WHO and China bring people-centered care to the fore
WHO has been a longstanding partner with China to support its health system reform ambitions and its journey towards universal health coverage (UHC). Since 2009, China has embarked on a new round of health reforms to provide basic health care to the entire Chinese population. In 2019, WHO and the Government of China organized a joint review of health reforms undertaken in the previous 10 years. The review found that despite the great strides in improving access to healthcare and health system capacity, there is an urgent need to develop people-centered integrated care (PCIC) service systems based on strong primary health care (PHC). The joint review report was submitted to the Vice Premier of the State Council and has informed the development of the 14th Five Year Plan on health reform priorities in China, including highlighting the priority to accelerate the development of PCIC systems.
How did China do it, and how did the WHO Secretariat support China?
Building on the policy recommendations from the joint review, WHO and the Chinese government jointly launched a flagship pilot programme: “Translating the ‘For the Future’ vision into local pilots in China—building a high-quality and value-based service delivery system towards UHC”, also known as the “People-Centered Integrated Care (PCIC) Pilot”, in 2021 at a critical juncture of China’s health system transition.
The programme aims to build PCIC service delivery systems through local pilot projects to test pathways and models to effectively respond to the challenges of noncommunicable diseases (NCDs), ageing and infectious diseases. The pilot projects will provide models for developing resilient and effective health systems during the 14th Five Year Plan and contribute to the development of national PCIC policies and guidelines. This work also aims to put the WHO Western Pacific Region’s “ For the Future” vision into action in China by advancing the thematic priorities of NCDs and ageing. The pilot also utilizes one of the “For the Future” operational shifts, adopting a systems reform approach to UHC, including coordinated measures on governance, financing, payment, organization of service delivery and information integration with the goal of improving population health.
The PCIC pilot is being implemented in six counties in three Chinese provinces, which represent different levels of socioeconomic development and varying progress made on health reform and UHC. A three-year (2021-2024) programme was designed with adequate time in year one allocated to piloting system level changes, notably situation analysis and the design of tailored reform actions fit for local contexts. Applying a “grounds up” approach (also identified in “For the Future” as a key operational shift) allows countries to use feedback from the ground to adapt and refine programme interventions. Through its first year of implementation, the project has achieved noticeable policy impact with emerging models from the pilot sites for future scaling up and dissemination.
In 2021, the PCIC pilot was listed as one of the priorities of the country’s health system reform in a policy circular issued by the Central Government of China (State Council) demonstrating a strong political commitment from the Chinese government to the pilot work and PCIC systems in partnership with WHO. WHO supported the concept and underlying principles, and approaches of the PCIC pilot have informed the development of related national polices and guidelines on PCIC and quality service delivery systems in 2021.
Photo Credit: © WHO/Ao Xinhua
Photo Caption: A community doctor provides tailored diet counseling.
In the formulation of the reform plans of the six pilot counties, WHO worked with implementing partners to ensure that reform interventions reinforce a stronger role for PHC in service organization and delivery and the principle of prevention first, as well as a whole system approach to manage local health challenges. The approach resulted in the development of interventions such as:
- Promoting PHC through innovative solutions
- Community support group as a new model of social governance.
Changxing County of Zhejiang has developed an electronic "health profile" which integrates all sources of health data with real-time tracking of health status for residents based on health check-up, medical records and big data. Such a “profile” enables community care workers to implement precise management of chronic diseases such as hypertension and diabetes, as well as targeted interventions on risk factors through multisectoral collaboration.
Changxing has also reformed payment methods for diabetes and hypertension to incentivize community practitioners to focus on prevention and disease management, which has reduced hospitalizations and NCD complications.
Addressing the low participation of farmers, Gongcheng of Guangxi has piloted a community support system, which establishes a health management system targeting key populations living with or affected by chronic conditions. The community support system supports the building of community leadership, interaction between health teams and the community, and vertical integration of service networks to provide life course services.
China’s 14th Five Year Plan laid out a clear transition of its health service delivery model to address ageing, combat NCDs, and to reach the unreached to ensure that no one is left behind. The PCIC pilot contributes to the evidence and practice in building a PCIC model in a large, high-middle income country, which may merit both domestic scaling up and regional/global learning.
The significance of the PCIC pilot, combined with WHO’s inputs, is its direct contribution to China’s transition in its health service delivery system. For WHO, the initiative represents an orchestrated multi-level, cross-team effort to test the “For the Future” vision in the Chinese context. At a critical juncture of transition and reform in China’s health system as it combats the COVID-19 pandemic, WHO’s voice to champion UHC and PHC sends a positive signal for global health.
Photo Credit: © WHO/Zhang Wenhao
Photo Caption: Digital dashboard of the “health profile” in Changxing County, China.