He was diagnosed with tuberculosis last year, but had no money for treatment, His wife's salary is around 300 yuan (US$36) per month, and their son is attending university on a student loan.

Unable to afford the thousands of yuan needed for medical treatment, He thought he had no choice but to wait for death.

"He was skin and bones when I saw him in the middle of last month. What's worse, he had a high fever," said Zhou Zhaohui, an official from Tiexi Health Bureau who is now in charge of the Sino-UK Urban Health and Poverty Project (UHPP) in Tiexi District.

The pilot project covered He Honglin, and he was sent immediately to the local TB control center for treatment.

"He only needs to pay less than half of the treatment cost. If he still cannot afford it, he has a chance to receive additional aid," says Zhou.

Now He's disease is under control.

The UHPP is a national project co-funded by the Chinese government and the UK Department for International Development (DFID). The project focuses on urban health reform and poverty alleviation and is also the country's largest ongoing community health and medical aid program.

It is currently being piloted in four cities-Shenyang; Chengdu, in southwest China's Sichuan Province; Xining, northwest China's Qinghai Province; and Yinchuan, northwest China's Ningxia Hui Autonomous Region.

Shenyang's Heping and Tiexi districts have been chosen for the experimental project.

He Honglin is far from being the only beneficiary. More than 2,000 people in Tiexi District had received medical aid from the project by the end of March, according to Zhou.

"As the nation's traditional industrial base, Shenyang has suffered a great economic downturn in the past decade. There are many laid-off workers whose health requires special attention," says Li Weiran, an officer with Heping District Health Bureau.

Heping District alone has over 20,000 residents now living on the government's minimum subsistence allowance, and in Tiexi there are 26,942. These figures are much higher than in the other three experimental districts in Shenyang and Chengdu.

Since the project was put in place last August, the residents have enjoyed a ceiling subsidy of 2,000 yuan (US$241) for inpatient care. Disadvantaged and elderly residents can receive another annual payment of 60 yuan (US$7) for outpatient services.

The significance of UHPP

Dr. An Ni, UHPP national project manager, says the project now covers 2.6 million people in Shenyang and Chengdu. Around 76,800 in the two cities have benefited or will benefit.

Xining and Yinchuan, where the project is expected to cover the whole city, are attempting to follow suit.

"When I see people who benefit from our project and are able to live a healthy life, I feel very happy, as what I have done is of great significance," said An.

In fact, the ultimate aim of the project goes beyond just helping low-income people obtain medical care. It is exploring and setting up a new urban health system model for China.

"Since the very beginning, we have set our sights high. It is not just about the distribution of medical aid, but the exploration of a new healthcare model," says An.

An says they have designed four different experimental projects for the four pilot cities.

Because of the number of laid-off workers in Shenyang, the project there mainly covers local the members of this group who are living on a subsistence allowance.

In Chengdu, the project focuses on the large migrant worker population.

"This way, can we provide different models for government policy-makers. So even if some of the models ultimately fail, we may still have successful ones," says An.

Close attention is given to every detail of the project.

"We must make the budget as exact as possible before implementation. Otherwise, we cannot say the project is accomplishing its goal even though it may help many people," she says.

To ensure the success of the project, activities have been organized to help improve community healthcare. In Heping District, doctors and nurses from community health service stations have been organized to take part in formal medical training at China Medical University, according to Li Weiran.

Another training program has been started for project managers at the national, municipal and district levels. Last year, 21 project managers were sent to Britain to take related courses.

These are all significant moves to improve the social security system and ensure medical care for people trapped in financial hardship, says Zhao Wu, deputy director of the Shenyang Municipal Health Bureau.

"This is not about just throwing money in. The more important point is that it offers us a new urban healthcare system model and creates a group of professional personnel," says Zhao.

The UHPP is working to set up a Chinese-style urban healthcare system that will improve public health services in cities, says Professor Meng Qingyue of the Health Management and Policy Research Center at Shandong University.

Substantial progress has been made since the project was launched in 2001.

"Before the central government decides on a new policy, An has already experimented with it. She can provide us with the hands-on experience when we are making decisions," says Wang Hui, a senior official with the Civil Affairs Ministry.

(China Daily April 28, 2004)