Addressing domestic health and development challenges
We invest in developing and pilot-testing innovative approaches to controlling TB that improve diagnosis and treatment and reduce patient costs.
Over the past two decades, China has expanded its use of the TB control strategy recommended by the World Health Organization (WHO). This approach helped China meet its TB-related United Nations Millennium Development Goal—to reduce TB prevalence and mortality by half between 1990 and 2015—five years ahead of the target date.
However major challenges remain. According to WHO, China still has the third-largest TB epidemic, with about 900,000 new TB cases each year. China also has about one-fifth of the world’s cases of multidrug-resistant TB (MDR-TB), which is especially difficult and costly to treat.
In 2009, we collaborated with China’s Ministry of Health (now the National Health Commission, or NHC) to launch a six-year TB control program. Together, we are working to develop and demonstrate innovative TB control models that can help China further reduce cases of TB, particularly MDR-TB.
The model piloted during the first phase of the program (2009-–2012) focused primarily on MDR-TB. It identified nine times more MDR-TB cases than the existing system, shortened the time required for diagnosis and treatment initiation by 90%, reduced premature discontinuation of treatment by 90%, and reduced patients’ out-of-pocket costs by 80%. These results have been praised by WHO as a global model for addressing the threat of MDR-TB.
The second phase of the program (2013-–2015) expanded the model into a comprehensive approach for all TB cases, including integration with health systems, creative financing mechanisms, and the use of new tools such as molecular diagnostics and medication monitors. This model was piloted in the three prefecture-level cities of Zhenjiang, Yichang, and Hanzhong, benefiting about 14 million people.
The third phase of the program (2016–2018) scaled up the comprehensive TB control model in the provinces of Zhejiang, Jilin, and Ningxia, with a total population of 90 million. This phase helped the three provinces streamline collaboration among hospitals, centers for disease control and prevention, and primary healthcare units at all levels for TB care. It also implemented molecular diagnostics for universal TB drug susceptibility testing, electronic medication monitors for case management, and financing and payment reforms to reduce catastrophic medical costs for TB patients.
The third phase also led to important innovations in information and communications technologies, including upgrading the national TB information system to capture information on TB patients from hospitals and primary healthcare units and establishing an e-learning and certification system for TB-related healthcare providers at all levels.
The program is now in its fourth phase, which aims to further scale up the proven models. We are also launching programs to unlock China’s potential for research and development on TB treatments that can benefit people in China and around the world.
We work with the Chinese government and community organizations to prevent HIV transmission, and improve care and treatment for those infected.
Control of the HIV epidemic in China depends on reaching high-risk groups with prevention programs, accurate information, testing, and efficient and effective treatment programs. China can make significant progress by sustaining its investments in these areas and supporting research into new and better prevention and treatment methods.
From 2008 to 2013, we worked with the Chinese government and community organizations on a program to expand HIV prevention (through testing and interventions) among those most at risk of infection and to provide care and treatment to those living with HIV. In some program cities, more than half of all newly detected cases were identified through our collaboration with community organizations. Over the years, these community organizations have gained recognition and government support for their critical role in preventing and controlling HIV.
In 2014, we launched the second phase of the program, with a focus on deepening participation by community organizations. The program has helped the Chinese government establish and operate a special fund to support the work of community organizations, and it advocates for relevant policies, such as the inclusion of rapid HIV tests in the National Guideline for Detection of HIV/AIDS.
In addition, we are supporting a series of public events that are designed to help build an enabling social environment for disease control and reduce social discrimination against those living with HIV/AIDS.
We work with Chinese researchers, government agencies, and domestic and international organizations to advocate for policies that reduce tobacco use in China.
China is the world’s largest producer and consumer of tobacco and has the highest burden of tobacco-related disease. More than 300 million Chinese smoke, and more than that twice that number—including 180 million children—are exposed to secondhand smoke. As a result, 1.4 million Chinese die each year from tobacco-related causes, including lung disease, cancer, heart disease, and diabetes.
China is a signatory of the WHO Framework Convention on Tobacco Control (FCTC), the world's first and only global public health treaty. The FCTC compels its 180 signatory countries to meet minimum standards in tobacco control provisions, including tobacco taxes that raise cigarette prices for consumers, bans on tobacco advertising, graphic health warning labels and plain cigarette packaging, and indoor smoking bans. These measures have proven successful in reducing tobacco use in higher-income countries and could bring vast benefits in China in terms of improved health and lives saved. In particular, tobacco taxes could make a dramatic difference—they offer the most effective way to reduce tobacco use, particularly among young people, and they can provide a significant source of domestic revenue to help fund a range of public health and development efforts.
China’s leadership has put tobacco control on the national agenda, and more progress on FCTC compliance in China is expected over the next decade. We support strategic partners in China in advocating for proven policies, in line with the FCTC. These partners work with a network of sub-grantees to conduct policy research, build tobacco control capacity, and create advocacy campaigns in support of tobacco control measures.
We bring together a wide range of partners to encourage charitable giving and advocate for improved policies in China’s philanthropic sector.
China has the potential to significantly increase the level and impact of philanthropic activities globally. The combination of entrepreneurial spirit among the first generation of wealth creators, an emerging policy infrastructure for the charitable sector, and new social media technologies could lead to new models of philanthropy for the rest of the world. We work with a wide range of partners in China—including the government, academia, social organizations, and individual philanthropists—to encourage charitable giving and advocate for improved policies in China's philanthropic sector.
We work with Chinese government agencies and other partners to help improve the availability and accessibility of live-saving vaccines across China.
China’s National Immunization Program (NIP), launched in 1978, has contributed to major progress in public health in China. Coverage rates for the five major vaccines under the program (BCG, DTP3, polio, HepB3, and measles) have been at 99 percent since 2009, and the program has been described by UNICEF as “highly successful and cost-effective.”
We see an opportunity for further expansion of the NIP and are working with our partners to support the introduction of new vaccines (such as PCV, HPV, Rota, and Hib) in order to save lives and improve health equity in China. We work with the China Center for Disease Control and Prevention, the National Immunization Advisory Committee, and other partners to identify and address policy, resource, and supply barriers and other obstacles to making these vaccines available and accessible to all families in China.
We work with Chinese government and other partners to help improve primary healthcare in rural China and prevent poverty caused by illness.
China has had unparalleled success in poverty alleviation, reducing the number of people living in poverty by 850 million over 40 years. This constitutes more than 70 percent of all global poverty reduction to date. Over the past years, we have launched projects to focus on health poverty reduction, contributing to China’s overall goal of eliminating extreme poverty.
Currently, we are working with partners such as the National Health Commission (NHC) to conduct innovative pilots to enhance primary healthcare systems in rural areas and facilitate experience sharing, with the goal to improve the health of rural population, and prevent people from slipping back into poverty due to illness.
We work with partners to support China in reducing malnutrition by focusing on proven interventions during the critical first 1,000-day period of a child’s life.
Although China has made strong progress in reducing malnutrition, stunting remains a major challenge especially in less developed regions in China. Many young children in poor rural areas are not fed diversified and nutritious solid foods after 6 months of age, leading to impaired physical and cognitive development and continued cycles of poverty. Exclusive breastfeeding rates for children aged 0-6 months are low, due to a general lack of knowledge about the benefits of breastfeeding and optimal breastfeeding practices, and a lack of support for women who do want to breastfeed.
We work with the National Health Commission and China Development Research Foundation (CDRF) to support nutrition improvement interventions to reduce micronutrient deficiency among rural children.
We also support programs to improve the policy and social environment for breastfeeding so that more mothers choose to and receive support for their decision to breastfeed longer.