Abstract
Background: The 2015 two-child policy was the most important institutional change in China’s family planning since the 1978 one-child policy. To implement the two-child policy, China merged the former health departments and family planning departments into the new Health and Family Planning Commission organization. We collected and analyzed funding and expenditure data, providing a novel approach to assessing the family planning outcomes under China’s two-child policy. The paper shows how the management structure and funding levels and streams shifted with the new two-child policy and assesses the new management structure in terms of the ability to carry out tasks under the new family planning policy. Methods: We collected data on the funding, structure of expenditure and social compensation fee in Shandong province from 2011 to 2016, to evaluate how resources were allocated to family planning before and after the organizational change. We also collected interview data from family planning administrators. Results: While total family planning government financing was reduced after the organizational change, expenditures were shifted away from management to family planning work. Funding (80%) was allocated to the grass-root county and township levels, where family planning services were provided. The overlapping work practices, bureaucracy, and inefficiencies were curbed and information flows were improved. Conclusions: The new Health and Family Planning Commissions shifted resources to carry out the new family planning policy. The aims of the two-child policy to reduce inefficiencies, overlapping authorities and excessive management were achieved and expenditures on family planning work was enhanced and made more efficient.
Highlights
China’s family planning institutions have a long history, punctuated by significant policy shifts and changes in the organizations that implement population control
To assess whether the new family planning organizations implemented management structures and funding levels to promote the two-child policy, we measured the reallocation of funding and expenditure to family planning work, reductions in overlapping work practices between departments, elimination of wasteful funding and streamlining of information flows and decision-making
Without a reduction in family planning services and over 80% of all funding contributed at the county and township levels, these changes suggest that grass-roots organizations mainly carried out family planning work
Summary
China’s family planning institutions have a long history, punctuated by significant policy shifts and changes in the organizations that implement population control. This paper asks the question: Did the management structure and funding levels and streams shift in response to the new two-child policy and did the new management structure promote the new family planning policy?. We collected and analyzed funding and expenditure data, providing a novel approach to assessing the family planning outcomes under China’s two-child policy. The paper shows how the management structure and funding levels and streams shifted with the new two-child policy and assesses the new management structure in terms of the ability to carry out tasks under the new family planning policy. Results: While total family planning government financing was reduced after the organizational change, expenditures were shifted away from management to family planning work. The aims of the two-child policy to reduce inefficiencies, overlapping authorities and excessive management were achieved and expenditures on family planning work was enhanced and made more efficient
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