UNICEF committed to supporting services for rural children in China

In mid-January, I travelled to Liangshan Yi Autonomous Region, an ethnic minority area in Sichuan Province, with Daniel Toole, UNICEF Regional Director for East Asia and the Pacific. The visit to the impoverished mountainous terrain of Liangshan was part of a mission to participate in the preparations for UNICEF's next five year plan with the Government of China, and see what had been achieved in the last few years. 

For Daniel, the nearly four hours' drive from the prefecture's government seat, Xichang, to Zhaojue County, confirmed that despite the enormous success China has made in addressing poverty, wide disparities are still separating millions of Chinese rural children from their urban counterparts. 

The road to Zhaojue County was under construction, so the convoy had to run alternately on stretches of concrete pavement and bumpy earth road. Traveling among snow-capped mountains that were swathed in the morning mist, the vehicles wound through abrupt turns throughout the journey, sometimes on road covered by a layer of thin ice. As the convoy pulled closer to the county, the road condition became even worse. For villages up in the mountain, only single lane traffic was allowed.

Zhaojue County, where nearly 98 per cent of the 309,000 residents are of Yi ethnic minority, has been at the heart of UNICEF's partnership with local authorities on Integrated Maternal and Child Health (IMCH) project, Conditional Cash Transfer (CCT) project, and Bare Foot Social Worker (BFSW) project.

During a visit to the county's Tiaoba Village, Daniel sat around the fire with Ergu Wuhe, 25, and his 30-year-old wife Aku Riga in their house. The couple, beneficiaries of UNICEF-supported projects, told Daniel that both their three year-old son and one-year-old daughter were delivered at the hospital. They named the boy Yisheng, which literally means "born at the hospital" in Chinese.

Despite being no stranger to China, having visited the country on many occasions in the last four years, Daniel recognized this visit was the toughest to date, confirming that disparities remain in the country which has come to be known for its modernized metropolis, as well as the many astonishing achievements in fields from economy to space technology.

As Children in China: An Atlas of Social Indicators 2014, a latest UNICEF publication, indicated, striking geographical disparities and rural-urban gap have led some children missing out on access to health, education and protection services.

"While we celebrate the enormous successes for children in China, we know that national averages fail to account for growing inequalities among income and social groups and along gender lines. We also know in China that even small percentages still equate to large numbers of individual children's lives," Daniel said at a meeting with counterparts from the Chinese government in Beijing at the beginning of his visit to China.

Liangshan, home to a population of 4.73 million, is one of the regions failing to keep up with the country's development. Eleven out of the prefecture's 16 counties are national poverty-stricken counties, and its per capita GDP in 2013 only accounted for 63.5 per cent of the national average. Moreover, HIV prevalence among the prefecture's adult population is above 1 per cent.  

Since 2011, UNICEF has supported projects to improve quality of maternal-child care and welfare of the most marginalized children in inaccessible and hard-to-reach regions of Liangshan.

In Tiaoba Village, Daniel was told that 50 households in the village have joined the innovative CCT project, which gives a cash incentive to poor households that meet certain requirements, such as hospital delivery, antenatal care and immunization.

The cash payment can be up to 1,000 yuan ($161) for each household if all conditions are met. It promotes healthy behaviour and serves as a significant contribution to the household budget, helping to offset many of the out of pocket expenses related to having a baby.

By joining the CCT in August 2013, Ergu's family have received three instalments of cash for hospital delivery, antenatal care and immunization for their little girl. They spent the money on children's clothing, diapers and other necessities.  "By joining the project, both the babies and my wife have been in good health," Ergu said.

Another couple from the village, Mahai Ziti, 37, and Mabi Cizuo, 36, who have five children aged between five months and 16, only had their youngest child delivered at the hospital. When Daniel asked about the difference between the children, they replied that the one delivered at the hospital is healthier, and the whole delivery process was much safer.

Such behavioural change wasn't easy, as in the traditional Yi culture, women in labour are not supposed to be in the presence of outsiders.

According to the county authority, as of January 12, 414 households had been enrolled as beneficiaries of the project, and 71,160 yuan had been handed out.

As a result of UNICEF's IMCH project and CCT project, a 34.9 per cent reduction in maternal mortality rate and 5 per cent reduction in under-five mortality rate have been observed in the prefecture. The number of pregnant women who delivered in health facilities increased from 51.4 per cent in 2010 to 79.1 per cent in 2014, and the proportion of women who received antenatal care increased from 53.9 per cent in 2010 to 71.3 per cent in 2014.

At a meeting with county officials, Gillian Mellsop, UNICEF's Representative to China, who was traveling with Daniel, said that UNICEF will have a mid-term evaluation of the CCT project later this year to examine how cash incentives improve uptake of MCH services in poor rural areas for possible government scale-up .

Despite the improvement, the poor infrastructure in the mountainous region, shortage of qualified health workers and poor awareness among the locals mean progress is gradual. 

Briefing Daniel on the challenges, Luo Xue, deputy director of Zhaojue County MCH Hospital, said the hospital's Gynecology & Obstetrics department only has four doctors and six nurses, who are overwhelmed by consultations and house calls. Moreover, the hospital's two ambulances, which had been kept in service far longer than originally intended, added to the problem. "The most remote village is six hours' drive away. It is not rare for the ambulance to break down before reaching the villages," she explained.

The logistics are a common headache in the mountainous prefecture. Shama Guyi, who used to be an ambulance driver in Meigu County for five years, said they used to take tents and sleeping bags with them during field missions, so the doctor could deliver the babies in the countryside in case they couldn't make it to the hospital. 

At the Zhaojue County MCH Hospital, 21-year-old Mahai Wuniu, who gave birth to her first baby the previous night, told Daniel that she took a bus to the hospital after feeling contractions. Luckily, she made it to the hospital after a four-hour ride on the bumpy and hilly road, and gave birth safely to her boy.

In order to cope with the situation, UNICEF has piloted the establishment of maternity waiting rooms in Liangshan, which provides free accommodation to expected mothers from remote areas so as to ensure their access to delivery services.

Impressed by the tremendous improvement in maternal and child care and children's welfare in Liangshan, Daniel told local authorities that UNICEF would continue to invest in children's rights and health in its next country program cycle.

"Helping you reach the unreached – walking the last mile with you – will remain a central element of our collaboration," he said.