Building policy capacity for managing rapid, complex change in China’s health system

Abstract

Abstract The concept of policy capacity is often used to explain the success or failure of governments or countries in conceiving of, developing, and implementing policies, but is often poorly systematised. Wu et al provide a framework for understanding types of policy capacity, arguing that three kinds of capacity, distributed across policy systems, are needed for effective implementation. This paper applies that framework to a discussion of China, a country that has been managing a fundamental transformation since at least the late 1970s, which has underpinned the country’s growth and development. The paper focuses on a subset of China’s reforms – reforms to the healthcare system since the 1990s. Discussion of policy capacity shows (1) that policy capacity is dynamic and adaptive, in response to changing challenges due to rapid transformation in the country; (2) that the development and distribution of capacities has, overall, been government-directed, with strong research and analytical support from public think tanks and universities; (3) that understanding of policy capacity is evolving, with government paying increasing attention to the need to develop a learning state and society in response to increasingly complex problems of development. Examination of the Chinese case has relevance for how other countries develop and adapt policy capacities over time to manage rapid transformation, uncertainty and shocks.