Bridging knowledge gaps for healthy China 2030 plan: a province-wide assessment of primary healthcare workers' competencies and training preferences in Henan, China

Background Primary healthcare workers (PHCWs) are foundational to equitable health service delivery. In 2016, China launched the Healthy China 2030 plan, the first medium- to long-term national health strategy which elevates disease prevention, health promotion and universal coverage as national priorities. Addressing knowledge gaps in the PHC workforce is therefore essential to achieving the plan's goal of raising average life expectancy to 79 years by 2030. We examined PHCWs' self-perceived knowledge gaps and training preferences across Henan province to understand how workforce development can support Healthy China 2030. Methods A cross-sectional survey of 119,051 PHCWs across Henan was conducted in August 2023. Participants were recruited from village health clinics, township health centers, community health service centers, and health management institutions. Respondents included healthcare workers across seniority levels, ranging from junior level, intermediate level, associate senior level, to senior level. Data on self-perceived knowledge gaps (basic theory, professional knowledge, and practical skills) and training preferences (Theory-based, Case-sharing, Interactive discussion, and Skills simulation) were analyzed using descriptive statistics, Generalized Linear Models (GLM), and K-Means clustering. Results Significant knowledge deficiencies were reported by 40.0% of PHCWs across all the tested domains, with notable gaps in practical skills (15.7%) and professional knowledge (14.1%). Gaps were most pronounced in rural-based clinics and among junior staff. PHCWs strongly preferred experiential learning like case sharing (76.4%) and skills simulation (75.2%). Clustering analysis identified six distinct knowledge gaps and training preference profiles. Conclusion Henan's PHC workforce faces pervasive knowledge gaps that threaten progress toward the prevention-oriented, equitable healthcare envisioned by Healthy China 2030. Policymakers should design competency-based training programs that prioritize rural clinics, integrate digital and hands-on modalities, and reinforce health promotion and chronic disease management. Establishing regional training hubs, mentorship systems, and rigorous evaluation mechanisms will help build a workforce capable of advancing China's national goals of improving health literacy, reducing chronic disease burdens, and achieving universal health coverage.