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Huang Xiao'e is very grateful for the rural cooperative medical scheme (RCMS).

Lying in her hospital bed with her husband sitting beside her, she is recovering from an operation she has just had on her stomach.

Thanks to the RCMS, Huang's procedure at the township hospital near her home in Dunzhou village in the northern part of Fujian Province cost her just over a third of what it would have at a city hospital.

She could not have afforded the full price, and the nearest alternative hospital is a two-hour bus ride away.

Launched in 2003, the RCMS now benefits more than 90 percent of the nearly 2 million farmers in Nanping city. And as well as helping the people, it has breathed new life into many of the local township hospitals, several of which were previously on the verge of closure.

Cai Zhongmu, deputy head of the Nanping health bureau, said most of the city's 120-plus township hospitals were built in the 1960s and 70s. Prior to the launch of the RCMS they had an average of 12 to 15 employees and just 100,000 to 200,000 yuan ($13,500 to $27,000) worth of equipment.

Almost all of them were in arrears with employees' wages, so no one bothered to work, or even turn up. "It was a classic vicious circle," he said.

But things have changed thanks to the RCMS, Zhou Dongwei, head of the health bureau in Nanping's Shaowu County, said.

Farmers have to pay just 10 yuan a year to join the scheme, which encourages them to use local hospitals instead of city-based alternatives. In return, patients pay only a fraction of the usual treatment fees, he said.

As a result, the township hospitals have been revitalized, he said.

The popularity of the RCMS also provided the catalyst for further support measures.

Following its launch, the Fujian provincial government took the decision to fully finance the renovation of 100 township hospitals every year. And in a 2005 document, it ordered all city-level governments to make annual donations of medical equipment to hospitals in their jurisdictions.

Furthermore, all doctors and nurses in Nanping must now work for at least one year in a township hospital before they can apply for promotion. And since 2005, 200 medical professionals from the townships have taken part in exchange programs with their colleagues in city hospitals to boost their experience and learning. But there is still work to be done, Ying Bin, the health chief for Nanping's Yanping district, said.

"This isn't a long-term solution, of course. We need to do more to ensure the sustainable development of our medical talent in rural areas.

"Policy and financial incentives should be introduced to encourage doctors and nurses currently working in the cities to return to their hometowns in the countryside," he said.

Cai agreed: "What we have now are short-term solutions.

"We need to provide more help for the support agencies and better manage the transfer of doctors."

But he remains positive about the progress that has been achieved.

"Township hospitals are the very heart of China's medical network. Thanks to the central government's policy and the measures we have introduced, we have been able to transform them from moneymakers into service providers," he said.

"I am confident we will see even more improvements in the future."

(China Daily November 15, 2007)