Developing Community Health Services,Revitalizing Urban Primary Health Care

China played a leading role in primary health care in the 1950s and 1960s.However,since the introduction of a market oriented health care system in 1980s,the infrastructure on which the Chinese model of primary health care was built has been altered dramatically. Government funding as a proportion of health expenditure has decreased sharply with the health care organization carrying increasing financial risk. The Chinese health system has become more hospital and more technology oriented and increasingly reliant on out-of-pocket payment of the patients with widening inequities with respect to access to health care. This is the context in which the Chinese government initiated the urban community health reforms of 1997,aiming to reinstate a strong primary health care sector and to reverse the trend towards hospital-dominated health service delivery. The key features of the urban community health reforms have been the establishment of community health centres and the emergence of general practitioners. This paper reviews the driving factors behind the development of the urban community health services,and comments on the achievements of urban community health services and the problems and challenges with which they must deal. The paper also draws out some lessons from Chinese experiences for the international community.