Beyond the Market: A Public-Private Partnership Model for Folic Acid Promotion and Its Lessons for China

Periconceptional folic acid supplementation has been demonstrated as an effective intervention for preventing neural tube defects (NTDs). China has achieved notable success in this regard, primarily through the implementation of a distinctive tablet supplementation approach. This study examines the unique public-private partnership (PPP) model underpinning this achievement, the SCRIANEN folic acid tablets case. This paper employs a mixed-methods analysis, integrating policy evaluation, historical data, and economic modelling, to investigate the role of the “Government Authorization-Enterprise Execution” framework in facilitating rapid nationwide coverage. The theoretical model developed herein demonstrates that the provision of temporary monopoly rights to a single enterprise constitutes an economically efficient solution to the problem of free-riding in the context of initial market creation. The analysis indicates that this approach facilitated rapid scaling, while concomitantly exposing limitations in equity and system resilience. These findings offer valuable insights for health governance in developing countries, demonstrating the potential of strategically designed PPPs to accelerate public health interventions, and emphasizing the necessity of transitioning towards equity-oriented policies for sustainable impact.