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Implementation of interventions in the CHIMACA project

Zhang, Wei-Hong, Raven, Joanna ORCID:, Zhang, Touhong, Shen, Yuan, Huang, Kun, Long, Qian, Klemetti, Reija, Temmerman, Marleen, Hemminki, Elina and Tolhurst, Rachel ORCID: (2010) Implementation of interventions in the CHIMACA project. Discussion Paper. National Institute for Health and Welfare, Helsinki.

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In China, there is significant disparity in maternal health between urban and rural areas. “Structural Hinders to and Promoters of Good Maternal Care in Rural China” (CHIMACA) is an international Co-operation project under the 6th European Union Research and Development Framework Programme ( This research project included searching and testing of appropriate interventions to alleviate financial access to and quality of maternal care in the specific context of rural China. This report describes the designs of community-based interventions in the study sites and evaluates the process of implementing the interventions using qualitative data.
Study areas and method
One province in central (Anhui) and two in western China (Chongqing and Shaanxi) were selected, representing relatively less developed areas of China. The interventions were implemented in two counties in Anhui and Shaanxi and one county in Chongqing between 2007 and 2008. The qualitative study was conducted in 2009 in each county to evaluate the implementation of the interventions. The methods included key informant interviews with local policy makers, in depth interviews and focus group discussions with township health managers, New Co-operative Medical System (NCMS) managers, healthcare providers and women who used maternal health services.
Design of interventions
The design of interventions varied in each province. In general, townships of the selected counties were allocated into one of the 4 intervention or control groups: a financial intervention in antenatal and postnatal care (only in Anhui and Shaanxi); training of healthcare providers on health education at township or village levels; training of healthcare providers on clinical skills at township level; and control group (current practice). Townships were paired by certain criteria and these pairs were randomly allocated to the groups.
The qualitative study showed that some local policy makers, health managers and healthcare providers thought that the financial intervention had somewhat improved the use of maternal health care and the quality of care, especially antenatal care. Some thought that the intervention had no effect due to the small amount of the subsidy and short intervention period, and contributed only little to the financial protection of women. Women did not fully understand the financial intervention for antenatal and postnatal care (content of care covered by the subsidy and the amount and procedure of reimbursement). All interviewed women said that the financial intervention did not influence their decisions about use of maternal healthcare.
Most local policy makers and health managers as well as some Maternal and Child Health (MCH) workers, village doctors and family planning workers thought that the health education training was useful. The training improved the participants´ knowledge of maternal health care and communication skills and strengthened their sense of responsibility in service provision. Hence, healthcare providers´ attitudes, content and quality of care was improved. However, in Chongqing some village doctors did not want to provide health education because they did not receive any financial compensation for conducting this activity. Generally, women were satisfied with the services and information received from doctors. In Shaanxi, some women were more likely to receive maternal health care information from doctors (township or county doctors) rather than village doctors, and thought that village doctors had little knowledge about maternal health care.
Many doctors indicated that their knowledge of antenatal, delivery and postnatal care was refreshed and their capacity to manage complications was improved by clinical skill training. Some managers also felt that after training doctors were more enthusiastic in providing maternal healthcare. However, it was difficult to get women's views due to limited sample size of women who had received care from the trained staff.
Although there were mixed views about the impact of the financial intervention on maternal health care utilisation, it was generally perceived to have only little contribution due to the small amount of the subsidy. Most respondents perceived that knowledge, skills and work attitudes were
improved by health education and clinical skills training, but the intervention effects varied by province.

Item Type: Monograph (Discussion Paper)
Corporate Authors: CHIMACA study group
Additional Information: Full text can be found on the National Institute for Health and Welfare, Finland website at
Uncontrolled Keywords: CHIMACA project
Subjects: W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 85 Patients. Attitude and compliance
W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care
WA Public Health > WA 20.5 Research (General)
WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
WQ Obstetrics > Childbirth. Prenatal Care > WQ 175 Prenatal care
WQ Obstetrics > Pregnancy > WQ 200 General works
Related URLs:
Depositing User: Faye Moody
Date Deposited: 14 Feb 2012 15:33
Last Modified: 27 Jan 2022 09:59


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