Describing the Chinese HIV Surveillance System and the Influences of Political Structures and Social Stigma

Zhang, Lei; Fung Chow, Eric Pui; Zhang, Jun; Jing, Jun; Wilson, David P

Authoritarianism describes any political structure in which overall authority is concentrated in the hands of a single leader or a small group of elite. Prior to economic reform in China, the ultimate political powers were mastered by the chairman of state, who is simultaneously the president of the party and chief commander of the army. Political Fig. (1) . Schematic diagram of flow of information for HIV surveillance in China. decisions and national policies were implemented strictly "from top to bottom" through a pyramidal administrative structure (Fig. 2a) . During the process of political decentralisation initiated by the economic reform in China, provincial governments and ministerial institutions were given high degrees of autonomy to stimulate economic growth. Although the central government remains at the peak of the power hierarchy, opportunities for competition and bargaining between governments and institutions became possible. This phenomenon was coined "fragmented authoritarianism" by Lampton in 1987 [37] . As a result of fragmented authoritarianism, government authority below the very peak of the Beijing central government is fragmented and disjointed [37, 38] . As the highest administrative body, the central government does not generally dictate the execution of policies by provincial governments. Between equal level governments or governmental institutions, and even between local and central governments, there exists a large space for competition and cooperation, which leads to extensive bargaining concerning policy execution and project development of common interests (Fig. 2b) . Fragmented authoritarianism in China can be viewed as the mixed product of traditional authoritarianism and demands for increase in political freedom triggered by the economic reform.