DESPITE growing worries about SARS in Shanghai, Wang Zhizhi, a migrant worker from Southwest China's Sichuan Province, isn't even thinking about leaving the city to return to his hometown.

　　"If, unfortunately, I was hit by SARS here, the hospitals would be able to treat me; but in my hometown, probably it's death waiting for me," Wang explained.

　　It's sensible of Wang wanting to stay in Shanghai because the city with its more than 16 million population has a complete health and medical network in place ready to prevent or, if necessary, to combat any SARS outbreak.

　　Up until May 14, locally confirmed SARS cases remained at seven with one death.

　　This achievement in preventing a major SARS outbreak, similar to the ones which occurred in Beijing or Hong Kong, has been attributed to the city's high state of readiness to cope with the disease and this has been acknowledged and praised by officials from the World Health Organization.

　　Vulnerable countryside

　　While overseas and bordering countries are worried about the risk of SARS spreading outside China, the government in Beijing is worried about the disease spreading into China's rural areas - especially into Western China where medical infrastructure is in a comparatively poor state and there is a shortage of trained medical staff.

　　The battle against SARS now involves 25 provinces and municipalities on the Chinese mainland, but the countryside always remains the weakest link in the chain.

　　SARS victims in rural areas are mainly confined to Guangdong, Shanxi and Hebei provinces and Inner Mongolia.

　　Experts have cautioned that while the overall epidemic rate is falling, it is rising in rural areas.

　　"It's time to improve the healthcare situation in rural areas and rebuild the old co-operative medical insurance system," said Gu Xingyuan, a professor at the Public Health School in Fudan University.

　　In Shanghai's suburban districts, about 80 to 90 per cent of farmers and rural workers are covered by co-operative medical insurance. But the figure around the rest of rural China is less than 10 per cent. As a result, most of China's 800 million farmers, about two thirds of the total population, have to pay all their medical bills in cash.

　　The out-of-pocket payment deters farmers from going to hospital or forces them to go in for treatment much later than they should have because of fear of what the medical treatment will cost.

　　As a result, a disease which should have been treated at an early stage develops into a really serious condition.

　　Also, farmers forced to borrow money for medical treatment then find the repayments make their lives even more impoverished.

　　"Illnesses and high medical expenses put about 40 to 50 per cent of poor farmers into a troubled financial situation," said Gu.

　　Good old days

　　China was once praised by the World Health Organization and the World Bank for its unique success for improving the health of its rural population.

　　"All this was due to the mass-coverage of rural co-operative medical insurance system, which covered almost 90 per cent of the entire rural population," said Gu.

　　The farmers had to pay very little money for medical treatment and the government had trained several million "barefoot" doctors who had mastered a basic medical knowledge who practiced medicine at the rural grassroots.

　　"After graduating from high school in 1970, I was trained and served as a 'barefoot doctor' for over three years in East China's Jiangsu Province," said Wu Hongmei, now 51.

　　"The work at that time was very busy and hard but very fruitful. Every day, I went to four or five villages to see my patients and my medical training was good enough to treat common diseases from head to toe."

　　Although the system was designed to provide only basic healthcare services for the farmers, it greatly lowered the rural mortality rate and improved life expectancy to more than 70 by the 1980s.

　　However, this tremendously successful "grassroots" healthcare system slowly collapsed after the economic reforms started in 1978.

　　When the collective economic system started to end, the financial source for the co-operative medical schemes also dried up.

　　Experts frankly admit that while the economic reforms in China have proved beneficial in most areas, they have destroyed the public health system for the rural population.

　　Fiscal inputs urged

　　Between 1998 and 1999, Professor Gu took part in rebuilding a new co-operative healthcare system in a poor town in Anhui Province.

　　But the programme failed within one year. "The medical costs charged by hospitals was much higher than the fund collected by the farmers," he said. "Without government support, the system will eventually end in failure," Gu said.

　　The fundamental problem is that all hospitals with very little government fiscal support now are market-oriented, having to survive through high charges for medical treatment and the sale of expensive drugs.

　　In some rural areas in Guizhou, Yunnan and Shaanxi provinces, a strange social phenomenon is now being seen - the richest people in the villages are businessmen and the owners of rural clinics.

　　"The SARS crisis could be a turning point for China to rebuild its public health system especially in the rural areas. The government should pay more money for basic healthcare because a little investment will save much more in medical costs later," Gu said.

　　The central government has allocated 2 billion yuan (US million) to set up a SARS prevention and treatment fund from which 600 million yuan (US million) is earmarked for a national disease prevention and control system.

　　"This is just the first step but a good beginning to reform the medical system," said Gu,"but the public health system needs continuous fiscal input."

　　Experts also called for a drafting of the Public Health Law to provide a statutory basis for the government's financial contribution to public health.