By ANDREW JACOBS, New York Times, Published: December 2, 2009

 (Abridged from artilce entitled “H.I.V. Tests Turn Blood Into Cash in China“)

 …Although not trumpeted in its promotional materials, the foundations (Gates Foundation) other goal is more far-reaching: to empower the small but growing crop of nongovernmental groups that stand a better chance of addressing the AIDS epidemic than Chinas lumbering bureaucracy does.

To carry out its mission, the foundation has linked up with the Ministry of Health, which funnels $20 million to about 200 nonprofits, many of which exist in a bureaucratic gray zone and are viewed suspiciously by Chinas authoritarian government.

The distrust flows both ways.

By compelling the government to work with privately run organizations, the foundation is hoping to foster a lasting relationship between them and over time contribute to creating more profound changes in Chinese society.

Dr. Ray Yip, who runs the foundations China effort, acknowledges problems with the program but likens them to growing pains.

We are experiencing some of the hiccups of a less-than-perfect arrangement, but we expected that, he said. If you look historically at arranged marriages, some of them last.

Dr. Yip, who is the former director of the Centers for Disease Control and Prevention office in China, embraces the Gates Foundations philosophy of bold initiatives and risk taking traits often lacking in government-run global health behemoths. He said that if some of the money ended up in the pockets of corrupt officials running fake organizations, it was the cost of doing business in China, where government malfeasance is endemic.

We dont expect every grant in every city to be spectacularly successful, he said. Thats like buying 30 stocks and expecting them all to go up.

Sun Jiangping, deputy director of Chinas National Center for AIDS/STD Control and Prevention, said the program had already had a positive impact on government attitudes toward private AIDS organizations, whose numbers have increased to more than 400 from just a few dozen when the initiative started. He said his agency was working to weed out illegitimate groups.

Compared with the rates in other developing nations, the prevalence of H.I.V. in China is relatively low, with fewer than a million people thought to be infected, according to government figures released last week.

But public health experts are alarmed by an infection rate among gay men that has been doubling annually. By the end of 2008, nearly 5 percent of gay men in Chinas largest cities were thought to be H.I.V.

positive; in some cities, that figure exceeds 10 percent. Health officials say gay men now account for a third of all new transmissions, up from 12 percent in 2007.

Advocates for people with AIDS say the government has been ham-handed in its efforts to prevent the spread of H.I.V., in some cases banning condoms in bars or hounding activists who become too vocal.

In recent years, organizations have sprung up to help those with AIDS who are refused care by hospitals. Many, like Deep Blue, a group that operates from an apartment on the outskirts of Tianjin, are largely financed by grants from abroad.

Deep Blues two counselors meet with the 50 people who come each week for an H.I.V. test.

If you have any questions, contact the volunteers with the red armbands, says one poster. You can stop the testing at any time,

says another. About 65 percent of those who test positive come back for counseling, said the groups director, Yang Jie.

Tong Ge, a veteran AIDS activist who has advised the Gates Foundation on its China program, said he was pleased with the foundations work, though he said he wished there was more of an emphasis on training government workers and less money spent on testing. His biggest regret, he said, is that the foundation chose to funnel the money through the government.

So much of the Gates money has ended up nurturing corruption in a place it didnt exist before, he said. Then, after a pause, he added:

But the truth is we cant blame them. The real problem is with China.

 (Orginal article available at http://www.nytimes.com/2009/12/03/health/policy/03china.html?_r=2)

This partial delegation of government functions to social organizations is key to the guideline of Shenzhen’s current administrative reform. In line with previous statement, the government is to resolutely quit its roles unnecessarily presumed before. Even if the market is experiencing temporary downturns, the government will leave the leading role to social organizations and enterprises, and provide only necessary support.

The overall reform is to cancel, alter, and delegate over 300 administrative ratification items governmental functions in total, including the 100 functions being delegated this time.

But the Shenzhen government can only succeed if social organizations are capable to shoulder up the delegated responsibilities, and only if relevant laws and regulations can provide adequate support. Another potential concern is how to prevent social organizations from becoming “government branches” as they adapt to their new roles.

If government administrative system reform only aims to change the internal distribution of administrative power but does not weaken the disproportionally strong administrative branch, its effect can only be increased administrative efficiency, but not increased social justice. Neither can the reform be effective if it does not extend to the governance of social organizations but simply shifts the administrative power from the government to de facto government branches.

The current system has been repressive to the growth of social organizations. Citizens who would like to establish social organizations have to register through bureaus of Civil Affairs. To register, the organization needs to be affiliated with a governmental branch. Without such affiliation, an association can only acquire legitimate legal standing by registering through the Administration for Industry and Commerce as a corporate without tax exemption or the legal status as a non-profit. As a result, many Government-Operated Non-Governmental Organizations (GONGOs) have become the dominant “non-governmental organizations”. Such GONGOs, not surprisingly, resemble government branches more than real non-governmental organizations that should be open, rigorous, and autonomous.

However, the GONGOs that closely connected to government—in history, in terms of structure, in personnel make-up or even in directly affiliating with government branches—have been selected as the major undertakers for government to delegate its functions during the reform. They have gained an edge over real non-governmental organizations through a de facto unfair competition. Additionally, the GONGOs that have long been under protection of the government are often severely handicapped in their capabilities, operational mechanisms, professionalism in service and creativity, which make them bad candidates for undertaking the reform that focuses on innovation.

The government also needs to change its mentality regarding its relationship with social organizations. Instead of regarding itself as the “sponsor” of all social organizations, it should establish mutual respect with them and cooperate with them as equals, in accordance with the goal of achieving a balance of “government, market and society”.

Hence, the emphasis of the reform should be placed on removing administrative barriers that impede the growth of social organizations. As the government still takes the dominant position in policy reform, its mentality and decisions are vital to the success of the reform.

Columnist Li Jianhua sees this reform as one greatly benefiting the growth of social organizations. He notes that many of these delegated governmental functions involve “training and qualification of professional personnel” such as qualification assessment of accountants and tour guides, and quality evaluation such as hotel star classification, tourist attraction star classification, and travel agency qualification assessment.

Li notes that Chinese social organizations are relatively backward and are yet to acquire substantial influence, partially due to the overly imposing government restrictions. By taking up too many functions that could have been delegated to social organizations, the government left little space for the growth of social organizations. The reform, then, will be in line with both the governmental function reform and the need to strengthen social organizations.

To Li, Social organizations are autonomous non-profit organizations that represent certain public interests, and therefore competitive in nature: they compete with each other for “social recognition”, “social praise” “member satisfaction”, “social impact” and so on. Hence, for any event – an environmental cause, a charity event, or a hotel star classification assessment – there will very likely be several social organizations competing for the chance to undertake. Reasonable competition among social organizations can promote their growth, vigor, and make social organizations more useful in helping the society function and grow. Hence, the government should promote competition and avoid monopolizing when delegating its functions out to social organizations.

Li notes that trustworthiness of a social organization comes from its performance in organizing activities. Li suggests that China should take faith in the public’s judgment, in the capability of autonomous organization of the society, and in social organizations’ self-discipline and administration, all of which are core to the idea of an autonomous society with sufficient self-government.

(Translated by Yichen Chen and proofread by Hong Liu of Harvard University. Original abridged from  http://gd.news.sina.com.cn/news/2009/09/21/665724.html and http://www.chinanpo.gov.cn/web/showBulltetin.do?id=39801&dictionid=1940)

Since then, the number of registered and non-registered NPOs (nonprofit organizations) has increased in China in the recent decade, and along with this growth, the philanthropic and policy environment has gradually changed. Such changes were the focus of the afternoon panel discussion at the Hauser Center for Nonprofit Organizations on September 30, 2009, moderated by Professor David Brown, Senior Fellow at the Hauser Center, which brought together main figures from different sectors of the Chinese philanthropic world: Zhuang, Professor Hanlong Lu from the Institute of Sociology at the Shanghai Academy of Social Sciences, an expert on social policy in China, and Zhaomin Jin, Executive Director of the NDC and previous Deputy Secretary General at Shanghai Charity Foundation, a government owned foundation.

Zhuang began the panel discussion with a brief introduction to the development and expansion of her NPO Development Center in Shanghai, emphasizing the importance of such NPO support organizations to help enhance the capacity and legitimacy of grassroots NPOs—an “NPO for NPOs” of sorts. Such capacity and legitimacy may be difficult for grassroots NPOs that often lack professional resources to achieve on their own, especially given the rising expectations for Chinese NPOs by the government, donors and beneficiaries.

According to Zhuang, the key points to cultivating NPO success are to provide a supportive policy environment, good promotion and advocacy on the part of the media, and access to services such as training, coaching and networking. NDC’s influence and strength grew rapidly by strategically levering such needs and creating its niche as one of the few capacity building organizations. In addition to coaching NPOs in important skills such as grant writing and strategic planning, NDC has also helped bring together and forge partnerships between NPOs and the local government. NDC has expanded its services to NPOs throughout China and has created constituents in different areas such as health, disability and the environment. 

Over the past five years, NDC has trained over 4,000 executives and managers in the nonprofit sector in China, and has provided consulting to over 100 NPOs and corporations.

However, like most other nonprofits in China, NDC still faces major challenges of sustaining funding and recruiting highly qualified professionals.

Professor Lu followed up Zhuang’s introduction to her own NPO with a broader discussion of the policy and attitude changes towards NPOs and philanthropy in China throughout the last few decades. 1989 was the baseline year for recognition of NPOs with the establishment of the “Management Regulations of Social Associations,” one of the first documents outlining the Chinese government’s policy towards NPOs. Another key year was 2002, when China officially entered the World Tread Organization. Finally, he pointed to the 2008 earthquake in Sichuan that saw thousands of volunteers and donors gathering to help the victims, and the 2008 Beijing Olympic Games, which also inspired thousands of volunteers to action, as the most prominent signs of the emerging importance of philanthropy in China.

Lu divided Chinese social organizations into three categories: social organizations (such as the Chinese Handicapped Organization), civic non-profit enterprises (such as the NDC), and foundations. Between 1999 and 2008, the total number of social organizations in China increased by an astounding 290%, from 142,665 to 413,660.

Despite this increasing presence of social organizations, however, the official registration process continues to be restrictive. Registration requires the approval (or sponsorship) of a government agency at the county level or above. To prevent unnecessary competition, there can only be one of each type of organization in a given district.

Recent changes see, however, some regional government directing more resources towards NPOs; with greater provision of funding and even free NPO office space, the government is starting to include the development of the nonprofit sector into its long-term strategic plan.

Zhaomin Jin concluded the presentation portion with a brief overview of the current status of foundations in China, coming from her own previous experience of working at the Shanghai Charity Foundation. She noted that philanthropic donations in China are very unevenly distributed:  the top six foundations out of close to 1,600 foundations in China had collected 700 million dollars in donations out of the 1,200 million dollars collected by foundations in total last year. Furthermore, about 90% of all donations were received by “GONGOs”—governmental-operated NGOs—such as the Olympic Games Committee and the China Charity Federation.

According to Jin, most foundations in China run their own relief programs (operational foundations, rather than distributing grants to other nonprofits); for example, the Shanghai Charity Foundation operates nineteen branches throughout China and mostly allocates its funds to those programs. Even if funding is provided to other relief programs, very limited support is given to NPO support organizations like the NDC. However, recently, more and more foundations are moving towards becoming grant-making foundations, with Red Cross and Shanghai Charity Foundation giving out 8 million dollars for grassroots NPO programs last year.

When asked what they think will happen in the next ten years, all three speakers were hopeful about the increasing dialogue between the government and NPO sector and the gradual transition to a more enabling legal environment. Considering the immense rise of awareness of NPOs by the general public, especially following the 2008 Sichuan earthquake public relief efforts, the role of NPOs in Chinese society seems poised to increase.

Zhuang’s analogy of the philanthropic environment in China as a stage perfectly summarizes this optimism: “Currently, the government is the main actor on the stage; nonprofits are the ‘side figures’ running behind the stage. They’re there, but it’s hard to know what they’re doing or how they’re doing it. Eventually, the threshold to get on the stage will be lower; NPOs can then join the government on the main stage for equal assessment by all.”

(Written by Yongtian Tina Tan of Harvard University)

 “The global AIDS epidemic continues to worsen and is one of the leading develop­ment challenges of our era.” Facing this global crisis, “NGOs have played a decisive role in the response, both for advocacy and for services”, such as providing voices for the underrepresentative groups, promote risk-reduction education, providing HIV testing and treatment, and advocating for policy formulation.  

 China witnessed AIDS epidemic in the early 1980s and is now estimated to have 650,000 HIV infections throughout all of its thirty-one provinces, municipalities, and autonomous regions, with an annual growing rate of 30 percent. “Half of new infections are sexually transmitted, mainly among commercial sex workers, sexual partners of injecting drug users, and men who have sex with men.” Separately, in the late 1990s, a retired doctor revealed to the media a severe epidemic among former paid plasma donors due to tainted blood donation practice in Henan province, central China, as well as the indecent cover-up by the local government. While little care is given to the notorious groups of drug users and sex workers, public sympathy gradually arose for the “innocent victims of AIDS”, the farmers who rely on blood donation to improve their poor life a little bit.

 Learning from the failure of emergency preparedness and early response of SARS in 2003, China’s Center for Disease Control and Prevention’s National Center for AIDS Prevention and Control (NCAIDS) decided to take initiatives this time. To address the plight of AIDS-infected farmers of central China, “a free national AIDS treatment program was launched in 2003 by the Chinese government, called China Comprehensive AIDS Response (China CARES)”. China CARES not only “signaled the increase of political will to tack this problem”, but also increased funding substantially, put accountability on local governments and sent out intervention supplies. However, it soon realized that it was a mission impossible to resolve AIDS problems by the government alone, because “twenty years of fiscal decentralization and devolution of financing responsibility to lower levels has reduced the availability of social services, particularly health and education, in poorer areas”, thus opening up for the partnership with social organization or NGOs.

 “China’s overall NGO sector is unlike its counterparts in other parts of the world. In China’s one-party state, the political space for NGOs to operate is still very restricted, and government remains the main service provider, even for services that in the rest of the world NGOs have traditionally played a major role in deliv­ering. Paralleling the government service network, however, China’s mass orga­nizations and government-organized non-governmental organizations (GONGOs) operate through vertical hierarchies to local levels paralleling the government system…There are probably about two million civil society organizations in China, including foreign NGOs, trade and science associations, charity groups, farmers’ organizations, and doctor’s organizations…The working environment for Chinese NGOs is still beset by a climate of dis­trust. “It follows that “Chinese NGOs fall more into the sociological than into the political definition of civil society in terms of their relative levels of autonomy from the state and their shared goals.”

 “As with the overall context for NGOs in China, government remains the main service provider in the AIDS response, unlike in other countries, where NGOs play an important role in service delivery to marginalized groups. The government role has been mainly played by China’s Center for Disease Control and Prevention’s National Center for AIDS Prevention and Control (NCAIDS). The national CDC operates under the leadership of China’s MOH. At the provincial and local levels, the provincial health bureaus and their affiliated CDCs have led the AIDS response with designated responsibility for carrying out the official China CARES program of free testing and treatment provision and HIV prevention activities (with sub­stantial financial support from GFATM and other international donor programs), and are the main government counterparts for most international AIDS funding programs. Even though local CDCs are bureaucratically accountable to their own local governments (through local health bureaus), earmarked vertical funding from the GFATM through the CDC and health bureau system has increased their resources and independence to carry out technical work.

 However, because government-funded services such as public health educa­tion have been significantly weakened in the past two decades under China’s fee-for-service health system, which is focused on curative care, the need for greater local NGO involvement in China’s AIDS response is clear, especially to reach groups that avoid government scrutiny. And because the AIDS epidemic is expanding faster than the political space for NGOs at the local level, local CDCs have been engaging in pragmatic partnerships with grassroots NGOs and defend­ing that work to local government, therefore pushing the boundaries of what might normally be allowed. These pragmatic partnerships between local CDCs and grassroots NGOs are helping to improve understanding of the value of NGO roles, possibly to the benefit of all local NGOs in China.”

 On the other side, the diverse grassroots NGOs proliferate with specific focus on most at-risk populations like gay men, frequent migrants, youth, and on hard-to-reach populations. As we can imagine, some high-risk groups for HIV/AIDS, for example, drug users and sex workers avoid government services for fear of their illegal status and chances of being arrested. Unlike the government actions, NGOs are able to fill the gaps in need of most urgent services, to reach these marginalized subgroups, to provide outreach and education to gay men through hotlines and in bars and bathhouses, provide condoms to sex workers, exchange for needles and syringes, etc. In addition, online communities have been established and become an important “networking” mechanism in recent years “for groups with limited budgets for travel to conferences”. Undeniably, the value of grassroots NGOs have been more and more recognized by civil bureaus.

 Most inspiringly, NGOs have blazed their political space and made their voice heard in China. The country coordinating mechanism (CCM) founded the Global Fund in 2002 to fight AIDS “with a mandated governance mechanism that required the establishment of a group made up of civil society representatives.” Especially, Global Fund Round 6 is “an important further mechanism to institutionalize the AIDS NGO role in China’s AIDS response”, with commitment to local ownership and participatory decision making. China’s main AIDS GONGO is the Chinese Association of STD and AIDS Prevention and Control (CASAPC). Since 2000, the China STD AIDS Association has held several AIDS NGO coordination meetings, uniting grassroots NGOs to combat AIDS financially.

 Nevertheless, there is still space for improvement of collaboration between the government and NGOs for social service provision as follows:

 (1) Weak coverage of rural areas. Unless contracted and understood by the local government, even AIDS NGOs feel hard to reach rural areas, where medical professionals and employer health insurance are scarce.

 (2) Lack of operational funding. “Despite large amounts of donor funds for AIDS in China, little reaches the bottom”. To make things worse, “in-fighting between groups over funds, local ownership, and visibility has further inhibited needed coordination on advocacy and programs”.

 (3) Government’s unwillingness to cooperate under some conditions of political sensitivity. A typical example is the blood scandal of Henan province. For a quite long time following the revelation of the scandal by a retired doctor, the local government was still unwilling to respond directly on this issue. It detained and monitored the retired doctor and some media, and “conflicts between victim/patient groups and local government agencies have created a climate of distrust”. Regardless of the story-publicizing and censuring of human rights organizations outside of China, it will be very difficult for the government and NGOs to negotiate and cooperate.

 F0r more details see Chapter 8, The role of NGOs in China’s AIDS Crisis by Joan Kaufman, from Book State and Society Responses to Social Welfare Needs in China—-Serving the people, edited by Jonathan Schwartz, Shawn Shieh, Routledge, May 2009.

(Digested by Sheng Yongmei)

The history of China’s environmental NPOs is less than 30 years. Till 2005, there are 2768 environmental NPOs of various types in China. Among them, 1382 (49.9%) were initiated by the government, 202 (7.2%) were spontaneously rooted from civilians, and the portion of students associations for environmental protection were also very important (1116, 40.3%) (from All China Environment Federation, 2006). Approximately 224,000 people work for the environmental NPOs. The government-dependent NPOs have advantages on access to resources and official support, while environmental grass-roots are good at mass mobilization and inter-organization efficiency. These two types of organizations supplement with each other in the process of addressing emerging environmental issues.Chinese scholars Jialiang Xu and Fang Wan summarized the evoluntion stages the environmental NPOs in China from the 1970s to present into 3 stages: germination, springing up and expansion. Stage of Germination (1970s – 1990s)