Still Struggling for the Basics
Profile: Sichuan, Liangshan Yi Autonomous Prefecture, Jinyang and Butuo CountiesLiangshan Prefecture covers more than 60,000 mainly mountainous square kilometres of southwest Sichuan, bordering Yunnan Province in the south, and is home to some four million people. Roughly comparable in size and population to the Republic of Ireland, gross domestic product per capita in the Prefecture was CNY 3,633 (USD 443) last year, less than one fortieth of that in Ireland.
Liangshan does have some prospects for economic growth. The southern reaches are rich in minerals, and some mines are already in production. According to the prefectural government, geological surveys have identified 59 extractable minerals, including iron, zinc, copper, lead, non-ferrous and precious metals. The government is negotiating concessions with several foreign mining ventures, although no deal has yet been struck.
Hydropower along the Jinshajiang, Yalongjiang and Daduhe rivers is another potential growth area. The main transmission routes from the huge Ertan station, located in the municipal district of Panzhihua, south west of Liangshan, run through the prefecture to Sichuan's capital city, Chengdu. This provides Liangshan with power that is supplemented by several smaller, local installations. Provincial plans for future generation may well see projects within Liangshan.
The fertile Anning river valley, in the centre of the prefecture, has significant potential for increased production of high value vegetable and fruits crops.
At the edge of the valley and beside the as yet unpolluted Lake Qionghai, the prefectural capital, Xichang, enjoys a pleasant year-round climate and seems a clean and quietly prosperous city. Its current population of around 200,000 is projected to rise to 500,000 within the next ten years. It is located roughly half way along the railway line from Chengdu, to Yunnan's capital, Kunming, (about 11 hours by train in each direction), and has an airport with daily flights to Chengdu. Road links are not so good. A provincial plan for an expressway linking the city with Ya'an and Chengdu was shelved for lack of funds but, in the context of the Western Development Strategy, it is likely that the project will be revived in the not too distant future. It seems an ideal candidate for Asian Development Bank finance.
In the summer months, tourists from Chengdu and Chongqing come to Xichang to relax by Qionghai Lake, which is advertised as China's premier spot for water skiing. Another tourist attraction is an annual 'Torch Festival' held in the sixth lunar month. During this traditional Yi festival, villagers carry blazing torches around their houses and fields in a symbolic purification, accompanied by music and dancing around bonfires to express the collective hopes for a good harvest. The government hopes to see considerable expansion of the tourist industry in years to come, relying on mountainous scenery and 'ethnic minority appeal'. Some 41.5 % of the population are ethnic Yi, another 2.4% are drawn from 13 other minority ethnic groups, and 56% are Han Chinese.
The urban district of Xichang is also the site of the Long March rocket launch pad. But within a few dozen kilometres of this symbol of China's hi-tech capacity, upland rural households remain living in abject poverty.
According to the local government, up to half a million people in the prefecture are living below a locally defined, and extremely low, absolute poverty line of CNY 500 (USD 61) and 400 kg of grain per capita per year; and a further one million are poor, and vulnerable to extreme poverty. Seven out of 17 counties in the prefecture are nationally designated poverty counties, and a further two are provincially designated as poor.
Poverty is heavily concentrated among the ethnic minority populations. Prefectural Vice Governor, Ms. Liu Yan, considers that of 610 townships in the prefecture, 200 remain seriously impoverished, and all of these are in ethnic minority areas.
Ms Liu is unusual not only for being a woman in relatively high office but also in her outgoing determination to bring international NGOs to work in the prefecture. She compares her area to Yunnan Province, where numerous multilateral and bilateral projects are supplemented by a growing community of international NGOs. 'Liangshan is every bit as poor, and needs help in every field'. The invitation to china brief to visit the prefecture, extended through the local Red Cross Association, was part of an explicit strategy to attract international organisations to Liangshan. On the basis of our visit, we have no hesitation in endorsing this appeal for support. There is a great deal to be done.
From Xichang, a road climbs and twists 245 kilometres east through bare shouldered mountains to Jinyang County town, which is little more than a smattering of buildings along one street perched on the edge of a precipitous gorge, with no obvious room for expansion. Eighty seven percent of the county's surface area is officially classified as mountainous, rising to more than 4,000 metres above sea level. Small communities subsist on many of the high mountain tops.
For much of its length the road from Xichang is unpaved, but it is a veritable highway by the standards of the county. Over the last few years, local government has overseen the building of simple, rural roads to nine townships which previously were connected to the outside world only by footpaths, but the new roads are not passable by vehicles all year round. A further seven of the county's thirty townships remain accessible only on foot. Twenty of the townships do not have telephone connections, and fourteen out of thirty do not have electricity. Even along the main road to the county seat, some communities lying right next to the power lines have not been connected because the households simply cannot afford to pay for electricity (At CNY 0.6 - 0.8 per kilowatt, electricity in the county costs roughly twice as much as in urban areas of eastern China.)
County officials, most of whom are themselves ethnic Yi, argue that the inaccessiblity of the area, the lack of penetration by media such as radio and television, and the fact that much of the overwhelmingly Yi adult population does not speak Mandarin, combine to create cultural as well as physical isolation, marked by little interaction with and low receptivity to ideas from outside. As one example of this, the traditional style of dress among Yi people in Jinyang is quite distinct from that in neighbouring Butuo County. Mountain ranges create almost impermeable barriers between communities only a few dozen kilometres apart.
In this harsh, upland environment, the staple crops are potatoes and buckwheat, with a smaller area sown to maize at lower elevations. Better off households may have chickens, a few head of sheep and, in some cases, pigs, cows or bullocks used for ploughing. (During two days in the county, we did not see a single tractor. Elsewhere in the prefecture, families with draft animals are able to rent them out for CNY 30 per day during the Spring ploughing; but few Jinyang families can afford this, and very many rely exclusively on hand tools to break the ground).
Animals are grazed collectively during the day (although there is an evident lack of adequate of pastureland, with most hillsides sporting only the occasional tuft of withered grass). At night, in the poorer communities, it is still general practice for livestock to shelter in their owners' houses, penned in a corner. Most houses we saw comprised only one or two rooms and had little or no furniture: usually one bed; sometimes a cupboard, very seldom anything else. Household implements were generally limited to a single cooking pot and a couple of bowls. Food is cooked over an open fire with brushwood fuel collected from common land. Experiments with biogas have reportedly shown that it is impractical at such high altitudes.
Even in lower lying areas, families we spoke to reported a food deficit of several months per year. One family estimated their annual cash income at around CNY 100 - derived from the sale of sheepskins. A family we visited in Butuo County told us that, although they receive relief grain from the government, there are usually one or two months of each year in which they have nothing left, and are reduced to scouring the countryside for wild rice, grass and roots to eat.
Per capita land allocations in the county are quite large by national standards (generally, more than two mu [0.12 hectares] per capita), but productivity is extremely low. According to the Jinyang county government, last year grain yields (generally taken to include potatoes), reached a record, aggregate high of 290 kg per mu (equivalent to 4.35 tonnes per hectare). But even at this level of output, the county has little prospect of achieving food security, particularly as the centrally mandated policy of returning sloping farmland to forest begins to take effect.
A total of 30,000 mu (2,000 hectares) of sloping farmland in Jinyang was reforested last year, in line with the quota assigned the county under the national tuigeng huanlin ('returning arable land to forest') policy. Amidst the county's eroded and barren hillsides the case for ecological restoration hardly needs stating, but the very acuteness of the ecological-livelihood crisis leaves desperately little room for manoeuvre. Families we spoke to had been quite willing to give up farmland in return for the compensation package of 150 kg of grain per mu plus CNY 50 per mu to buy tree seedlings. But compensation is only guaranteed for five years; and it is not clear how rural families will survive after that time.
According to the county government, fully 80% of all farmed land in Jinyang is on slopes of 25 degrees or more, and so theoretically in line for reforestation under the new policy; but local officials are highly sceptical of the practicality of taking so much land out of production. Further allocations of land to be reforested will be much harder to enact, as authorities in Jinyang and elsewhere have naturally dealt with the first round of 'returns' by setting aside the most marginal, degraded and unproductive land. There is a self-evident and urgent need for this process to be accompanied by technical and funding support to establish alternative livelihoods.
Government poverty alleviation programmes have, in addition to repairing roads, refurbishing houses and installing drinking water supplies, attempted to encourage cash crop production on land that can support diversification into white konjak (baimoyu), prickly ash, tobacco, and silkworm production. But progress towards marketisation of the rural economy has been slow, given limited market access and limited capacity of housheholds to make productive investments. One woman we spoke to said she had received a CNY 1,500 government poverty alleviation loan, but had used it to buy food. She had no serious expectation of ever repaying the loan, and appeared to have regarded it as a providential source of temporary relief, rather than a genuine opportunity to permanently better her situation. Our hosts gave no indication that this was anything other than a typical case of poverty alleviation lending.
With an officially estimated 23,500 people in the county still living below the CNY 500 per year poverty line, local government is now beginning to look at the possibility of 'poverty alleviation through relocation' (yimin fupin) -- moving people from the most inhospitable, mountain environments to lower lying land. But, quite apart from the costs of doing this (put at around CNY 20,000 per house old), and the fact that communities are not always receptive to the idea (local officials put this down to superstition, saying that the Yi people fear inhospitable 'ghosts' in the new areas), there is simply a chronic shortage of available farmland. The reforestation of sloping land will exacerbate this, unless the policy can be implemented in ways that promote viable, alternative livelihoods.
For much of the population, it might appear that the best chance of improved living standards would come from migrating, at least temporarily, to work outside the county, which offers extremely few opportunities for earning off-farm income. But, in fact, out-migration from the county is generally very low. According to Vice-governor Liu, there are significant migrant flows both in and out of the prefecture considered as a whole, mainly to and from Chengdu, Panzhihua and Kunming; but Yi people from the poorest counties seldom leave, because they lack the cash to invest in the journey and the skills (including proficiency in Mandarin) to find work. This analysis seemed to be borne out by our visit: we did not find any households where people had left to work elsewhere. One young man, aged 22, who lives right beside the main road only 30 kilometres from Jinyang county town, told us that he goes to the town only once a year, and had never visited the prefectural capital, Xichang. The CNY 80 bus fare from Jinyang to Xichang is itself an investment that few families can afford.
T he cash strapped county government is equally hard put to invest in diversification, especially since the introduction two years ago of the national logging ban, which entailed the closure of several logging companies in Jinyang, reducing total county revenues by 20%. (In the west of Liangshan, the vast and sparsely populated Muli Autonomous Tibetan County was even worse hit, losing fully 90% of local revenue). Last year, Jinyang county government raised no more than CNY 5.85 million, which was not even enough to cover the salaries of the county's 3,000 government employees (including 1,200 schoolteachers). Apart from the poverty alleviation funding stream, targeted to special projects, the county is heavily dependent on budgetary support from prefectural and provincial governments in order to be able to maintain even the most basic services.
Education is a case in point. The County Education Bureau claims quite high primary school enrolment rates - over 80% even among Yi girls - but accepts that many children withdraw from school during peak agricultural periods. (This is exacerbated by the lack of modern agricultural technologies, making farm work highly labour intensive.) But the county has only six middle schools (compared to 212 primary schools) and is concentrating on universalising the first six years of primary schooling, rather than the whole nine years of theoretically compulsory education. Conditions in the primary schools are extremely basic, and very many of them are considered to be structurally unsound.
From the evidence of our visit, the reported primary enrolment rates of above 90% on average seem surprisingly high, since virtually every family we visited had at least one child out of school. Yi families are often quite large: couples are allowed, under discretionary population policies, to have three children, but in several cases we found families with four of five. Given extremely low cash incomes, it would be surprising if in nine out of ten cases parents could find the CNY 150 per annum for administrative and text book fees.
In fact, high enrolment rates are achieved only through explicit and implicit subsidies. Poverty alleviation funds of CNY 10,000 per year are allocated to covering living expenses of children in boarding schools and, according to the county government, since 1998 teachers in the county have themselves contributed, out of their own pockets, a total of CNY 410,000 to cover book fees for students. (This suggests that teachers in the county donate an average of more than CNY 100 each in this way every year). In addition, in one village in Butuo, we found a child whose book fees had been covered by contributions from slightly better off neighbours; the child's family said several other children in the village (although not all of those in need) were supported collectively in this way, and this appeared to be quite common practice in the area.
Getting children into school is of course only the very beginning of the educational process, and in Jinyang the barriers to significant learning achievement are daunting. Perhaps pre-eminent among them is the extremely difficult issue of language. County education authorities say the early grades of primary school are taught in Yi language, with Mandarin being introduced as the main language of instruction at a later stage. Children who drop out of school before completing basic education may therefore have only a smattering of Mandarin, which will constrain their potential in later life for engaging with the wider world; and even those who stay through junior high school will be disadvantaged in progressing to higher educational levels within the Mandarin national curriculum. Yet, given resource constraints and the initial, relative scarcity of well trained and fully bilingual Yi teachers, it would be extremely difficult to introduce bilingual teaching methodologies that can broaden children's educational horizons while at the same time preserving their own cultural heritage and language.
It is in the field of public health care, however, that the lack of government resources and capacity to provide services is most clear, with high social cost to the population.
According to the Jinyang Red Cross Association, not one of the Public Health Bureau's 253 health personnel is a fully qualified graduate of a medical university, and only 25 are graduates of senior vocational schools. Recent years have seen a steady drain of qualified staff out of the county. Most of those remaining have received only relatively basic training as paramedics and nurses. But even counting all 253 as health professionals, the county still has a ratio of only 1.94 health staff per 1,000 people, compared to a reported national average of 3.43 per 1,000. (The latter figure is derived from the 2000 Statistical Yearbook, which gives a total of 4.46 million health 'medical technical personnel' in China in 1999).
In 1993, when national guidelines gave the green light to do so, health authorities throughout Liangshan Prefecture stopped paying stipends for village level health workers, and the famed 'barefoot doctor' system simply fizzled out.
Existing human (and thereby financial) resources are heavily concentrated in the county seat. The Jinyang county hospital employs 125 people, and last year received CNY 1 million (USD 121,000) from the local government, covering 85% of its wage bill, which includes pensions for retired staff. The remainder of the wages and other overheads, were covered from net income of CNY 120,000, gained from a total CNY 800,000 in user charges. (A further CNY 680,000 is still owed to the hospital by patients who have not yet settled their bills).
This grimy, 100-bed facility is housed in dilapidated buildings virtually devoid of equipment. The 'emergency room' contains nothing but a bed. The obstetric department comprised two ancient delivery beds. The operating theatre, with ill fitting windows giving on to the yard below, also contained nothing more than an operating table with stained sheets and a vintage, overhead lamp, casting an uncertain, yellow light. The laboratory has no microscope or facility for testing blood.
At the time of our visit the hospital had less than ten in-patients; because, as hospital director, Lu Zhenghua, readily agreed, despite the extreme modesty of the facilities, people in need simply cannot afford to come. He estimates occupancy over the year as being no more than 20-30%, and there appears to be a clear, downward trend. Eight or nine years ago, he says, when village health workers were still paid through the public health system, occupancy rates for the hospital were around 70-80%. Thus, nearly half of the county's total budgetary expenditure on health care is now going to a facility that only a fraction of the population can afford to use.
Outside the county town, provision is even more rudimentary. A roadside township 'hospital' we visited consisted of three, dirty rooms, in one of which was a single, rickety bed for in-patient care. The hospital in fact appears to function as a simple clinic, with a very small supply of drugs, in several cases beyond their expiry date. Anomalously, in the middle of the consultation room, was a brand new, and apparently as yet unused, delivery bed. The doctor told us it was higher government policy to equip all township hospitals with such beds, at a cost of CNY 2,000 each.
In neighbouring Butuo County, we found the same, sorry situation. According to the head of the County Health Bureau, Zeng Min, average life expectancy in the county is no more than 44-45 years, compared to a national average of 71 years. Local government, he says, has stipulated that at least 5% of local gross domestic product should be allocated to health care, to reverse declining health standards. But, in this county where half of the 138,453 population (97% of whom are Yi nationality) are living below the poverty line, and where the government itself only raised CNY 10.6 million in revenue last year, it has not yet been possible to allocate as much as 3%. Again, none of the 292 medical personnel (2.1 per thousand of population) are fully qualified medical doctors, and only 28 are senior vocational school graduates.
The Butuo County Hospital is cleaner and more airy than its Jinyang counterpart, but no better equipped. It employs around 90 staff and has 48 beds but, when we visited, only seven of these were occupied. General consultations are provided through an outpatient clinic.
A few hundred yards away is another, much shabbier 'rural district' hospital, with 25 staff and five retirees on the books. The health bureau covers 94% of wages and pensions. This facility had no in-patients at all, but its outpatient clinic offers slightly cheaper treatment than that available in the county hospital. Typical charges for common ailments are CNY 3-7 for treating a cold; CNY 15-16 for diarrhoea (treated with rehydration and antibiotics), and CNY 20-30 for respiratory infections. This hospital is also responsible for maternal and child health and anti-epidemic work in one of the county's five administrative districts.
County-wide responsibility for both these areas of work falls to 'stations' in the county seat. The Anti-Epidemic Station has an annual budget of CNY 220,000, which covers wages for 23 staff and pensions for 9 retirees, but very little else. According to its Director, Tang Bing, staff often pay their own bus fares to deliver vaccines to township facilities. Not since the 1980s has the station had access to a vehicle of its own. Of the five, district-level Anti Epidemic Stations in the county, only one has an operational refrigerator to store vaccines. In these adverse conditions, Director Tang estimates that effective vaccination coverage in the county is 85-90%.
The county Maternal and Child Health Station (fuyou zhan) has 14 staff and 4 retirees. In the last year, only two women have given birth at the station. In the same period, it has performed around 150 voluntary abortions, charging CNY 50 each. (The Family Planning Station, which we did not visit, also performs abortions). The MCH workers are nominally responsible for outreach training and preventive work in the villages, but since the suspension of the village health worker system their activities are largely confined to supervision of staff at district and township level.
In the view of Station staff, almost no pregnant women in rural areas receive the recommended three ante-natal checks, and home deliveries are virtually universal. According to the MCH workers, Yi women traditionally give birth standing or kneeling. The MCH workers regard this as a dangerous practice. They also stress that rural homes have no clean instrument to cut the umbilical cord, or clean clothes to swaddle the infant.
Last year, there were 2,700 recorded births in the county, and 18 maternal deaths, suggesting a maternal mortality rate of 667 per 100,000 live births, around ten times the reported national average. The MCH station puts infant mortality last year at 292 per 1,000 live births - more than ten times the reported national average. Given typical family sizes of three or four children, it is probable that most poor families will experience at least one infant death.
The prefectural government is now hoping to revive the village level health worker system, and has allocated funds to pay stipends of CNY 100 per year to 1,200 primary health care workers, dispersed among the Prefecture's 4,200 villages. But, officials say, they have no funds to provide training or basic medical equipment for the village doctors. In Butuo, the county level training facility closed down several years ago.
Given the local government's frankness in discussing these issues and apparent determination to address them, there appears to be an excellent opportunity here for an international organisation to become involved in revitalising the primary health care system. But to do this successfully it will almost certainly be necessary not just to improve equipment and training, but also to rationalise the use of current resources, which are currently concentrated at county level, yet at the same time fragmented among different service providers
About the article:
Report by Nick Young with Fu Tao. Particular thanks are due to Mr. La Jiankang of the Liangshan Red Cross, who facilitated our visit, and to all the officials we met, who were helpful, open and forthright in discussing all aspects of this report. Agencies interested in potential collaboration with the authorities in Liangshan should in the first place contact Mr. La Jiankang: Tel/Fax +86 (0)834 216 9454 or (0)834 366 9492
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