After decades of efforts and resource inputs to accomplish the broad coverage of health services, the quality of care improvement at the PHC level remains essential to achieve NCD control objectives in the post-pandemic era. There are a few challenges that require attention from all relevant stakeholders.

(1) Given the large size of the total population, the aging trend, and increased service demand from the patients’ side, the national BPHS program may face continuous financing pressure, especially in some less developed provinces [9]. As the operation of PHC facilities primarily relies on government funding, lacking subsidies would result in less purchasing power to upgrade the equipments and cover salaries for the health workforce, which might adversely impact the service provision. (2) Insufficient capacity building and limited career development incentives would hinder health workforce retention at the PHC level [9]. Shortage in human resources may become one of the bottlenecks of high-quality care provision at the PHC level. (3) The slow progress of integration between clinical care and public health services brought unsatisfied patient experiences, which further diminished the trust in the PHC and drove people to bypass the PHC services. For instance, patients might face different doctors for every consecutive visit for NCD medication prescriptions, as well as repeat clinical checks due to the disconnection of different health information systems [9]. Thus, future actions would require continuous resource input into the grassroots levels for operation maintenance, talent retention, and service improvement.

With the favored policy environment and the opportunities that emerged from the pandemic, an action framework was jointly proposed during the 2023 Duke Kunshan Health Forum (Fig. 1), which aimed to drive the NCD prevention and control work to the next level.

Proposed action framework to strengthen PHC for accelerating NCD prevention and control in China

The framework focuses on achieving a people-centered, lifetime, comprehensive, continued, and quality NCD prevention and control services. The service provision relies on a health care system that integrates the primary, secondary, and tertiary level care in a coordinative and synergetic manner. As addressed in previous sections, six interconnected actions can drive continuous improvement of the whole system (Fig. 1). NCD services for the whole country population is essential as highlighted in the WHO initiated UHC framework and PHC strengthening. Therefore, prioritizing and integrating NCDs in the PHC and the UHC framework would place the issue on a higher political agenda, which can enhance multisectoral collaboration and direct more resources to sustain and upgrade quality care provision. Besides, leveraging the advantages of new technology, encouraging mutual learning of best practices between different provinces, and localizing other countries’ successful experiences would accelerate service improvement at the grassroots [10].