Community-integrated noncommunicable disease service models: lessons from China

Background: Integrated health services are advocated for primary health care to address non-communicable diseases (NCDs), especially in low- and middle-income countries (LMICs). However, evidence of care delivery models and means of scaling up is limited. This study examines community-integrated NCD service models in China, providing evidence on the steps that China took to reorient health services towards primary health care to address the NCD epidemic. Methods: A systematic review identified and included 20 studies (from 3959 records screened from five databases) conducted in various regions of China, published in English or Chinese. The evidence synthesis is narrative and thematic. Themes are built upon from the Chronic Care Model framework and issues identified in the World Health Organization package of essential noncommunicable (PEN) disease interventions. They cover priority diseases, interventions included in packages of care, delivery strategies at the community level, the roles of stakeholders, approaches to overcome health system challenges, outcomes, and gaps. Results: Despite facing common challenges like other LMICs, such as inadequate infrastructure and insufficient human resources, various community-level integrated NCD service models have been trialled and scaled up through health reform and policy implementation. Key interventions include health promotion, screening, tiered diagnosis and treatment, patient education, self-management, and digital health models. Family physicians and nurses are the main providers, supported by local governments and hospitals. The review identified creative service delivery strategies at the community, highlighting changes in patient clinical pathways, improved access to services, and positive clinical outcomes. Conclusions: China's experience with community-integrated NCD service models offers valuable insights for other LMICs. Key elements include prioritising universal health coverage, integrating public health and primary care, and optimising accessibility, efficiency, and patient-centredness. Future research should focus on long-term effects and sustainability, particularly in rural settings.