Background. Despite growing wealth and a strengthening commitment from the government to provide quality education, a significant share of students across rural China still have inadequate access to micronutrient-rich regular diets. Such poor diets can lead to nutritional problems, such as iron-deficiency anemia, that can adversely affect attention and learning in school. Large scale policies in Northwestern China have attempted to tackle these nutritional problems using eggs.  The overall goal of this paper is to assess the impact of the government’s egg distribution program by comparing the effect on anemia rates of an intervention that gives students an egg per day versus an intervention that gives students a chewable vitamin per day. We will also assess whether either intervention leads to improved educational performance among students in poor areas of rural China. To meet this goal, we report on the results of a randomized controlled trial (RCT) involving over 2,600 fourth grade students from 70 randomly-chosen elementary schools in 5 of the poorest counties in Gansu Province in China’s poor Northwest region. The design called for random assignment of schools to one of two intervention groups, or a control group with no intervention. One intervention provided a daily chewable vitamin, including 5 milligrams of iron. The other mimicked the government policy by providing a daily egg. According to the findings of the paper, in the schools that received the chewable vitamins, hemoglobin (Hb) levels rose by more than 2 g/L (over 0.2 standard deviations). The standardized math test scores of students in these schools also improved significantly. In schools that received eggs, there was no significant effect on Hb levels or math test scores. Overall, these results should encourage China’s Ministry of Education (MOE) to look beyond eggs when tackling nutritional problems related to anemia in an education setting.

Purpose – The purpose of this paper is to explore whether an in-service life teacher training program can improve boarding students’ health, behavior, and academic performance.

Design/methodology/approach – The authors conducted a cluster-randomized controlled trial to measure the effect of life teacher training on student health, behavior, and academic performance among 839 boarding students in ten central primary boarding schools in Shaanxi. And the authors also tried to identify why or why not life teacher training works. Both descriptive and multivariate analysis are used in this paper.

Findings – The authors find significant improvements in health and behavior. Specifically, compared to boarding students in control schools, 15 percent fewer students in treatment schools reported feeling cold while sleeping at night. The results also showed that student tardiness and misbehaviors after class declined significantly by 18 and 78 percent, respectively. However, the in-service life teacher training program had no measurable impact on boarding students’ BMI-for-age Z-score, number of misbehaviors in class, and academic performance. The analysis suggests that improved communication between life teachers and students might be one mechanism behind these results.

Originality/value – This is the first empirical work which explored how to improve the welfare of boarding students via their life teachers. Because of the sudden increase in boarding students in rural China, it is almost certain that school personnel lack experience in managing boarding students. As such, one promising approach to improving student outcomes might be in-service training for life teachers.

Objectives: To determine whether China's New Rural Cooperative Medical Scheme (NCMS), which aims to provide health insurance to 800 million rural citizens and to correct distortions in rural primary care, and the individual policy attributes have affected the operation and use of village health clinics.

Design: We performed a difference-in-difference analysis using multivariate linear regressions, controlling for clinic and individual attributes as well as village and year effects.

Setting: 100 villages within 25 rural counties across five Chinese provinces in 2004 and 2007.

Participants: 160 village primary care clinics and 8339 individuals.

Main outcome measures: Clinic outcomes were log average weekly patient flow, log average monthly gross income, log total annual net income, and the proportion of monthly gross income from medicine sales. Individual outcomes were probability of seeking medical care, log annual "out of pocket" health expenditure, and two measures of exposure to financial risk (probability of incurring out of pocket health expenditure above the 90th percentile of spending among the uninsured and probability of financing medical care by borrowing or selling assets).

Results: For village clinics, we found that NCMS was associated with a 26% increase in weekly patient flow and a 29% increase in monthly gross income, but no change in annual net revenue or the proportion of monthly income from drug revenue. For individuals, participation in NCMS was associated with a 5% increase in village clinic use, but no change in overall medical care use. Also, out of pocket medical spending fell by 19% and the two measures of exposure to financial risk declined by 24-63%. These changes occurred across heterogeneous county programmes, even in those with minimal benefit packages.

Conclusions: NCMS provides some financial risk protection for individuals in rural China and has partly corrected distortions in Chinese rural healthcare (reducing the oversupply of specialty services and prescription drugs). However, the scheme may have also shifted uncompensated new responsibilities to village clinics. Given renewed interest among Chinese policy makers in strengthening primary care, the effect of NCMS deserves greater attention.