Barriers to Community-Based Primary Health Care Delivery in Urban China: A Systematic Mapping Review

Abstract

Providing access to a range of basic health services, community-based primary health care (CB-PHC) plays a vital role in achieving the goal of health for all. Driven by a strong political commitment, China’s CB-PHC progress in the past decade has been swift and impressive. However, a well-functioning delivery system for care has yet to be established. This systematic mapping review synthesizes selected evidence on barriers to CB-PHC delivery in urban China and draws lessons for policy development. We performed searches on five electronic databases: CINAHL, MEDLINE, Scopus, Web of Science, and China National Knowledge Infrastructure, and included studies published between 2012 and 2021. The Downs and Black and Critical Appraisal Skills Program checklists were used to assess the quality of eligible papers. We conducted our searches and syntheses following the framework set out in the Primary Health Care Performance Initiative (PHCPI). We synthesized the results of the included studies using a thematic narrative approach and reported according to PRISMA guidelines. Six salient barriers arose from our syntheses of 67 papers: lack of comprehensive health insurance schemes, lack of public awareness, superficial care relationships, gaps in communication, staff shortages and poor training, and second-rate equipment. These barriers are grouped into three subdomains following the PHCPI framework: access, people-centered care, and organization and management. A host of negative impacts of these barriers on community-based health care were also identified. It was not possible to determine clear causes of these barriers from the contributing evidence because of the lack of conceptual frameworks and research methods constraints. Non-eastern regions of China and access-related barriers require further exploration. It follows that, at the national level, the problems are likely more severe than the research suggests.

Barriers to community healthcare delivery in urban China: a nurse perspective

“…Since 2009, community healthcare has been championed by the Chinese government as a high priority to promote and safeguard the health of urban dwellers. Considerable resources have been devoted to developing community healthcare, and commendable progress has ensued (B. Li & Chen, 2022a ). Nevertheless, a highly functioning delivery system for community health services in urban China has yet to be established, compromising the quality and value of community healthcare and preventing timely access to basic health services.…”

“…These interviews initially took place in Chinese and were later translated into English for this article. Existing literature on China’s community health services helped us draft interview guides, allowing us to identify critical issues in community healthcare, such as equipment and staffing (B. Li & Chen, 2022a ). These guides enabled us to start topic-focused conversations with respondents more easily and ensure that we did not miss common issues along the way.…”

“…A sizable body of literature on community healthcare delivery in urban China has identified various factors to account for its limitations (B. Li & Chen, 2022a ). For example, the fragmentation of social health insurance schemes decreases the likelihood that people will avail themselves of community healthcare for initial treatment and prevents many urban residents from obtaining equal and timely access to community health service facilities (Chung et al, 2016 ; H. Li et al, 2019 ; Zhong et al, 2018 ).…”

Survey and analysis on the resource situation of primary health care institutions in rural China

“…Rural healthcare systems are more susceptible to public health crises like the COVID-19 pandemic, and studies looking at how these systems were handled have highlighted the importance of being better prepared and adaptable ( 30 ). Research has also looked at policy initiatives and community-based approaches as potential ways to improve healthcare delivery in rural areas ( 31 , 32 ). This literature review ( Table 1 ) lays the framework for the current survey and analysis to help address these critical healthcare challenges by combining these findings and providing a comprehensive understanding of the socioeconomic variables that influence the resource status of primary healthcare institutions in rural China.…”