The relatively poor quality of and the generally high costs of China's rural health care has been a major concern of policy makers. The issue is particularly acute in remote areas where people have very little cash on hand to afford treatment. In many cases, villagers delay medical attention until their

symptoms become unbearable. Although rural health care facilities are mandated to provide preventive health care for all, due to limited resource input from the government and low motivation of personnel, in reality the health centres mainly only provide vaccination service for infants.

In order to motivate health-related personnel in rural areas to be more responsive and innovative, PCD has joined with teachers from Kunming Medical College (KMC), Sichuan University Public Health School (SCPHS) and Yibin Women's Federation (YWF) to organise a series of training activities for approximately 25 rural health care workers from Gong and Pingshan counties in the Yibin area of Sichuan Province. The objective of this initiative was to provide a platform for the participants to exchange views on promoting good quality and affordable community-based health services. The “community-based approach” refers to the principle of promoting self-mobilisation and decision-making by the local community on issues at hand, in this case health care. It also emphasises the use of local resources and sensitivity towards local culture and values.

Apart from exchanging views on best practices, participants form themselves into 5 action groups and are given a small grant to implement community-based primary health activities. Four out of the five initiatives have focused on health education for women, such as health education events targeting village women, selecting volunteers from the targeted village, and the provision of basic health checks with local hospitals. One action group promoted community participation in monitoring health services provided by the local hospital, such as setting up suggestion boxes, selecting volunteers from local neighbourhoods to act as liaisons between communities and the township hospital, and organising ways to facilitate dialogue between liaison volunteers and hospital staff.

Instead of adopting a hospital-based approach, many participants were prompted to reach out to rural communities. The feedback received from the rural women was clear: they never had such an opportunity for learning before and were desperate for health education. Simple messages such as washing one's underwear daily and separating it from other laundry, and drying it out thoroughly under the sun, are basic yet important reminders for preventing gynecological disease. An additional value of the outreach activity is that it brings women together to talk about their problems and to find solutions together, through their shared wisdom.

To ensure effectiveness of this outreach, it is crucial to enhance the capabilities of the outreach workers, including communication skills, motivation and attitudes. PCD is developing ways to build this capacity in our projects.