title: Essential drugs policy in three rural counties in China: what does a complexity lens add?
abstract: In 2009 the government of China identified an essential drugs policy as one of five priority areas for health system reform. Since then, a national essential drugs policy has been defined, along with plans to implement it. As a large scale social intervention, the policy will have a significant impact on various local health actors. This paper uses the lens of complex adaptive systems to examine how the policy has been implemented in three rural Chinese counties. Using material gathered from interviews with key actors in county health bureaus and township health centers, we illustrate how a single policy can lead to multiple unanticipated outcomes. The complexity lens applied to the material gathered in interviews helps to identify relevant actors, their different relationships and policy responses and a new framework to better understand heterogeneous pathways and outcomes. Decision-makers and policy implementers are advised to embrace the complex and dynamic realities of policy implementation. This involves developing mechanisms to monitor different behaviors of key actors as well as the intended outcomes and unintended consequences of the policy.
authors.affiliation: Center for Health Policy Evaluation and Health Technology Assessment, China National Health Development Research Center, P.O.B. 218, Xueyuan Rd., Haidian District, Beijing 100191, PR China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Xiao
authors.forename: Kun
authors.initials: K
authors.lastname: Zhao
authors.forename: David M
authors.initials: DM
authors.lastname: Bishai
authors.forename: David H
authors.initials: DH
authors.lastname: Peters
mesh_terms: D002681:China; D018954:Drugs, Essential; D006291:Health Policy; D006801:Humans; D017146:Models, Organizational; D036301:Qualitative Research; D019035:Rural Health Services / Q000458:organization & administration*
chemical_list: D018954:Drugs, Essential
keywords: Chinese health system reform; Complex adaptive systems; Essential drugs policy; Policy implementation; Unintended consequences