Gender inequality in healthcare is still a concern in poor rural China, despite the national level policies that try to improve the situation. Based on fieldwork conducted in a poor county in south-western China, this paper examines local health service planning and women’s organisation. It explores approaches to increasing women’s participation in local health planning so as to enhance the responsiveness and accountability of health facilities to women’s needs and thus lead to the improvement of gender equity in health. The findings show that county and below county level health authorities and service institutions have little space to make local health plans, due to the centralised and top-down planning approach in China. The limited planning power is further constrained by the extreme insufficient financial resource in poor counties. Target-oriented responsibility management system has been used by the upper-level government to ensure the accomplishment of important health indicators that are defined and planned by the upper levels of government since the late 1980s. The fulfilment of these indicators imposes an ‘unfunded mandate’ on poor counties. Health authorities and institutions exploit the opportunity provided by the market to generate income to fulfil their obligation, which leaves little space for them to respond to local women’s needs. There is no institutional arrangement to bring local health needs, particularly women’s needs into the decision-making process. This further exacerbates the non-responsiveness of health institutions to local needs. The ‘All China Women’s Federation’ is the sole legitimate women’s organisation in the county and it cannot be claimed as a representative organisation of rural women. However, its constitution indicates it has potential to develop into a real representative organisation and although it did not participate in local health planning, its working guideline contains women’s health indicators. There is potential to increase women’s participation in local health planning by transforming the Women’s Federation or creating a new organisation. However, there will still be a long way to go to improve gender equality in health in poor rural China using the approach of women’s participation in local health planning.
