Primary health care system responses to non-communicable disease prevention and control: a scoping review of national policies in Mainland China since the 2009 health reform

Shangzhi Xiong^{1

2}, Chang Cai³, Wei Jiang⁴, Pengpeng Ye^{1

4}, Yanqiuzi Ma⁴, Hueiming Liu^{1

5}, Bingqin Li⁶, Xinyi Zhang⁷, Ting Wei⁷, Hongru Sun⁸, Thomas Hone³, David Peiris¹, Limin Mao⁹, Maoyi Tian^{1

8}

Affiliations

¹ The George Institute for Global Health, Faulty of Medicine and Health, University of New South Wales, Sydney, Australia.
² Global Health Research Centre, Duke Kunshan University, Kunshan, China.
³ Department of Primary Care and Public Health, Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK.
⁴ National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100032, China.
⁵ Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, Australia.
⁶ Social Policy Research Centre, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, Australia.
⁷ The George Institute for Global Health at Peking Univeresity Health Science Center, Beijing, China.
⁸ School of Public Health, Harbin Medical University, Harbin, China.
⁹ Centre for Social Research in Health, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, Australia.

PMID: 36879784
PMCID: PMC9985060
DOI: 10.1016/j.lanwpc.2022.100390

Primary health care system responses to non-communicable disease prevention and control: a scoping review of national policies in Mainland China since the 2009 health reform

Shangzhi Xiong et al. Lancet Reg Health West Pac. 2022.

. 2022 Feb 2:31:100390.

doi: 10.1016/j.lanwpc.2022.100390. eCollection 2023 Feb.

Authors

Affiliations

¹ The George Institute for Global Health, Faulty of Medicine and Health, University of New South Wales, Sydney, Australia.
² Global Health Research Centre, Duke Kunshan University, Kunshan, China.
³ Department of Primary Care and Public Health, Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK.
⁴ National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100032, China.
⁵ Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, Australia.
⁶ Social Policy Research Centre, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, Australia.
⁷ The George Institute for Global Health at Peking Univeresity Health Science Center, Beijing, China.
⁸ School of Public Health, Harbin Medical University, Harbin, China.
⁹ Centre for Social Research in Health, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, Australia.

PMID: 36879784
PMCID: PMC9985060
DOI: 10.1016/j.lanwpc.2022.100390

Abstract

This study aims to review China's national policies related to non-communicable disease (NCD) prevention and control at the primary health care (PHC) level since China's 2009 health system reform. Policy documents from official websites of China's State Council and 20 affiliated ministries were screened, where 151 out of 1,799 were included. Thematic content analysis was performed, and fourteen 'major policy initiatives' were identified, including the basic health insurance schemes and essential public health services. Several areas showed to have strong policy support, including service delivery, health financing, and leadership/governance. Compared with WHO recommendations, several gaps remain, including lack of emphasis on multi-sectoral collaboration, underuse of non-health-professionals, and lack of quality-oriented PHC services evaluations. Over the past decade, China continues to demonstrate its policy commitment to strengthen the PHC system for NCD prevention and control. We recommend future policies to facilitate multi-sectoral collaboration, enhance community engagement, and improve performance evaluation mechanisms.

Keywords: CVD, Cardiovascular disease; China; Health reform; LMICs, Low-and middle-income countries; NCD, Non-communicable disease; Non-communicable disease; PHC, Primary health care; Policy review; Primary health care; WHO, World Health Organization.

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Conflict of interest statement

The authors declare no conflict of interests for this study.

Figures

Fig 1 — **Figure 1**
Combined theoretical framework.

Fig 3 — **Figure 3**
Multi-sectorial collaborative PHC policy making: network mapping* * MO: Ministry Of; admin: Administration. The three coloured circles are the three ministries with the top-three highest numbers of jointly released policies. The size of each circle indicates the relative frequency of the ministry's involvement in jointly released policies. The width of each connecting line indicates the relative frequency of the two adjoining ministries in being involved in the same policies’ releases.

Fig 4 — **Figure 4**
Leading PHC policies and policy cross-referencing* * The direction of arrows in this figure represents the direction of referencing.

Fig 5 — **Figure 5**
Number of policy documents mapped against the combined theoretical framework.

Fig 6 — **Figure 6**
Major Policy Initiatives for PHC-focused NCD Control* * PHC stands for primary health care, NCD stands for non-communicable diseases, and TCM stands for traditional Chinese medicine.

See this image and copyright information in PMC

References

1. Murray C.J., Abbafati C., Abbas K.M., et al. Five insights from the global burden of disease study 2019. Lancet North Am Ed. 2020;396(10258):1135–1159. - PMC - PubMed
1. Vos T., Lim S.S., Abbafati C., et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of disease study 2019. Lancet North Am Ed. 2020;396(10258):1204–1222. - PMC - PubMed
1. Lu J., Lu Y., Wang X., et al. Prevalence, awareness, treatment, and control of hypertension in China: data from 1·7 million adults in a population-based screening study (China PEACE Million Persons Project) Lancet North Am Ed. 2017;390(10112):2549–2558. doi: 10.1016/S0140-6736(17)32478-9. - DOI - PubMed
1. Wang L., Peng W., Zhao Z., et al. Prevalence and treatment of diabetes in China, 2013–2018. JAMA. 2021;326(24):2498–2506. doi: 10.1001/jama.2021.22208. - DOI - PMC - PubMed
1. World Health Organization . WHO/EURO; 1978. Declaration of alma-ata. copenhagen: world health organization. regional office for europe. 1978-3938-43697-61471.

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Primary health care system responses to non-communicable disease prevention and control: a scoping review of national policies in Mainland China since the 2009 health reform

Affiliations

Primary health care system responses to non-communicable disease prevention and control: a scoping review of national policies in Mainland China since the 2009 health reform

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

LinkOut - more resources

Full Text Sources

Miscellaneous