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Hospital Twinning Partnership for Health System Strengthening in Rural China: A Mixed-Methods Implementation Study
Wenjuan Tao1, Wenwu Shen1, Hao Guo1
1Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China.
Health Policy and Planning
|May 14, 2026
Summary
Domestic hospital twinning strengthens rural health systems by addressing multiple building blocks. This partnership model shows promise for resource-limited settings, improving service capacity and workforce development.
Area of Science:
- Health Systems Research
- Implementation Science
- Global Health Equity
Background:
- Limited evidence exists on domestic hospital twinning for health system strengthening in low- and middle-income countries.
- Hospital partnerships are a strategy to improve healthcare delivery and capacity.
Purpose of the Study:
- To examine a domestic hospital twinning partnership in China.
- To identify partnership components, implementation determinants, and outcomes.
- To assess the replicability of the model for health system strengthening.
Main Methods:
- A mixed-methods implementation study using the World Health Organization health system building blocks and the Consolidated Framework for Implementation Research (CFIR).
- Data collection via semi-structured interviews (n=10), structured surveys (n=63), and administrative records.
- Integration of qualitative and quantitative findings to understand implementation determinants.
Main Results:
- Partnership elements covered all six health system building blocks, focusing on leadership, service delivery, and workforce.
- Key facilitators included supporting hospital reputation, government backing, and a collaborative approach.
- Barriers involved IT limitations, funding issues, intervention complexity, and resistance to change.
Conclusions:
- Structured domestic hospital twinning is a promising strategy for strengthening rural health systems.
- The model, addressing multiple health system components and extending to primary care, offers a replicable approach.
- Improvements in service capacity, workforce development, and organizational culture were observed.
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