‘Hybrid’ top down bottom up health system innovation in rural China: A qualitative analysis

Joris van de Klundert, Dirk F. de Korne, Shasha Yuan, Fang Wang, Jeroen van Wijngaarden · 2020 · PLoS ONE

Summary. China's Rural Health Reform Project piloted a hybrid top-down and bottom-up approach to health system reforms across rural counties serving 21 million people. Initial implementation struggled because counties lacked autonomy and initiative, but tight top-down supervision combined with expert support helped counties develop the mindset and capabilities to tailor reforms to local needs. Successful counties achieved sustainable improvements and developed advanced learning capabilities.

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Klundert, J. V. D., Korne, D. F. D., Yuan, S., Wang, F., & Wijngaarden, J. V.. (2020). ‘Hybrid’ top down bottom up health system innovation in rural China: A qualitative analysis. PLoS ONE. https://doi.org/10.1371/journal.pone.0239307

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  title   = {‘Hybrid’ top down bottom up health system innovation in rural China: A qualitative analysis},
  author  = {Joris van de Klundert and Dirk F. de Korne and Shasha Yuan and Fang Wang and Jeroen van Wijngaarden},
  journal = {PLoS ONE},
  year    = {2020},
  doi     = {10.1371/journal.pone.0239307},
  url     = {https://doi.org/10.1371/journal.pone.0239307}
}

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Details

DOI: 10.1371/journal.pone.0239307
Countries: China
Regions: Asia
Categories: rural-healthcare, policy
Added: 2026-04-28