China's Free-Healthcare Project Safeguards Women's Health Dreams

ByShao Liehong and Du Weili April 14, 2015

More than 30 million rural women have benefited from a free cervical and breast cancer screening project currently being carried out across the country, just as 55-year-old Pan Xiuhua from Minhou County in southeast China's Fujian Province did.

"The screening usually costs more than 100 yuan (U.S. $16). In the past, I was reluctant to spend money needed to do the screening," said Pan. Thanks to the project, Pan and her fellow female villagers were able to receive the service at no cost.

In July 2009, the All-China Women's Federation (ACWF) and the National Health and Family Planning Commission (NHFPC, formerly the Ministry of Health) jointly launched the rural cervical and breast cancer screening project.

By the end of 2013, the project had provided free cervical-cancer screening for 32.49 million rural women and free breast cancer screening for 4.66 million rural women, and had subsidized medical treatment of 20,715 impoverished women who had already been diagnosed.

The free-screening project, which has benefited thousands of rural women and their families, has become a people's wellbeing project of governments at different levels.

Project's First Three Years See Remarkable Achievements

With women's increasing work pressures and evolving lifestyles, cervical cancer and breast cancer have become two major "killers" in women's health.

Statistics show that in China, the incidence of cervical cancer is 13.3 per 100,000 while that of breast cancer is 10.7 per 100,000; and approximately 67,000 women die of these two diseases every year. In less-developed rural China, the incidence of the two cancers is even higher, due to limited medical resources and facilities.

Experts point out that incidence could be reduced by as much as 50 percent if women receive the screening.

In China, early medical treatment for either cancer costs 10,000–20,000 yuan (U.S. $1,612–3,224), whereas the medical expenses for advanced cancer exceed 100,000 yuan (U.S. $16,120). Many patients will lose their lives due to untimely medical treatment and not having begun the process proactively.

In 2009, with efforts from the ACWF and NHFPC, screening for cervical and breast cancer for rural women was included in the government work report for the first time.

Later, the ACWF and NHFPC jointly issued a pilot plan for the screening project, which stipulated that China would provide free screening for cervical cancer to 10 million rural women in 221 counties and free screening for breast cancer to 1.2 million women in 220 counties from 2009 to 2011.

As of 2011, China had earmarked a total of 562 million yuan (U.S. $91 million) to the project, completing cervical cancer screening for 11.69 million rural women and breast cancer screening for 1.46 million rural women.

A total of 16,313 positive cases of cervical cancer and precancerous lesions were diagnosed with the ratio of 141.56 diagnoses per 100,000 screened. Of those positively diagnosed, the cases of early detection amounted to 14,963, accounting for 91.7 percent.

Meanwhile, 4.75 million women were diagnosed with fibroids or reproductive tract infections, and 631 women were diagnosed with breast cancer with the positive-diagnosis ratio at 48 per 100,000 and the early-detection proportion at 69.72 percent.

The project has improved the quality of life of patients, reduced medical costs and mortality rates, and effectively controlled hazards threatening women's health.

"Thanks to the favorable policy, I was able to detect that I had breast cancer and was able to receive timely medical treatment before it was too late," said Wang Guiqin, a woman from Chengzhuangzi Village in north China's Tianjin Municipality.

In September 2009, Wang, who was diagnosed with breast cancer during a free screening, underwent chemotherapy and operative treatment, with the severity and effects of the illness ultimately controlled.

New Round of Screening Benefits Even More Women

Although the first round of the free cervical and breast cancer screening project did indeed achieve remarkable results, the free screening was conducted among 11.2 million women and couldn't meet the demands of the nearly 200 million rural women across China.

In an effort to regulate and implement the screening project in the long term, the ACWF drew up a report to summarize the first three-year round of the project and to put forward relevant suggestions.

Reviewing the report, Li Keqiang, then–Vice Premier of China, gave high praise to the project and demanded that the medical reform office and the Ministry of Finance (MOF) proactively support the project and expand its coverage.

In July 2012, the ACWF, MOF and NHFPC held a joint video and telephone conference to begin the next stage of the project's implementation in 2012–2015, expanding its coverage to women aged 35–64 in 1,140 counties (districts) and providing free cervical-cancer screening for 50 million rural women and free breast cancer screening for 6 million rural women.

By the end of 2013, China had invested 740 million yuan (U.S. $119 million) in the project, with 20.8 million and 3.2 million rural women undergoing the screening for cervical cancer and breast cancer respectively.

Since 2009, the project has helped diagnose 43,654 women with cervical cancer and 3,626 with breast cancer (both figures include precancerous lesions).

In 2013, the incidence ratios of early cervical and breast cancers hit 91.7 percent and 70 percent respectively.

The free-screening project has brought tangible benefits to the rural women of China.

When ACWF President Shen Yueyue visited northwest China's Gansu Province in 2013, she demanded that women's federations of different levels continue to promote the project so as to further improve rural women's health and promote the harmonious development of rural China.

Medical Subsidies Bring Hope to Rural Women

During the implementation of the project, a big problem with which diagnosed rural women were faced was how to pay their diseases' medical expenses, which were scarcely within the family's budget and would more than likely drive them into poverty.

In 2011, in order to solve the problem, the ACWF endeavored to seek financial support from the MOF to set up for the project a special relief fund, which would provide medical subsidies of 10,000 yuan (U.S. $1,612) to each diagnosed woman from a poverty-stricken family.

ACWF Vice President Song Xiuyan said that women would need to pay only a portion of their medical expenses thanks to medical subsidies, reimbursement from the new rural cooperative medical system and social charity funds.

During the following three years, the ACWF sought a special relief fund totaling 200 million yuan (U.S. $32 million) from the MOF. In addition, the ACWF raised social charity funds for 20,715 impoverished female patients with each receiving 10,000 yuan (U.S. $1,612), totaling 207.15 million yuan (U.S. $33 million).

For example, the Gansu Women's Federation raised more than 14.52 million yuan (U.S. $2.4 million) from various channels to subsidize 2,344 poverty-stricken women.

The project has helped rural poverty-stricken women settle their medical-expenses problem. For example, Zhang Jinfeng, who was diagnosed with cervical cancer in 2012, received a subsidy of 10,000 yuan (U.S. $1,612) for her medical expenses. When asked about the impact the financial relief had, Zhang said, "I thought that the only thing that was left for me was death. The subsidy from the local women's federation restored my hope for a future life."

Looking at the practical effects of the special fund, the staff from the Xinjiang Women's Federation of northwest China's Xinjiang Uyghur Autonomous Region agreed that the project has helped enhance ethnic harmony and mutual assistance while boosting women's confidence and effort in fighting against illness.

Promoting Knowledge on Personal Health

During the course of the project's implementation, women's federations of different levels have also been promoting and disseminating knowledge on how to prevent cervical and breast cancer, to help women develop healthy lifestyles.

In addition, the ACWF has arranged for medical experts to compile and print handbooks titled "100 Questions on Women's Health." To date, more than 3 million copies have been distributed to rural women, and, meanwhile, competitions on women's health knowledge have been held to further promote the learning of these key concepts among women nationwide.

A promotional advertisement of the project has been broadcast on China Central Television and other local TV channels.

Mainstream newspapers, such as People's Daily, Farmers' Daily and China Women's News, have included in their publications full-page features to promote the project as well as knowledge on the prevention and control of cervical and breast cancer.

In recent years, the ACWF has organized health-themed running events in five provinces and municipalities and has organized health-themed lecture events in 11 provinces, regions and municipalities to promote the project.

In 2011, the ACWF teamed up with Goldman Sachs — an American multinational investment banking firm — to launch a three-year pilot program to improve Chinese women's awareness for breast cancer prevention and control through introducing to Chinese communities a number of tried-and-true American methods for promoting breast cancer prevention and control.

The pilot program has further improved women's health awareness, has built up a new educational and training model for breast cancer prevention and control in China, and has thus contributed to the development of the overall cause of women's health.

Women's federations of various levels have made great efforts in health education and promotion. In 2013, they distributed more than 20 million health handbooks on cervical and breast cancer prevention and control, organized 11,000 health training courses, and held 17,000 health lectures, whose collective viewing audience exceeded 4 million rural women.

In addition, women's federations published more than 80,000 articles to promote cervical and breast cancer prevention and control in newspapers and online media.

Thanks to health education and promotion, rural women have improved their awareness of cervical and breast cancer screening. According to a 2011 sample survey by the NHFPC, the initial acceptance rate of the screening was less than 50 percent; but after three years of implementing the project, the acceptance rate jumped to more than 98 percent.

Building Effective Health Mechanisms

Building effective work mechanisms is the most important means of ensuring improvement to the free cervical and breast cancer screening project and the medical-fee subsidy program that runs alongside.

Since the launch of the project, women's federations have made great efforts to promote its smooth implementation. Firstly, a cooperative mechanism has been set up, whereby the government plays the lead role while different departments work together with efforts and contributions from the general public.

Secondly, a healthcare-subsidy guarantee mechanism has been established. Women's federations and health authorities have proactively advanced the new rural cooperative medical system, government subsidies and social aids. At present, cervical and breast cancer have been included among the 20 major diseases covered by medical insurance, thus reducing the burden on female patients.

Thirdly, a scientific management mechanism has been established. Women's federations have included the screening project and the special relief fund into their work evaluation. Through an online information system, they have strived to develop a subsidy application as well as an approval and supervision mechanism to regulate the screening project and its subsidy work, in order to ensure that the project benefits rural women in an equal and fair manner.

During the past five years, the free cervical and breast cancer screening project has played an important role in preventing and controlling the two cancers, and its special relief fund has brought a new ray of hope to female patients from poverty-stricken families.

In the future, the ACWF will work even harder to advance the project and expand its coverage so that more and more women can benefit from the favorable public policy.

(Source: Chinese Women's Movement/Translated and edited by Women of China)

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