Paper short abstract:

Exploring ownership in Chinese health initiatives, this study reveals its dual impact on marginalized populations’ access. Balanced stakeholder engagement is key for reducing health inequalities in LMICs.

Paper long abstract:

This study delves into the dynamics of state capacity, healthcare disparities, and socio-economic inequality in the Chinese health sector, particularly focusing on the role of ownership in mitigating health-related vulnerabilities and improving healthcare access for marginalized populations. It analyzes three key initiatives, each addressing a distinct health crisis: the World Bank/UK Basic Health Services Project (1998-2007) for rural health system strengthening amidst marketization, the Gavi Hepatitis B vaccination project (2002-2010) for reducing Hepatitis B prevalence, and the Global Fund HIV/AIDS Rolling Continuation Channel (2010-2014) for enhancing civil society engagement with “most-at-risk populations” in HIV/AIDS. Data from 67 project and policy documents, 282 literature sources, and 56 stakeholder interviews were analyzed. The study reveals a nuanced donor–recipient relationship. Key practices, including multi-stakeholder governance, donor–recipient co-financing, and alignment with existing management and service delivery systems, technical and institutional capacity building were instrumental in establishing local ownership, advancing agenda and facilitating project transitions into local health systems. However, challenges were identified in ad-hoc transition processes without coordinated donor–recipient planning due to the strong ownership demonstrated by Chinese counterparts. This research thus highlights the complex interplay between ownership and healthcare delivery. While strong ownership can lead to successful integration of project components, it can also pose risks such as marginalization of certain populations and exclusion of essential health services for the poor. The study emphasizes the need for a balanced approach that considers local health needs and long-term sustainability, emphasizing the importance of ownership building and sustained stakeholder engagement for health outcomes in LMICs.