The Chinese Government should inject more money to pursue better healthcare for children and women, officials and experts said.

Great progress has been made in the past 55 years in China to protect the health of children and women, said Yang Qing, director of the Department of Maternal, Children and Community Health at the Ministry of Health.

The progress can be seen by checking the changes of infant and maternal mortality rates, which are two of the three most important standards to judge a nation's health level.

In 1949 when the People's Republic of China was established, the infant and maternal mortality rates were respectively 200 per 1,000 people and 1,500 per 100,000.

In 2003, the ratios declined to 25.5 per 1,000 and 51.2 per 100,000, Yang said. Today marks World Health Day, which has a theme of "make every mother and child count."

Among the 191 countries in the world, China stands at 88th, which is quite good compared with other developing countries, he noted.

The third standard of judging a nation's health level is the average life expectancy, which has increased from 35 in 1949 to 71.8 in 2003, indicating China has done a lot in taking care of its citizens.

However, all this progress cannot hide big problems: There is a very serious shortage of financial investment from the government in public health.

And there is a big gap in medical services between the rich and poor, between cities and countryside, and between the east and the west in China.

In 2004, governments at various levels put a total of 84.8 billion yuan (US$10.2 billion) into health, accounting for 0.6 per cent of the total GDP.

And of this money, only a small fraction was put into women and children's healthcare, Yang said.

Moreover, the majority of the money was used to maintain the daily operations of health organizations and hospitals.

The government should think about what its role in healthcare should be, and how it should use public funding, said Henk Bekedam, the World Health Organization's representative in China.

"China has used the market strategy well. If you look outside, you can see the great development of China," Bekedam said,

However, China should not look at health as a market commodity. The government should provide free services to women and children in certain medical areas, such as immunization.

China will soon issue an immunization regulation which might change the present situation whereby people are free to receive some kinds of vaccines but have to pay for the service of health workers, said an official at the Ministry of Health who declined to give his name.

In China, the 768 million rural residents, who make up 70 percent of the whole population, only consume about 33 percent of total health spending.

The most outstanding reason for the poor being unable to access medical services in rural areas is that they do not have enough money.

About 80 percent of rural residents have no medical insurance at all.

An authoritative survey shows that about 32 percent of children in 100 selected villages were born at home instead of in hospital.

"Poor awareness is one reason for people to do this. But undoubtedly, the shortage of money is the biggest cause," Yang said.

He said that his dream is to make all Chinese women bring children into the world in hospital someday in the future. And he is confident about that.

In China, the infant and maternal mortality rates in rural areas are two to four times more than those in urban areas.

And between inland and eastern regions the gap is also as big.

For example, the maternal mortality rate in the Tibet Autonomous Region, Qinghai Province, the Xinjiang Uygur Autonomous Region, Guizhou Province and Gansu Province, are still as high as 100 per 100,000.

In eastern regions, such as Shanghai, the infant and maternal mortality rates have respectively reached to 5 per 1,000 and 10 per 100,000, which are almost as good as developed countries.

But problems do not only exist in rural areas.

Poor families in urban areas, such as with laid-off workers and migrants, are also facing difficulties in taking care of their mothers and children.

China has more than 100 million farmer-turned-workers in urban areas and these people do not have medical insurance either.

To reduce maternal and infant mortality rates, China began to carry out a program in 12 western provinces and regions in 2001. Up to now, the program has extended to 1,000 counties of all the 23 provinces and regions in western and central China.

A total of 400 million yuan (US$48 million) has been invested in the program to raise public awareness of birth at hospitals, and to help hospitals in rural areas buy equipment and train their health workers.

About 300 million people have benefited from the program and the mortality rate in these areas has been greatly reduced.

However, this money is still far from enough to help rural families cover their expenses in hospitals.

(China Daily April 7, 2005)