I. Ensuring People's Right to Health Based on China's Conditions
When the People's Republic of China was founded in 1949, China had a weak medical and health system due to low levels of development in its economy and society. The nation had only 3,670 medical and health institutions, 541,000 health workers and 85,000 beds at health institutions. The average life expectancy was 35 years. To change this situation, the government devoted great efforts to developing the medical and health services, and implemented guidelines which stipulated that the health services were to serve vast majority of the people, that prevention should be stressed, that both Western medicine and Traditional Chinese Medicine (TCM) should be utilized, and that health promotion and people's involvement should be incorporated. The people were mobilized to carry out health promotion programs, and basic knowledge about healthcare was widely spread. All this greatly enhanced the people's health, and major breakthroughs were made in medical sciences.
The development in the field of health services has brought concrete benefits to the Chinese people. The average life expectancy of the Chinese rose to 76.5 years in 2016 from 67.9 years in 1981; maternal mortality dropped from 88.9 per 100,000 persons in 1990 to 19.9 per 100,000 persons in 2016; and infant mortality declined from 34.7 per 1,000 in 1981 to 7.5 per 1,000 in 2016. The main health indicators of the Chinese are generally better than the average level of middle- and high-income countries, and China has achieved the UN's Millennium Goals in this regard ahead of schedule. Furthermore, China has established a complete medical and health system that is guided by the Constitution, based on civil laws and regulations, laws and administrative regulations on health, and local regulations, and directed by the outlines, programs, and plans of the health sector. The system has proved effective in maintaining sound doctor-patient relations, addressing medical disputes with impartiality, and ensuring citizens' right to health.
Significant progress has been made in developing a system of medical and healthcare services. A basic medical services network covering both urban and rural areas has been put in place, with 980,000 medical and health institutions at all levels, 11 million health workers, and seven million beds at medical institutions. The state has increased its efforts to foster more medical professionals. A standardization training system for resident doctors is being established, and outstanding figures such as Nobel Prize laureate in Physiology or Medicine Tu Youyou have made significant contributions to society. As more social resources flow into the medical sector, private hospitals now account for over 57 percent of all hospitals, making medical services more diverse. China's medical and health emergency rescue capability is among the world's best. It stood the severe test of the Ebola epidemic, blocking all infectious sources from outside its territory and achieved zero infection while Chinese medical teams went on assistance missions in Africa.
Graphics shows main health indicators in selected years written in the "Development of China's Public Health as an Essential Element of Human Rights" white paper, issued by the State Council Information Office. [Photo by Ma Yan from Xinhua]
II. Continuous Improvement of Health Environment and Conditions
China is keen to promote a healthy lifestyle, national fitness and health education, protect food and drinking water safety, and improve the environment for production, people's life, ecology and society in order to better guarantee the Chinese people's right to health.
Developing a healthy lifestyle. In 2007, China launched the Healthy Lifestyle for All campaign, calling on the Chinese people to develop a healthy diet and engage in physical exercises, advocating healthy lifestyle ideas, creating a supporting environment for a healthy lifestyle, and enhancing the people's awareness and behavioral abilities to develop a healthy lifestyle. By the end of 2016, the campaign had covered 81.87 percent of counties (districts) across the country. China published the Chinese Dietary Guidelines (2016); the government has intensified monitoring of the Chinese people's nutritional status and health conditions while keeping track of, and issue information about chronic diseases and the people's nutritional status; the government is continuing to tighten control on the use of tobacco and implement the WHO Framework Convention on Tobacco Control. By the end of 2016, 18 cities had adopted regulations on a smoke-free environment, covering one tenth of the population.
Giving full play to national physical fitness. Since the National Fitness Regulations were promulgated in 2009, 16 provinces and ten major cities have worked out local regulations on fitness for all, and all of the country's 31 provinces, autonomous regions and municipalities directly under the central government have worked out provincial-level fitness-for-all programs. Since 2009, August 8 has become National Fitness Day in China. From 2011 to 2014, 3,405 fitness centers, 9,447 community multipurpose sports playgrounds, 2,366 sports parks, 24,879 fitness squares and 878 outdoor camps were established nationwide, with 1.69 million outdoor fitness facilities installed. Physical fitness venues and facilities can be found in communities (administrative villages), sub-districts (towns and townships), counties (districts) and cities (prefectures). By the end of 2015, up to 33.9 percent of the whole population engaged in physical exercises on a regular basis; the per capita sports venue area reached 1.57 square meters; the coverage rate of sports associations at county level and above was 72 percent; the number of various kinds of juvenile sports clubs was 7,147; every ten thousand people shared three fitness centers on average, and thus a popular national fitness network was basically formed.
Promoting national health education. Publicity media are utilized for public health publicity, education and consultation to help people develop a self-tailored and self-disciplined healthy lifestyle. Health awareness in both urban and rural areas rose to 10.25 percent in 2015 from 6.48 percent in 2008.
Vigorously pursuing environmental improvement. From 2011 to 2015, the nationwide chemical oxygen demand, emissions of ammonia nitrogen, sulfur dioxide, and nitrogen oxide decreased by 12.9 percent, 13 percent, 18 percent and 18.6 percent, respectively. In 2016, the PM 2.5 average concentration dropped by 6.0 percent year on year and the number of days with excellent and good air quality increased by 2.1 percentage points year on year in 338 cities at the prefectural level and above. A fund for soil pollution prevention and control has been set up, and from 2016 to 2017, RMB15 billion was earmarked by the government for this purpose. A national soil environment network has been primarily established, with 22,000 basic monitoring spots and about 15,000 risk-monitoring stations. In 2016, according to the state-controlled monitoring bodies of surface water, the proportion of such spots of Grades I-III reached 67.8 percent, while that of inferior water bodies of Grade V dropped to 8.6 percent.
Progress in comprehensive management of environmental hygiene in urban and rural areas. The China Healthy Cities and Towns Initiative is being pursued to largely improve living conditions in urban and rural areas. According to a survey in 2012, since the initiative was introduced, the proportion of standardized fairs and markets had risen to 60.6 percent from 35.2 percent, and the percent of residents who are satisfied with urban amenities and the environment increased from 30 percent to 98 percent, with 98 percent of them satisfied with the effect of the initiative. By the end of 2015, the sewage treatment rate in urban areas had increased to 92 percent while the pollution-free treatment rate of household garbage in urban built-up areas had reached 94.1 percent. Comprehensive environmental improvement had been carried out in 78,000 villages, benefiting over 140 million people in rural areas; waste treatment and resource utilization facilities had been installed in 61,000 large-scale livestock and poultry farms. By the end of 2016, the treatment rate of household garbage in rural areas was around 60 percent, and the proportion of administrative villages with sewage treatment had reached 22 percent. In 2016, 80.4 percent of rural households use toilets while the rate was 71.7 percent in 2012; in some provinces in the more developed eastern areas the figure was 90 percent or higher.
Drinking water safety issues in rural areas basically solved. From 2006 to 2010, the investment in safe drinking water projects in rural areas reached RMB105.3 billion, providing safe drinking water to 212 million rural residents in 190,000 administrative villages. From 2011 to 2015, RMB121.5 billion from the central government and over RMB60 billion from local governments were appropriated for safe drinking water projects in rural areas. By the end of 2016, the safe drinking water monitoring covered over 85 percent of rural villages, and up to 82 percent of rural residents enjoy centralized water supply. The state has allocated funds to areas with particular difficulties, and raised the subsidy standards, such as by appropriating RMB495 million to provide safe drinking water to over 1,400 monasteries, 32,300 monks and nuns and 60,000 other residents with temporary needs in the Tibet Autonomous Region.
Enhancing occupational health management. In 2011, China revised the Law of the People's Republic of China on Prevention and Control of Occupational Diseases. By the end of 2016, the government, in accordance with the law, had punished the corporations that refused or failed to improve their occupational health management, demanding 1,524 corporations to suspend production for rectification, shutting down 1,576 corporations in response to public demand, and eliminating 426 illegal enterprises. The government has intensified supervision and inspection on occupational health management of employers. From 2013 to 2016, the number of corporations nationwide that had been brought under government supervision and inspection increased from 229,000 to 395,000, up by 72.5 percent.
Tougher control of food safety. In 2015, China revised the Food Safety Law. In 2016, regulatory agencies at all levels conducted inspections of the food production process of 521,000 food producers, 15,000 food additive producers, and 72,000 food processing workshops. As for the selling of food products, regulatory agencies at all levels conducted inspections of 12.093 million businesses, and 8.869 million catering services. In 2016, competent authorities conducted random inspections on 257,000 food samples, of which 96.8 percent met the required standards, and properly settled several food safety incidents, including one involving the sale of counterfeit infant formulas.
III. Public Health Service Capability Improving Steadily
The Chinese government gives priority to prevention while combining prevention with treatment, and makes great efforts to ensure the people's equal access to public health services. It devotes great efforts to preventing and controlling epidemic, chronic and endemic diseases, strengthening the quick response capacity on public health emergencies, and developing an increasingly equal and universal basic public health service system.
The coverage of basic public health services has been further expanded. By the end of 2015 the vaccination rate of every town or township was at least 90 percent and the incidence of and mortality from diseases that can be prevented by programmed vaccines had fallen to the lowest level ever. From 2010 to 2017, the state subsidy for basic public health services has increased from RMB15 to RMB50 per person, and the services have also expanded from 41 in nine categories to 47 in 12 categories. By the end of 2016, the government had set up digital health archives for 76.9 percent of Chinese citizens, covering 90.23 million hypertension patients and 27.81 million diabetes sufferers. At the same time, 91.6 percent of pregnant and lying-in women and 91.1 percent of children under the age of three were brought under systematic management.
The scope of beneficiaries of the basic public health services has expanded steadily. By 2012, China had eliminated tetanus among all newborn babies. In 2014 through injection of hepatitis B vaccine to newborn babies, the prevalence of hepatitis B surface antigen in children under five years of age decreased from 9.67 percent in 1992 to 0.32 percent in 2014, achieving the WHO's goal of reducing that figure to below 1 percent three years ahead of schedule. An increasing number of the floating population now have better access to basic public health services. Epidemic diseases have been effectively prevented and controlled among them, and more than 90 percent of their children have received vaccinations. Aiming at serious diseases, major risk factors affecting health and key groups, the state has formulated and implemented major public health service projects that cover nearly 200 million people, such as hepatitis B vaccination for people under 15 years of age who missed the vaccination earlier, nutrition improvement for children in impoverished areas, facilitating rural pregnant women's delivery in hospital, screening for cervical and breast cancers among women in rural areas, and construction of hygienic toilet in rural areas. In 2009 the government launched the Regaining Eyesight Program for a Million Impoverished Cataract Patients, and had subsidized surgery for more than 1.75 million cataract patients by the end of 2013.
The ability to control epidemic diseases has continuously improved. The Chinese government has established the world's largest online direct reporting system for notifiable epidemic diseases and public health emergencies. Reported incidence of epidemic diseases has dropped by 19.4 percent. The early detection and early warning capacities have been further improved. The epidemic disease reporting system covers 71,000 medical institutions, with 160,000 users and nine million annual individual reports. In 2016, the reported incidence and death rate of epidemic diseases in categories A and B was controlled below 215.7/100,000 and 1.31/100,000, respectively. The spread of HIV remains at a low level, and its rapid growth in certain areas has been checked. The efforts to prevent and treat tuberculosis have achieved good results, with a cure rate of over 90 percent. In 2016, the reported incidence of tuberculosis had decreased by 12.6 percent compared to 2011, and the mortality rate from tuberculosis had dropped to 2.3 per 100,000 patients, reaching the level of developed countries. In the same year, there were 3,189 malaria cases reported nationwide, with only three domestically infected. This was much lower than the 4,262 cases in 2010. The disease has now been eradicated in over 80 percent counties that once had a widespread malaria problem. The prevention and treatment of major parasitic diseases have achieved solid results. By the end of 2016, the transmission of schistosomiasis was brought under control in all the 453 counties where it once had been widespread.
The effects of China's practice in preventing and controlling chronic diseases have remarkably improved. By the end of 2016, the service of screening for and intervention of cerebral apoplexy had been provided to more than 6.1 million people, 820,000 of whom were found to be at high risk, and 952,000 follow-up interventions were conducted. Early screening and comprehensive intervention of cardiovascular disease had been provided to 3.389 million people, 776,000 of whom were found to be at high risk, and 524,000 follow-up interventions were conducted. Comprehensive oral disease intervention had provided free oral examination to 100 million children. A total of 5.168 million children received free dental sealants treatment and 2.229 million children received free local fluoride varnish treatment. The early diagnosis and treatment of cancer service had been provided to 2.14 million high-risk people. Some 55,000 cancer patients were diagnosed through this service, and the overall early diagnosis rate reached 80 percent or above.
The spread of endemic diseases is under effective control. By the end of 2015, 90.8 percent of counties whose water sources contained excess iodine had reached the benchmark that 90 percent of salt consumed was iodine-free, and 94.2 percent of the nation's counties had eradicated iodine deficiency, ranking among the top of all 128 countries and regions officially using iodized salt. Kaschin-Beck disease has been eradicated in 95.4 percent of villages where it was once widespread, and Keshan disease has been put under control in 94.2 percent of the counties where it was once prevalent. In the counties that suffered from endemic fluorosis caused by coal burning, 98.4 percent of coal stoves have been transformed, and in the areas suffering from drinking water-caused endemic fluorosis, 93.6 percent of the rural population now have access to de-fluoridated drinking water. Areas suffering from arsenic poisoning through coal burning have had their stoves transformed, and all people in water-related arsenic poisoning areas now have access to safe drinking water.
Mental health services have been improved constantly. The state issued the Mental Health Law of the People's Republic of China, putting the related work within the legal framework. At the end of 2015, China had 2,936 mental health institutions with 433,000 beds - increases of 77.9 percent and 89.9 percent, respectively compared with 2010. There were 27,700 practicing (assistant) psychiatrists nationwide, an increase of 20.2 percent over the 23,100 at the end of 2012. Between 2012 and 2016, the number of registered patients with severe mental illnesses increased from 3.08 million to 5.4 million nationwide. From 59.1 percent to 88.7 percent, more and more patients were put under management.
The ability to quickly respond to public health emergencies has been strengthened in a comprehensive way. Thirty-six national teams and nearly 20,000 local teams, with over 200,000 members for four categories of emergencies, have been set up in different regions. In 2014, China's core public health emergency response capacity achieved 91.5 percent of the requirements of the International Health Regulations, better than the world's average of 70 percent.
IV. Great Improvement in the Quality of Medical and Health Services
The resource factors of the medical and health-service system keep increasing. From 2011 to 2015, China invested RMB42 billion to support the building of 1,500 county-level hospitals, 18,000 town and township health centers, and more than 100,000 village clinics and community health centers. By the end of 2016, there were 983,394 medical and health institutions in China, among which 29,140 were hospitals (12,708 public hospitals and 16,432 private ones), 36,795 town and township health centers, 34,327 community health centers (stations), 3,481 disease prevention and control centers, 2,986 health inspection institutes (centers), and 638,763 village clinics; there were also 5.291 million items of medical equipment each worth RMB10,000 or more, among which 125,000 were worth more than RMB1 million each. In 2016, the number of beds in medical institutions increased by 395,000 compared with 2015 - 5.37 beds for every 1,000 people; the number of beds in hospitals increased by 358,000. There were 266 hospitals of ethnic healthcare, with 26,484 beds, providing 9.687 million treatment sessions annually, and the number of discharged patients reached 588,000.
Graphics shows beds in medical and health institutions for every 1,000 people written in the "Development of China's Public Health as an Essential Element of Human Rights" white paper, issued by the State Council Information Office. [Photo by Ma Yan from Xinhua]
Health personnel optimized. China has built a medical education system of the largest scale in the world. By the end of 2016, there were 922 medical colleges and universities in China, 1,564 secondary schools with medical courses, 238 organizations granting master's degrees, and 92 granting doctoral degrees. The number of students at these schools had reached 3.95 million, among whom 1.14 million were students of clinical majors and 1.8 million of nursing majors. Fourteen educational institutions now offer specialties in ethnic healthcare, and research into ethnic healthcare in TCM majors, with about 170,000 students. TCM colleges in Yunnan, Guangxi and Guizhou offer undergraduate specialties of healthcare of the Dai, Zhuang and Miao peoples. Some ethnic-healthcare colleges and TCM colleges cooperate to cultivate personnel specializing in ethnic healthcare. By the end of 2016, the number of health workers totaled 11.173 million, with 8.454 million technical personnel, and 2.31 physicians for every 1,000 people; practicing (assistant) physicians with a college degree or above made up 81.2 percent of the total. The number of high-caliber professionals is increasing year by year. The number of nurses for every 1,000 people has reached 2.54, and the ratio of doctors to nurses has reached 1:1.1.
The non-governmental sectors operating hospitals are growing. Private hospitals now account for more than 57 percent of all hospitals, the number of beds in medical and health institutions operated by non-governmental sectors has increased by 81 percent compared with 2011, and their outpatient visits take up 22 percent of the total in China. Now, of the physicians who have obtained licenses that give them permission to work for more than one organization, more than 70 percent also work in medical institutions operated by non-governmental sectors.
Community and rural medical conditions further improve. Now almost every town or township has a health center, every administrative village has a village clinic, and every 1,000 rural residents have a village doctor.
Medical and health service supply is becoming more refined and targeted. The diagnosis and treatment rate based on appointments in Grade III hospitals has reached 38.6 percent, and nearly 400 medical institutions have set up ambulatory surgery centers. We are also providing family physician contracted services. More than 80 percent of citizens are satisfied with the skills and attitude of family physicians. The people's service experience has greatly improved.
The quality and the safety level of medical services continues to rise. We have promoted clinical pathway management (CPM) by developing 1,212 clinical pathways, which cover almost all common and frequently occurring diseases. We have also strengthened supervision over prescription and drug use. In 2016, the rate of inpatients using antibacterial drugs was 37.5 percent, 21.9 percentage points lower than in 2011; the usage rate in outpatient prescriptions was 8.7 percent, a decrease of 8.5 percentage points compared with the rate in 2011. Medical liability insurance covers more than 90 percent of hospitals at Grade II and above. We attach great importance to blood safety and supply. By the end of 2015, we had realized the full coverage of nucleic acid tests in blood stations, with a blood safety level equivalent to that of developed countries. We also encourage voluntary unpaid blood donations and rational clinical use of blood. In 2016, 14 million people donated blood gratis, an increase of 6.1 percent over 2015 and almost satisfying the demand for clinical blood use. Donation has become the main source of organs for transplants.
The drug supply security system keeps improving. Since the implementation of the policy, the prices of basic drugs have dropped by about 30 percent on average, and basic drugs have been sold in community-level medical and health institutions with zero markup, easing the financial burden on patients. By the end of 2016, the patients' expenses had been reduced by nearly RMB100 million. From 2011 to 2015, 323 innovative drugs in China were approved for clinical research, 16 innovative drugs including Icotinib Hydrochloride Tablets were approved for production, 139 new chemical generic drugs entered the market, a total of more than 600 Active Pharmaceutical Ingredients (API) and over 60 pharmaceutical companies reached the international advanced GMP standard.
TCM is receiving more support from the government. From 2013 to 2015, China invested a special fund of RMB4.6 billion to support the capacity building of TCM. In 2016, it issued the Outline of the Strategic Plan on the Development of Traditional Chinese Medicine (2016-2030). The revenue generated by Chinese medicine producers each with turnover over RMB20 million per annum reached RMB865.3 billion in that year, accounting for about one third of the total revenue generated by all the drug producers each with turnover over RMB20 million per annum in China. Since 2011, 49 achievements in TCM scientific research have received national science and technology awards. ]
V. Improvement of the National Medical Security System
Basic medical insurance covers all urban and rural residents. The whole population is now covered by medical insurance, which is mainly composed of basic medical insurance for working urban residents, basic medical insurance for non-working urban residents, and the new type of rural cooperative medical care. By the end of 2016 basic medical insurance had more than 1.3 billion recipients nationwide - a coverage of above 95 percent.
Support for basic medical insurance schemes and its sustainability have been increasing. The income and expenditure of the basic medical insurance fund for working urban residents in 2016 were RMB1,027.4 billion and RMB828.7 billion respectively - RMB421.2 billion and RMB341.9 billion more than those of 2012, representing an annual increase of 15.7 percent and 15.6 percent on average. The income and expenditure of the basic medical insurance fund for non-working urban residents were RMB281.1 billion and RMB248 billion, respectively - RMB193.4 billion and RMB180.5 billion more than those of 2012. In 2017 government subsidies for basic medical insurance for non-working urban and rural residents are increased, with annual per capita subsidies at all levels reaching RMB450.
Basic medical insurance benefits have been improved. In 2017 outpatient and inpatient reimbursement rates from the new type of rural cooperative medical care scheme are about 50 percent and 70 percent, respectively. The National Medicine List for Basic Medical Insurance, Industrial Injury Insurance and Maternity Insurance (2017) includes 2,535 items of Western medicines and Chinese patent medicines, with 339 more medicines than those in the previous list, or an increase of 15 percent, almost including all therapeutic medicines in the National Essential Medicine List (2012).
Forms of reimbursements from basic medical insurance have been improved. More than 70 percent of regions in China are exploring new forms of payment from basic medical insurance, such as payment by a certain category of disease, by capitation or by Diagnosis Related Groups (DRGs). By the end of August 2017, real-time reimbursements had been realized for all areas covered by basic medical insurance across the country; real-time reimbursements for cross-region inpatient medical expenses within the same province had been basically realized in the country. A national real-time reimbursement network for cross-province inpatient expenses has been put in place, and all provinces (including Xinjiang Production and Construction Corps) have joined the national network of cross-province reimbursement of basic medical insurance. By the end of August 2017, China had a total of 6,616 designated medical institutions for real-time reimbursements of cross-province inpatient expenses.
Serious illness insurance for urban and rural residents has been improved. By the end of 2015 serious illness insurance for urban and rural residents covered all recipients of basic medical insurance. In 2016 serious illness insurance covered more than 1 billion urban and rural residents; according to provincial policies, the serious illness insurance reimbursement rates shall be more than 50 percent, and the actual reimbursement ratio was raised by 10 to 15 percentage points.
Medical assistance mechanisms have made marked progress. In 2016 China appropriated RMB15.5 billion in medical assistance subsidies (excluding illness emergency assistance subsidies), 92 percent of which went to central and western regions, and poverty-stricken areas, assisted 82.565 million cases, and helped 55.604 million people with financial difficulties to receive basic medical insurance. The proportion of inpatient recipients within the annual limit exceeded 70 percent. Medical assistance services have become more convenient, as 93 percent of the country has realized one-stop reimbursement from medical assistance funds and basic medical insurance. In 2013 China set up an illness emergency assistance fund to help unidentified patients who need immediate treatment, or identified patients who cannot afford the related medical expenses. By June 2017 some 640,000 patients had received help from the fund.
Medical security for the rural poverty-stricken population has been improved. In 2016 China started to implement poverty relief through healthcare. Now the rural poverty-stricken population is fully covered by both basic medical insurance and serious illness insurance for urban and rural residents. The inpatient reimbursement rates for the rural poverty-stricken population have been raised by more than five percentage points. China has mobilized over 800,000 medical workers to visit illness-and-poverty-stricken families, and investigate 93 major diseases with high occurrence, high treatment costs and severe impact on work and life, thereby keeping a record and setting up a database for poverty relief through healthcare. The country provides categorized treatment to rural poverty-stricken population suffering from serious illnesses and chronic diseases. By May 2017 China had given such treatment to over 2.6 million people. The country has adopted preferential policies favoring the rural poor with respect to reimbursement from serious illness insurance. China implements a policy of treatment before payment and one-stop reimbursement for rural poverty-stricken inpatients at county-level hospitals. In addition, China has designated 889 Grade III (top-level) hospitals to assist 1,149 county-level hospitals in all poverty-stricken counties across the country.
VI. Significant Improvement in the Health of Special Groups
The maternal and child healthcare service system has been continuously improved. A three-level network of maternal and child healthcare service has been put in place in urban and rural areas. In 2016, the Chinese government invested RMB2.9 billion to support the construction of 247 city- and county-level maternal and child healthcare institutions. By the end of 2016, there were 3,063 such institutions, 757 maternity hospitals, 117 children's hospitals, and 370,000 gynecologists, obstetricians and pediatricians, and assistants. Full-time and part-time maternal and child healthcare workers were available in 34,000 community health centers (stations), 37,000 town and township health centers and 640,000 village clinics.
Antenatal and perinatal care services have been upgraded. Since 2009, the Chinese government has been expanding year by year the coverage of cervical cancer and breast cancer screening programs in rural areas, and the number of beneficiaries has grown. Between 2009 and 2016, the government carried out free cervical cancer screening for more than 60 million rural women aged 35-64 in 1,299 project counties, and subsidized more than 74 million rural pregnant and lying-in women with a special investment of RMB22.6 billion. The rate of hospital deliveries for rural women increased from 92.3 percent in 2008 to 99.6 percent in 2016, and rates of maternal and infant mortality in rural areas decreased sharply.
Children's health has improved remarkably. In 2013, the pure breastfeeding rate of babies aged 0-6 months increased to 58.5 percent nationwide. The breastfeeding rate keeps growing. In 2016, infant mortality was 7.5 per thousand and that of children under five was 10.2 per thousand, both meeting the targets set in the UN Sustainable Development Goals and the Program for the Development of Chinese Children (2011-2020) ahead of schedule. This shows that the gap between China and developed countries is rapidly narrowing. In 2016, for children under five, the underweight and growth retardation rates, and anemia prevalence decreased to 1.49 percent, 1.15 percent and 4.79 percent, respectively - all meeting the targets set in the Program for the Development of Chinese Children (2011-2020) ahead of schedule. According to the fifth survey of Chinese children' s physical development in 2016, in the past 40 years the physical development of children under seven improved rapidly, even higher than the child growth standards published by the WHO.
Children's disease control has been consolidated. In 2016, the rate of mother-to-child transmission of HIV decreased to 5.7 percent, and the incidence of neonatal tetanus was less than 1 per thousand. Children' s vaccination rate under the national childhood vaccine program was more than 99 percent. The country remains polio-free, and has a low reported incidence of tuberculosis in children.
The healthcare service system for the elderly has improved. By the end of 2015, there were 453 rehabilitation hospitals, 168 nursing homes and 65 nursing stations around China, up by 69.0 percent, 242.9 percent and 16.1 percent, respectively from 2010. The number of health personnel working in the above three kinds of institutions was 36,441, 11,180 and 316, respectively, up by 96.5 percent, 286.7 percent and 69.9 percent from 2010. In 2015, the government offered 118 million medical examinations to senior citizens aged 65 or above, a health management rate of 82 percent. The mental health of the elderly has also attracted full attention.
The combined medical and elderly care services have been promoted. In 2016, 90 cities (districts) were selected as state-level pilot units to provide combined medical and elderly care services. Across China there were 5,814 institutions providing both services, with a total of 1.2138 million beds. Of these, 3,623 were nursing institutions for the elderly that have established medical facilities, 1,687 were medical institutions that have added care services for the aged, and 504 were institutions offering both services. In total, 2,224 were among designated medical insurance institutions.
Disability prevention and rehabilitation services for persons with disabilities have improved. From 2012 to 2016, 15.26 million people with disabilities received basic rehabilitation services nationwide. By the end of 2016, there were 7,858 rehabilitation institutions for the disabled around China, with 223,000 employees; and 947 municipal districts and 2,015 counties (cities) provided community-based rehabilitation services, with 454,000 coordinators.
Rehabilitation sports for the disabled have been expanded to more areas. The Chinese government has funded six western provinces (autonomous regions and municipalities directly under the central government) in introducing rehabilitation sports into 8,000 households, from which a national campaign started, offering services to 88,884 households. It also subsidized 50 communities in installing fitness facilities as demonstration sites, and subsequently 1,842 new ones were set up nationwide. Now people with disabilities who regularly participate in sports and fitness activities make up 9.6 percent of the national total, a percentage higher than before.
Orphans with disabilities receive special care. By the end of 2016, the country had invested RMB860 million in offering corrective operations and rehabilitation training to more than 90,000 orphans with disabilities.
Edited by Bao Lianying