Role of Comprehensive Primary Healthcare in Curbing Diabetes Crisis in China

This paper explores the role, relevance, and future potential of comprehensive primary healthcare in curbing the diabetes crisis in China. It discusses the principles of comprehensive primary healthcare and how they can be applied to address the specific health issue of diabetes in developing countries. The paper highlights the importance of inter-sectoral collaboration, equity, and participation in promoting wellbeing and transforming global health policy.

Running head: PRIMARY HEALTHCARE IN DEVELOPING COUNTRIES 1
Primary Healthcare in Developing Countries
Student’s Name
Institutional Affiliation

PRIMARY HEALTHCARE IN DEVELOPING COUNTRIES 2
Primary Healthcare in Developing Countries
Comprehensive primary health care is a transformational healthcare intervention which
was developed in 1978 through a collaborative move by 67 organizations and 134 countries. The
main agenda of the comprehensive primary healthcare was to create a social model health system
that would replace the biomedical system, which was dominant at that time. The comprehensive
primary healthcare system aimed at including all the citizens and organizations in the efforts for
promoting wellbeing. The model emphasized on inter-sectoral collaboration, equity, and
participation. The comprehensive primary healthcare approach aimed at strengthening the
correlation between socioeconomic development and health while transforming the global health
policy. Even though different researchers have addressed the benefits of comprehensive primary
healthcare in promoting wellbeing among individuals in developing countries, little emphasis has
been placed on discussing the topic with respect to a specific health issue in a chosen developing
country. Different nations set targets which aim at promoting good health among the citizens.
However, no anticipations are undertaken with respect to the future of comprehensive primary
healthcare in achieving the desired objectives across the globe. Thus, it is necessary to research
the application of comprehensive primary healthcare in handling specific health issues in
developing countries. Therefore, this paper has been set to explore the role, relevance, and future
potential of comprehensive primary healthcare in curbing the diabetes crisis in China.
Diabetes is a fundamental problem in China. Approximations show that one individual in
ten suffers from diabetes in China (Mark, 2019). These rates outweigh a similar concern in the
United Kingdom, where almost one individual in twenty suffer from the disease (Mark, 2019).
Different cases of diabetes develop on a daily basis in the country. Currently, the actual number
of diabetes patients in China is hard to estimate as most cases have remained undiagnosed. The

PRIMARY HEALTHCARE IN DEVELOPING COUNTRIES 3
country has the largest number of type one patients who are undiagnosed and overlooked. In fact,
China is currently ahead of India in reporting incidences of diabetes (Zimmet et al., 2014; Xu,
Zhou, Liu, Tan, & Cai, 2013). The country is largely affected by the epidemic as it records the
highest rate in the world (92 million patients diagnosed) (Xu et al., 2013; Li, et, al., 2014; Li,
2012; Mi, et, al., 2013). The developing nature of China is a fundamental crisis with respect to
diabetes type 2 (Xu et al., 2015). Currently, the western lifestyle in rapidly infiltrating the
Chinese culture where most individuals tend to consume more while exercising less. This has led
to rapid growth in cases of diabetes type 2 in the country (Zhou et al., 2013). The crisis in
paramount in urban areas where traditional lifestyles are easily eroded. However, less emphasis
has been placed on the application of Comprehensive primary healthcare in curbing the problem.
Yet, the approach has proven to be very effective in handling the crisis.
The execution of the principles of comprehensive primary healthcare serves a significant
role in curbing the obesity crisis in the country. There are five principles of comprehensive
primary healthcare mentioned on the Ottawa Charter. Such principles include the creation of a
supportive environment, creation of a healthy public policy, reorienting the health services,
promotion of personal development, and strengthening of community action. Inclusion of such
principles in the comprehensive primary healthcare system has greatly promoted nurses’
effectiveness in curbing the incidences of diabetes in the country.
Firstly, strengthening of community action has proven to be a very effective strategy in
handling the problems linked to diabetes in China (World Health Organization, 1986). Currently,
Sanofi is highly requesting the scientific community and Chinese authorities to execute projects
with training and education focus. Nurses and other healthcare practitioners have a fundamental
role to play in strengthening community action against diabetes. Nurses and other healthcare

PRIMARY HEALTHCARE IN DEVELOPING COUNTRIES 4
practitioners engage in plenty of operations in promoting community action. The comprehensive
primary healthcare system has been utilized to direct the nurses on what to do in curbing the
crisis. Some of the interventions undertaken include designing and execution of community
development programs to empower the society about the disease (Edmonson et al., 2017).
Diabetes is a disease which is linked to diverse causes. Such predisposing factors include lack of
exercises, excess consumption of sugar, obesity, insulin resistance, and genetic history of the
family.
Most importantly, the causes of the disease are manageable through the proper
application of lifestyle operations. Usually, prevention is better than cure when it comes to issues
of health. For instance, overweight and obesity can be managed through dietary eating. Obesity
can also be managed through physical activity. On the other hand, insulin resistance has been
linked to overweight and overnutrition hence manageable through eating. However, such
operations cannot be done within the hospital setting across the population of individuals in
China. Therefore, promotion of community action as emphasized through the comprehensive
primary healthcare system is the most appropriate approach in curbing the problem. Nurses and
health practitioners strengthen community action by organizing and implementing community
development programs. The community has to be empowered on how to design a quality diet
and the performance of isometric exercises as a strategic approach in curbing the predisposing
factors to diabetes. Therefore, it is clear that the promotion of community action as a strategic
approach enshrined within the comprehensive primary healthcare action plays a significant role
in curbing diabetes in China.
The second principle of the comprehensive primary healthcare emphasizes the creation of
a supportive environment to the patients. This a fundamental principle in curbing diabetes in

PRIMARY HEALTHCARE IN DEVELOPING COUNTRIES 5
China. This principle has been executed in diversity of ways in the country. The nurses and
other health practitioners in the country have a significant role under the ethics of the
comprehensive primary healthcare action to support all diabetic patients, their families, and the
entire community. On the other hand, the government has the responsibility to provide all the
resources necessary for the management of the problem in China. Typical examples of
supportive services offered by the nurses and other medical practitioners in the country include
education programs and treatment services. Education encompasses the empowering of the
patients on how to conduct a self-test of the glucose level in the blood. The self-test program is
vital for the patients in the identification of the time of the day when glycemia is at the peak
(Coppola, Sasso, Bagnasco, Giustina, & Gazzaruso, 2016). The education programs also enable
the patients to make opportune modifications during the therapeutic process (Wong et al., 2016).
Educating the patients helps reduce the occurrence of accidents through the privation of pieces of
advice that aid in the management of associated health conditions (Krall et al., 2016). Such
pieces of advice play a significant role in promoting wellbeing among patients by reducing the
number of hospital admissions with respect to diabetes as a fundamental problem in China.
Nurses and other medical practitioners offer optimum support to diabetic patients. Often,
diabetes is associated with poor nutritional programs and lack of exercises (American Diabetes
Association 2019). Therefore, the medical practitioners in the hospital setting execute the
principle of comprehensive primary healthcare by providing optimal care to the patients. The
nurses not only design nutritional diets for the patients but also come up with isometric exercise
programs that enable the patients to recover from the condition. The support offered by the
nurses does not end in the hospital setting but extend to home-based care programs (Munshi et
al., 2016). The government in China is also playing a significant role in creating a supportive

PRIMARY HEALTHCARE IN DEVELOPING COUNTRIES 6
environment for the management of patients with diabetes. The government is developing health
facilities in urban centers (Wang et al., 2015). The country, under the leadership of the Chinese
Health Ministry, has initiated a China Initiative for Diabetes Excellence (CIDE) program with a
positive intention of creating a supportive environment in the management of the crisis. The
program emphasizes maximum collaboration between the private and public sector in the
management of diabetes. Emphasis on a collaborative move is a clear appreciation of the key
goals and objectives of the transformation of the healthcare system from a biomedical model to a
comprehensive primary healthcare approach. The program encompasses the career development
of five hundred experts in the field who will be empowered to work collaboratively with the
local doctors in providing optimum support and care for diabetic patients. Also, the program
entails training of ten thousand community and county doctors whose skills shall be developed
with respect to optimization of resources on the ground. It is naïve to hesitate to acknowledge
the fact that the entire supportive environment that plays a significant role in the management of
diabetes was initiated by the transformation of the medication program from the biomedical
model to a comprehensive primary healthcare approach.
The principles of comprehensive healthcare emphasize on the development of personal
skills among the nurses and other nursing practitioners. This strategy has a fundamental role in
curbing the obesity problem in China. Personal development among nursing practitioners has
proven to have plenty of benefits in nursing practice. For instance, personal development has
helped minimize the number of accidents in nursing practice. Additionally, personal
development among nurses has improved the quality of health services delivered to diabetic
patients. Quality services, on the other hand, has promoted diabetic patient satisfaction, which
ultimately transforms the efforts of the nurses and other medical practitioners in delivering

PRIMARY HEALTHCARE IN DEVELOPING COUNTRIES 7
quality services to the patients. This principle has made health organizations to initiate training
and development initiatives in the hospital setting. Therefore, nurses engage in such programs
and share their knowledge and understanding of the nursing practice thus promoting effective
delivery of health services to diabetic patients (Institute of Medicine, 2011) Nurses and other
healthcare practitioners in the country also engage in global migration operation with a
fundamental aim of promoting their skills, knowledge, and competency in the management of
diabetes.
Furthermore, nurses are expected to employ reflective action in their nursing practice. A
typical example of the models used in personal reflective practice is the Gibbs model. The model
enables nurses and other health practitioners to reflect upon their nursing practice, identify the
gaps and strengths in the nursing practice, empress s the strengths in the future operations and
come up with interventions to mitigate the challenges faced during the incident. Comprehensive
primary healthcare approach also emphasizes on collaborative healthcare, which included the
patient and their family members in the healthcare programs. It is vital for nursing practitioners
to acknowledge the fact that the health care system is made up of patients from diverse cultural
entities. Therefore, the nursing practitioners have to engage in training and development
programs that will promote their cultural competency (Ni, et, al., 2014; The Joint Commission,
2014). Effective communication which has been incorporated in the new medication program
(comprehensive primary healthcare approach) has proven to have positive effects in curbing
diabetes in China. Excellent collaboration and effective communication have proven to improve
patients' safety and quality of services during the treatment of diabetes in the hospital entity. In
so doing, the patients' outcomes are enhanced, thus promoting patient satisfaction (Shi et al.,
2014). As a result, the nurses and other health practitioners are likely to be happy thus providing

PRIMARY HEALTHCARE IN DEVELOPING COUNTRIES 8
an incentive to deliver quality services in curbing the obesity crisis in the country (Li, et, al.,
2014; Lu, Zhao & While, 2019).
Comprehensive primary health care emphasizes the creation of a healthy public policy
(Clendon & Munns, 2018). The predisposing factors of diabetes call for policy-oriented
interventions to handle the crisis. The nurses and other healthcare practitioners across the globe
serve a significant role in transforming the scope of the global policy with respect to the
promotion of wellbeing among the citizens. Most of the policy-making healthcare organizations
across the globe have impressed comprehensive primary healthcare approach. For instance, the
Joint Commission serves a significant role in accreditation of the nurses to ensure that they are
fully qualified and meet the standards predetermined in promoting the principles of
comprehensive primary healthcare approach (Arnold, et, al., 2016). Such standards have proven
to be significant in transforming the scope of the healthcare system. Specifically, the standards
have periodically made the management of diabetes in developing countries like China, very
effective. Nurses and midwives from the country are part of the World Health Organization,
which enacts the rules and regulations that guide the healthcare system.
Most importantly, the World Health Organization work towards the promotion of the
principles of comprehensive primary healthcare (World Health Organization, 2015). The
comprehensive primary healthcare system plays a significant role in setting healthy policies that
promote effective curbing of the diabetes crisis in China. For instance, the World Health
Organization is working closely with the government in the country to curb smoking and alcohol
intake (World Health Organization, 2014). Often, smoking and alcohol intake have been
predisposing factors of diabetes disease (Hu, 2011). A collaborative movement between the
healthcare sector and the government authorities in China, as promoted through the

PRIMARY HEALTHCARE IN DEVELOPING COUNTRIES 9
Comprehensive healthcare approach, has served a vital role in creating a healthy policy for
cubing the diabetes crisis.
Finally, the Comprehensive healthcare approach serves a significant role in reorienting
the healthcare services in the country. Following the diabetes crisis, as a health issue in question,
the World Health Organization has greatly transformed the healthcare services with respect to
the principles of the Comprehensive healthcare approach. The World Health Organization
presents diverse strategies in curbing non-communicable diseases across the globe. Most
importantly, this strategy encompasses the management of diabetes, as it is a non-communicable
disease. The World Health Organization acknowledges the fact that non-communicable diseases
are attributed to potential risk factors like old age and substance abuse. Therefore, the
organization suggests new strategies to be employed in mitigating the risk factors rather than
concentrating on treatment interventions. A similar ideology has been emphasized in the
principles and objectives of the comprehensive primary healthcare approach. Currently, nurses,
midwives, and other medical practitioners in developing countries like China are greatly
engaging in mitigation of risk factors with respect to the management of diabetes. Such risk
factors include smoking, alcohol consumption, lack of exercise, obesity, and overweight.
Different factors have promoted the implementation of a comprehensive primary
healthcare approach. For instance, China has good government policies and legislature, which
promotes the equitable implementation of cost-effective healthcare interventions. Government
policy also emphasizes the need for community engagement in the healthcare sector. Usually, it
is important to create a political commitment by the ruling government before initiating the
implementation program of any primary healthcare program. Governmental commitment is

PRIMARY HEALTHCARE IN DEVELOPING COUNTRIES 10
essential in decentralizing healthcare services in promoting access to comprehensive primary
healthcare, particularly in rural areas.
Additionally, active community participation has proven to highly promote the
implementation process of the comprehensive primary healthcare approach. Community
participation encourages engagement in the planning process, thus enhancing the subsequent
implementation process that ultimately improves the healthcare outcomes. Cost-effectiveness
and equity have also promoted the implementation process. Setting lower prices on healthcare
services enhances affordability by diverse socioeconomic classes in the country, thus promoting
effective implementation. Equity is also a highly advocated strategy among nurses in urban areas
of China (Chen et al., 2014). Therefore, health services that promote equity in the country are
likely to lure community engagement, thus promoting effective implementation of the
comprehensive primary healthcare approach. Therefore, it is clear that community participation,
political engagement, cost-effectiveness, and equity are the key contributing factors that promote
effective implementation of comprehensive primary healthcare in China.
Even though several factors promote the implementation process, it is naïve and irrational
to hesitate to mention the barriers to the execution process. Several factors continue to impede
the implementation of comprehensive primary healthcare in China. Implementation of
comprehensive primary healthcare is hard because the model calls for a multi-sectoral, holistic,
and multi-disciplinary approach. The system also requires a larger number of medical staff in all
disciplines, improves transport services, developed infrastructure, sufficient and clean water, and
proper supply chain system for the medicine and laboratory services. Even though the
governmental integration is promoting the implementation process, the political will in the
country is still too low. A low political will in the implementation process present fundamental

PRIMARY HEALTHCARE IN DEVELOPING COUNTRIES 11
problems. The government is slow in providing equitable healthcare services to Chinese
individuals, thus negatively impacting the execution of the comprehensive primary healthcare
approach. In other words, the government has retarded the promotion of equity healthcare
services, thus negatively impacting healthcare outcomes. Even though the current rate of
development in China is rapid most of the transport systems and infrastructure, in general, has
remained underdeveloped thus providing a negative impact to the implementation of the
comprehensive primary healthcare approach. The government is also reluctant in promoting
equal distribution of resources in the management of diabetes. As a result, the country is
currently facing a heavy burden of non-communicable diseases, which includes obesity and
diabetes.
Even though heavy challenges hindering the implementation process, many developing
countries like China are on the upfront in executing comprehensive primary healthcare approach.
These efforts are generated by the relevance of the approach in promoting wellbeing among the
citizens of such nations. Firstly, it is clear that most of the individuals in less developed countries
are low and medium income earners. Therefore, such individuals do not have enough capital to
handle hospital bills. In such cases, promotion of education programs like community
empowerment is relevant as a strategic approach in curbing health issues. Following the topic at
hand, comprehensive healthcare is relevant and applicable to the low and medium income
Chinese citizens as it aids in preventive strategies like educating the community about healthy
nutrition and performance of isometric exercises in the management of diabetes.
Additionally, China is a rapidly developing country which attracts most of the western
investors. Therefore, the traditional lifestyle of the individuals in the country is rapidly being
eroded by the new western culture, which involves heavy consumption and minimal exercises.

PRIMARY HEALTHCARE IN DEVELOPING COUNTRIES 12
Therefore, comprehensive primary healthcare approach is relevant to the citizens in the country
as it incorporates empowerment of the society regarding quality nutrition and performance of
isometric exercises in the management of not only diabetes but also the predisposing factors like
obesity and overweight. Smoking is a fundamental problem in China Statistics show that almost
half of the men in China are regular smokers of cigarette. Currently, the country records
approximately three hundred million smokers, which is a value larger than any other country in
the word. Unfortunately, there is no government regulation in the country to prevent smoking
behaviour among citizens. Therefore, Comprehensive primary healthcare is relevant in the
country as it addresses the management of diabetic risk factors like smoking and alcohol
consumption. Comprehensive primary healthcare also promotes the creation of healthy public
policy. Thus, the approach is relevant in empowering a country which is deeply rooted in the
smoking problem while lacking any regulations despite having fundamental related challenges
like diabetes. The country is also having a crisis in alcohol consumption. In fact, 42% of men in
the country are drinking. The country has traditionally permitted the drinking culture among its
citizens. Therefore, there is a need to initiate a policy-oriented program that will aid in curbing
the alcohol consumption problem s a strategic approach in handling diabetes health issue.
Following the future potential of the comprehensive healthcare approach in China,
several points can be laid. Firstly, China is having a shortage in the number of medical doctors.
Overcrowding of the patients in hospitals is the order of the day in the country. For instance, an
outpatient department in Beijing records approximately ten thousand individuals daily.
Additionally, the country has a scarcity of hospitals in rural areas, thus making patients
overcrowd in hospitals in nearby cities. With the current rate of economic growth in the country,
there is a likelihood that the rural areas shall be developed and promote the initiation of

PRIMARY HEALTHCARE IN DEVELOPING COUNTRIES 13
healthcare facilities thus promoting accessibility of comprehensive primary healthcare by the
citizens. Additionally, the current development might result in infrastructure development in
rural areas, which will promote educational programs to empower the medical practitioners in
the country for efficient delivery of comprehensive primary healthcare services.
The advancing technology in China is likely to ease the overcrowding problem in
hospitals. A good example of technological inventions is Al technology. The technology makes
it easy for the radiologists in China to deal with the large amounts of medical images. The
country is emphasizing on the development of technologies that will ease the workload of the
patients in improving patient outcomes. Al is currently helping the physicians in the country to
analyze medical images. Al also combines machine learning and language processing with
clinical knowledge, which helps in collecting the clinically relevant information into a single
dashboard. Thus physicians are able to collect information and data from unstructured reports
within a very short period of time in getting the complete picture of the patient (Xu et, al., 2019).
Therefore, it is clear that there exists a great potential in the future of comprehensive primary
healthcare in China. However, great efforts have to be incorporated in ensuring that quality
healthcare is accessible to all the citizens in the country. Especially, the rate of growth in the
population of the country is likely to present fundamental problems to the comprehensive
primary healthcare approach in the country. United Nations estimates that the country is likely to
reach 303 million people by 2040 (Andy, 2018). Therefore, the efforts in promoting effective
comprehensive healthcare approach in the country might hit the wall if great care is not
undertaken to curb the current shortage in medical professionals in the country.

PRIMARY HEALTHCARE IN DEVELOPING COUNTRIES 14
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