National and province-level primary health care policies for the prevention and control of non-communicable diseases in China from 2009 to 2023: a scoping review.

Abstract

This study systematically characterises policies related to the prevention and control of non-communicable diseases (NCDs) at the provincial primary healthcare (PHC) level, identifying key characteristics and potential gaps compared with national policies. Policy review and thematic content analysis. Policy documents from Guangdong and Heilongjiang provinces (2009-2023) were analysed using the WHO's six building blocks framework. A total of 135 eligible documents were included, with thematic analysis conducted to categorise policies as 'extension' or 'reduction' based on their alignment with national directives. 12 major policy initiatives were identified, with most themes reflecting provincial adaptations ('extension') of national strategies. Leadership and governance, medicines and technologies and service delivery received robust policy support, while health information systems lagged. Provincial policies demonstrated significant multisectoral collaboration, though gaps in health financing and workforce capacity persisted. To strengthen PHC-based NCD control, future reforms must prioritise multisectoral collaboration, interoperable digital health systems and tailored health education. Addressing regional disparities in policy implementation is critical for equitable outcomes.