and the Department of International Development of the UK in the design and implementation of a project which encouraged a large number of poor rural counties to test strategies for strengthening their health service. The end-of-project evaluations documented the many changes they had put into place and the contribution this project made to national policy processes. The authors played different roles in the project. This enabled them to gain first-hand knowledge of the relationship between levels of government and between officials of the government and the international agencies. When the project came to an end they decided to reflect on what they had learned. This practice paper presents the results of this reflection. It provides unique insights into the way China is managing health system change and into the working of partnerships between the Government of China, the World Bank and bilateral donor agencies.