Approach

When top-down implementation in rural health care issues fails and decisions of the Ministry of Health are not applied or their meaning is distorted at the local level, it is important to explore how evidence is used at the local level to redefine the ideas generated at the central levels. In order to be able to theorize the existing distance between central and local state agencies (Weigelin-Schwiedrzik 1999, 2006) and explain policy failures, this project will apply an actor-centered approach. It follows a rational choice argument. Three actor groups can be defined: health care administrators, health care providers, and health care users. Patients, doctors, and administrators form a system of conflicting interests. Success and sustainability relies on the ability to integrate divergent interests and perceptions (Klotzbücher 2006: 55ff). Using this approach in our project can help in defining conditions for successful intervention and factors for enhancing sustainable development at the local level: In contrast to direct interventions from “outside,” choices, strategies and objectives made by the peasants and the local authorities are of crucial importance. According to this theoretical concept, scientific-grounded interventions will be successful when they follow these principles:

• Meeting demands and perceptions of patients, health workers, and administrators;
• Enhancing their prevailed core competences; and
• Initiating new perceptions and local negotiations that let peasants perceive health care as added-value in their existing categories (Willke 1996, Luhmann 1987).

Innovative methodological approaches

This project tries to overcome existing boundaries of academic disciplines and foster transdisciplinary dialogue among researchers in Chinese Studies and Public Health by following a methodological research design involving:

• A combination of quantitative and qualitative methods: Quantitative analysis methods prevail in studies of rural health care of nomadic people in Xinjiang (e.g.. Xiao/Kong 2002; Yang/Lin 2003, Shishitiming 2001, Weishengbu tongji xinxi zhongxin 2003b,c), focussing on epidemiological research with statistical interference. Qualitative studies by Chinese scientists are rare (f. e. Wu/Gao 2000, Wu Ming 2004, Wang Hongwan 2003) and are conducted only in regions with a Han-Chinese population. 
• Interdisciplinary project design: Some phases of this project are organized in different work packages for which Shihezi University or University of Vienna is responsible.
• Transdisciplinary approaches, which intend to create new knowledge by establishing cross-sectoral scenarios and interdisciplinary concepts for solving a defined problem (Higginbotham et al. 2001, Sommerfeld 2003, Rosenfield 1992). By focusing on one particular problem from the perspective of different scientific disciplines, it is possible to work out integrative culture- and setting-sensitive health scenarios in order to mobilize all the potentials from different fields of society.
• Cross-sectoral approach: Previous health surveys of Xinjiang have assessed the distribution of diseases and health care delivery through health surveys. With its focus on the social capital and institutional capacity of a rural society, this project widens the previous scope of studies on the health care sector from a single sector to a cross-sectoral analysis on the basis of case studies.
• Participatory negotiation process for rural health care: Many expert-led approaches have failed in health care because they could not integrate the perceptions of the local people and their interests (Uzochukwu 2004, Yip/Egglestown 2004). Yet peasants are the ones who know the locally available resources and how to effectively use these resources to improve their livelihoods. Their daily life experiences are embedded knowledge for capacity-building. Consequently, the insiders must be empowered and enabled to resolve their own problems (see Marschalek 2005: 24, also PCS 2005). The local negotiation process is a participatory tool for exploration and awareness-building, for activating local knowledge and scientific knowledge as well as for analyzing and defining the fields of intervention and (self-) evaluation in the villages. Concrete aims for the negotiation process are defined as follows:
  - To identify crucial health delivery problems (quality) and to analyze different crucial actors (e. g., women and children, community representatives) and issues (economic interests, health as a source of additional legitimacy) in the interfaces of rural health care.
  - To initiate and activate local processes of mobilizing resources/competence, awareness of prevention, and support for the pastoral hospital.
  - To guarantee transparency through public discussions aiming at building trust of health care services within the community.
  
• Case study in a county in one of the main pastoral region of the Western Xinjiang Uygur Autonomous Region: This project will combine the case study approach with a bottom-up approach. The discussions at the local level will define ways of integrating the improvement of pastoral health stations into the strategies or objectives of all relevant actors in the community.

Institutional partners

Department of Public Health, Shihezi University
Health Bureau of the AR Xinjiang
County health bureau 

Time frame

Summer 2005 (Pilot study):
Concretizing the research question and finding suitable project county for the case study.

Summer 2006:

Fieldstudy

1. Data collection
a. quantitative: health survey in case study group of 457 livestock farmers
b. qualitative: 12 focus interviews with stakeholders (county administration, rural dwellers, village doctors, village heads) discussing the relevance of affordability and accessibility of health care service in a pastoral mountainous area.

2. Data aggregation and analysis

 
Summer 2007:

Fieldstudy

1. Further focus interviews with stakeholders
2.  discussing intervention measures in project case study

 
2008:

Presentation of an implementation plan;

March 29-30: Symposium "State, society and health in Xinjiang" at the Department of East Asian Studies - Sinology. 

Integration, generalization of findings, interregional perspectives

2009:

Evaluation and dissemination, preparing following projects with a more interregional perspective with additional European partners

Financial grant 

FWF (Austrian Science Fundation):  1.2007-12.2009 (P19433)
EPU (Eurasia-Pacific Uninet): 6-7.2005, 8-9.2006, 7.2007

Last update: April 2008