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Evaluating Family Planning Organizations Under China’s Two-Child Policy in Shandong Province

by Lizheng Xu 1,2, Fan Yang 1, Jingjie Sun 3, Stephen Nicholas 4,5,6,7,* and Jian Wang 8,9,*
Center for Health Economics Experiment and Public Policy, School of Public Health, Shandong University, Key Laboratory of Health Economics and Policy Research, NHFPC (Shandong University), Jinan 250012, China
School of Health Sciences, Wuhan University, Wuchang District, Wuhan 430071, China
Shandong Provincial Health and Family Planning Information Center, Jian 250014, China
School of Management and School of Economics, Tianjin Normal University, West Bin Shui Avenue, Tianjin 300074, China
Newcastle Business School, University of Newcastle, University Drive, Newcastle, NSW 2038, Australia
Guangdong Research Institute for International Strategies, Guangdong University of Foreign Studies, Baiyun, Guangzhou 510420, Guangdong, China
Top Education Institute, 1 Central Avenue, Australian Technology Park, Eveleigh, Sydney, NSW 2015, Australia
Dong Fureng Institute of Economic and Social Development, Wuhan University, Dongcheng District, Beijing 100010, China
Center for Health Economics and Management at School of Economics and Management, Wuhan University, Wuchang District, Wuhan 430072, China
Authors to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(12), 2121;
Received: 23 May 2019 / Revised: 11 June 2019 / Accepted: 11 June 2019 / Published: 14 June 2019
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. View Full-Text
Keywords: family planning; government financing; organizational change family planning; government financing; organizational change
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Xu, L.; Yang, F.; Sun, J.; Nicholas, S.; Wang, J. Evaluating Family Planning Organizations Under China’s Two-Child Policy in Shandong Province. Int. J. Environ. Res. Public Health 2019, 16, 2121.

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