CHIMACA: Structural Hinders to and Promoters of Good Maternal Care in Rural China


General objective:

To strengthen and improve the performance of health care system in rural China in order to improve maternal and child health.

Specific Objectives:

To describe current situation of access to antenatal and obstetric care services in the rural areas by 1) re-analysing the data collected  from the national health service surveys conducted in 1993, 1998 and 2003, and 2) synthesising all the evidence available    from published/unpublished and grey literature in English or Chinese;

To assess the relative importance of major socio-economic and health system barriers that the rural women are facing in accessing    antenatal and obstetrical care and constraints of providers in implementing appropriate and quality antenatal and obstetrical care;

To develop detailed intervention strategies for a trial for improving access to, and quality of, rural antenatal and obstetric care services. Among The proposed interventions to be developed and tried are 1) adding MCH services into the service benefit package of CMS (a community-based prepayment scheme) in order to alleviate financial access and service provision barriers, 2) providing extensive in-service training to midwives and MCH workers at the village and township levels in order to improve quality.;
To implement a community based controlled trial on the developed interventions and evaluate their impact in the study areas of rural China;
To develop and strengthen research capacity for the partners from China;
To develop evidence-based policy recommendations on how to improve access to and quality of antenatal and obstetrical care for local and central government and international organisations, such as WHO, World Bank, UNICEF, EU;
To disseminate key research findings and recommendations at international, national and local levels during different stages of the project implementation through different communication channels;
To provide a practical example and information on impact of abolishment of user fees on service utilisation.


Qualitative investigations
Quantitative investigations
Evaluation through comparison of pre- and post intervention data on process and post-intervention outcome indicators


Development of Methodological and Analytical Framework and Preliminary data collection instruments
Analysis of existing national & provincial data
Pre-intervention data collection on health system
Set up/Negotiations (Dialogue with community - Explore preliminary
proposals, Site Selection, Preliminary preparations
Design (Synthesis of analysed data & final intervention
proposal development, Paper appraisal - Qulaity Assurance, Participatory Consultation)
Implementation (Final preparations and training, Implementation and data collection for intervention evaluation, Monitoring of the intervention implementation)
Intervention Evaluation (Set up evaluation Framework, Post -intervetnion data collection and process evaltuion, Outcome/impact data analysis & evaluation, evaluation results & dissemination)
Dissemination & Exploitation (Dissemination plan, Stakeholder work-shops, Electronical dissemination, Papers and conferences)


Final conclusions and recommendations for Chinese and international policy makers
Articles and communications in public platforms
Articles submitted to Chinese and International peer reviewed journals


National Research and Development Centre for Welfare and Health (STAKES) Finland; Liverpool School of Tropical Medicine (LSTM) England; Karolinska Institute (KI) Sweden; Ghent University, International Centre for Reproductive Health (ICRH) Belgium; Fudan University, School of Public Health (SPHFU) China; Centre for Health Statistics Information, Ministry of Health (CHSI) China; Chongqing University, School of Public Health (SPHCU) China; Anhui Medical University (AMU) China; Xi’an Jiaotong University, School of Medicine (JUSM) China


September 01, 2005 - August 31, 2009

Project status

Project closed

Team members

Ms. Marleen Temmerman
Ms. Wei-Hong Zhang


United Kingdom of Great Britain and Northern Ireland


Mother and child health