Equity of National Essential Public Health Services (NEPHS) in Mainland China, 2019: a cross-sectional study based on the NEPHS database.

BACKGROUND

China's National Essential Public Health Service (NEPHS) Program was launched in 2009 to deliver population-based public health and individual health management services to all residents at 800,000 primary health-care centers nationwide. This study assessed NEPHS utilization data and evaluated usage inequities using comprehensive nationwide data.

METHODS

A cross-sectional study was conducted, selecting 16 indicators (out of 18) from 12 service packages to evaluate inequity. These included 4 indicators for services provided to all residents and 12 for pregnant women, new mothers, children aged 0-6 years, and patients with hypertension, diabetes, severe mental disorders, or tuberculosis. Data on service utilization and target populations for these indicators across the 31 provinces and 453 cities in mainland China were obtained from the NEPHS database and management platform for the period January 1 to December 31, 2019. Service utilization rates and bias-corrected bootstrap confidence intervals (CIs) were calculated to determine utilization. Inequities were assessed using the Gini coefficient and Sitthiyot-Holasut composite inequality index at the national and provincial levels, and the Theil index was employed to decompose overall inequity into within-region and between-region subgroups.

RESULTS

The NEPHS collected health records for 88.25% of China's permanent residents (95% CI: 79.23%-98.82%). The nationwide vaccination coverage rate was 97.44% (95% CI: 91.33%-99.91%). Newborn visit and child health management rates for children aged 0-6 years were 92.08% (95% CI: 74.85%-98.34%) and 90.87% (95% CI: 82.49%-98.47%), respectively. At the national level, NEPHS service utilization in 2019 was generally equitable, with Gini coefficients below 0.4 for the 15 indicators. Potential large equity gaps were observed in the provision of health education services in Shanghai [Gini coefficient = 0.358 (95% CI: 0.219, 0.444)], Inner Mongolia [Gini coefficient = 0.370 (95% CI: 0.073, 0.440)] and Xinjiang [Gini coefficient = 0.457 (95% CI: 0.217, 0.502)]. Additionally, the utilization of family planning education and sanitation inspection services also indicated potential large and severe equity gap in 13 provinces. The Theil indices revealed that inequities primarily existed within rather than between regions. Province-level results indicated perfect equity in health record management and vaccination coverage, while several provinces showed potential equity gaps in health education and family planning services. Potential equity gaps were also observed in health management services for patients with hypertension and diabetes, particularly in Beijing, Hunan and Xinjiang.

CONCLUSIONS

This study provides evidence for health planning in China's primary health sector and guidance for analyzing equity in national health programs similar to the NEPHS Program.