Control of chronic diseases is one of the key tasks that primary healthcare institutions take on. One of China's biggest chronic diseases is diabetes, which affects 92 million Chinese adults. This and other chronic health problems such as hypertension and coronary heart disease have been on the rise in recent years.

Chang Shuling, who believes that such diseases are caused by modern lifestyles, says that community-based healthcare institutions are essential as the first point of contact for residents in order to prevent and control chronic disease. Doctors in community clinics analyze patients' diet and physical activity in order to find the best course of action. Many sufferers of chronic diseases end up changing their unhealthy lifestyles alongside the treatment they receive. From eating a balanced diet to engaging in regular exercise, advice from community doctors has helped patients better manage their health and has raised public awareness of health issues.

Community clinics also offer training to family members of chronic patients to become household health workers, so they can help their entire family lead a healthy lifestyle. Liu Wei is one of the 120,000 household health workers in Beijing. Since her husband was diagnosed with coronary heart disease, Liu assumed the responsibility of assisting community doctors to monitor his condition. She knew nothing about the disease before her training and had no idea what to do if faced with an emergency. "The community health center organized related training programs and I learnt first aid for myocardial infarction, and about rehabilitation. Now I can take good care of my husband."

Community healthcare centers also provide special care for children, the elderly and people with disabilities. Beijing West Chang'an Avenue Community Health Service Center organizes clubs for the elderly who do not have family close by to look after them, giving health lectures and counseling. That in the Zhanlanlu neighborhood offers complementary therapy integrating preventative TCM with standard disease management, targeting those in high-risk groups or with poor health. The treatments include acupuncture, massage, and advice about how to integrate herbal remedies into their diets.

Though aware of the merits of TCM, such as lower side effects, Mrs. Song was previously not keen on it, mainly because it takes at least two hours every day to prepare each batch, and a course of treatment usually spans several weeks or longer. "But now community clinics offer ready-prepared TCM medicines," Mrs. Song, who has joined the growing ranks opting to use TCM locally, says happily. Furthermore, as the cost of the medicine is partly covered, she pays little for the treatment.

Naturally, community healthcare institutions also play a crucial part during public health emergencies. When H1N1 influenza broke out in 2009, community healthcare institutions across the country took on the responsibility of monitoring returning international travelers, paying follow-up visits to patients with fever and respiratory symptoms, and sterilizing public places in their districts. Providing so many essential services, community healthcare centers may be small in size, but they build a solid foundation for citizens' health.

Knowing Me, Knowing My Health

Community doctors have a close relationship with the public. In Mrs. Song's experience, community doctors are more patient than doctors in large hospitals, and ready to spare the time to explain complicated conditions in a way that she can easily understand. Community doctors get to know patients, along with their health, medical history and even living habits, very well. Such detailed knowledge of seemingly insignificant details can help doctors with diagnoses.

Cao Guozhi has been suffering for years from shoulder and back pain caused by fasciitis. One day, she went to Zhanlanlu Community Healthcare Center complaining of continuous pain in her chest and back. Dr. Guo, who was quite familiar with Cao Guozhi's condition and knew that her pain always focused in certain spots, noticed that the pain had expanded to her entire back and that it could not be caused by her usual problem. On the advice of the doctor, Mrs. Cao had an electrocardiogram, which revealed signs of a myocardial infarction. Staff at the center immediately transferred Mrs. Cao to a bigger hospital nearby and informed her family.

The close relationship between community doctors and patients is best seen in the home visit service that community health centers provide. The service is rendered by a team made up of a general practitioner (GP), a nurse and a health worker. They offer free medical care to families in the community, making regular follow-up visits, tracking patients' conditions and conducting health assessments. The team not only provides medical services round the clock, but also shows extra consideration to needy families and people with disabilities, especially during festivals and holidays. Seniors without children to support them regard the teams as family members, and not only consult them about health problems, but also tell them about their personal problems.

Over the past five years of development, community healthcare institutions have won people's trust and are making great contributions to the nation's drive to improve public health. As of the end of October, 2011, 33,000 community healthcare centers had been established nationwide. In the first ten months of 2011, they received 400 million visits. The surge in the number of patients seeking community medical services has highlighted the shortfall of GPs, who constitute the core of community medical workers. There are just 78,000 registered GPs in China at present. China hopes to provide two to three general practitioners per 10,000 residents by 2020, which means increasing the total number to between 300,000 and 400,000.

In the past, medical graduates preferred to work in major hospitals rather than become GPs in community healthcare centers, where salaries are lower and work toilsome. The low pay for community medical workers has proved a barrier to the nation's attempts to improve community healthcare. What's more, being a GP not only requires comprehensive medical knowledge, but also involves making home visits, helping patients with rehabilitation, and documenting the medical health of families. Another problem is that China previously made training specialist physicians a greater priority. This led to the situation where patients only trust specialists in major hospitals.

To reverse this trend and encourage more graduates to enter careers in community healthcare, the central government is launching a series of policies to increase salaries and improve the welfare of community health workers. At the same time, community healthcare institutions all over the country are providing GP internships for medical school students. In June 2011, the State Council decided to establish a systemic training program that includes five years of clinical medicine undergraduate education and three years of GP training at medical institutions. This new system guarantees professionalism among community health workers entering the field.

China's economic growth and improved social security system offer increasingly favorable conditions for the establishment of a complete public healthcare system. Although community healthcare is still nascent in China, it is growing fast with support from government policies and people's changing attitudes. In time, GPs will become the trusted guardians of the nation's public health and form the backbone of an efficient health system.