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. 2022 Dec 14:31:100664.
doi: 10.1016/j.lanwpc.2022.100664. eCollection 2023 Feb.

Factors associated with the uptake of national essential public health service package for hypertension and type-2 diabetes management in China's primary health care system: a mixed-methods study

Shangzhi Xiong  1   2 , Wei Jiang  3 , Ruilin Meng  4 , Chi Hu  5 , Hui Liao  6 , Yongchen Wang  7 , Chang Cai  8 , Xinyi Zhang  9 , Pengpeng Ye  1   3 , Yanqiuzi Ma  3 , Tingzhuo Liu  9 , Dandan Peng  4 , Jiajuan Yang  5 , Li Gong  6 , Qiujun Wang  7 , David Peiris  1 , Limin Mao  10 , Maoyi Tian  1   9
Affiliations

Factors associated with the uptake of national essential public health service package for hypertension and type-2 diabetes management in China's primary health care system: a mixed-methods study

Shangzhi Xiong et al. Lancet Reg Health West Pac. .

Abstract

Background: China launched the primary health care (PHC) system oriented National Essential Public Health Service Package (NEPHSP) in 2009, to combat health challenges including the increasing burden from hypertension and type-2 diabetes (T2DM). In this study, the PHC system was assessed to understand factors influencing the uptake of the NEPHSP for hypertension and T2DM management.

Methods: A mixed-methods study was conducted in seven counties/districts from five provinces across the mainland of China. Data included a PHC facility level survey and interviews with policy makers, health administrators, PHC providers, and individuals with hypertension and/or T2DM. The facility survey used the World Health Organisation (WHO) service availability and readiness assessment questionnaire. Interviews were thematically analysed using the WHO health systems building blocks.

Findings: A total of 518 facility surveys were collected with over 90% in rural settings (n = 474). Forty-eight in-depth individual interviews and 19 focus-group discussions were conducted across all sites. Triangulating the quantitative and qualitative data found that China's continuous political commitment to strengthening the PHC system led to improvements in workforce and infrastructure. Despite this, many barriers were identified, including insufficient and under-qualified PHC personnel, remaining gaps in medicines and equipment, fragmented health information systems, residents' low trust and utilization of PHC, challenges in coordinated and continuous care, and lack of cross-sectorial collaborations.

Interpretation: The study findings provided recommendation for future PHC system strengthening, including improving the quality of NEPHSP delivery, facilitating resource-sharing across health facilities, establishing integrated care systems, and exploring mechanisms for better cross-sectorial engagement in health governance.

Funding: The study is supported by National Health and Medical Research Council (NHMRC) Global Alliance for Chronic Disease funding (APP1169757).

Keywords: Diabetes; Hypertension; Mixed-methods study; Non-communicable diseases; Primary health care system.

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Conflict of interest statement

The authors declare no conflict of interests for this study.

Figures

Fig. 1
Fig. 1
The locations of all study sites in the map of China∗. ∗The percentage of urban population in China was 64.7%, and the per capita disposable income was 47,412 RMB for urban residents and 18,931 for rural in 2021. Data in this graph was collected from official governmental reports and websites (in Chinese, more details are given in appendix 2). ∗∗The study site in Zhejiang Province participated in the qualitative interviews but not the quantitative surveys. All other sites completed both quantitative and qualitative research.
Fig. 2
Fig. 2
The triangulation of quantitative and qualitative research components for joint-display of findings.
See this image and copyright information in PMC

References

    1. Wang Z., Chen Z., Zhang L., et al. Status of hypertension in China: results from the China hypertension survey, 2012–2015. Circulation. 2018;137(22):2344–2356. - PubMed
    1. Li X., Krumholz H.M., Yip W., et al. Quality of primary health care in China: challenges and recommendations. Lancet. 2020;395(10239):1802–1812. - PMC - PubMed
    1. Li Y., Teng D., Shi X., et al. Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: national cross sectional study. BMJ. 2020;369:m997. - PMC - PubMed
    1. Health Mo, editor. Standards for national essential public health services 2009 version. 2009.
    1. Commission NHaFP, editor. Standards for national essential public health services 2017 version. 2017.

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