This study aims to review China's national policies related to non-communicable disease (NCD) prevention and control at the primary health care (PHC) level since China's 2009 health system reform. Policy documents from official websites of China's State Council and 20 affiliated ministries were screened, where 151 out of 1,799 were included. Thematic content analysis was performed, and fourteen 'major policy initiatives' were identified, including the basic health insurance schemes and essential public health services. Several areas showed to have strong policy support, including service delivery, health financing, and leadership/governance. Compared with WHO recommendations, several gaps remain, including lack of emphasis on multi-sectoral collaboration, underuse of non-health-professionals, and lack of quality-oriented PHC services evaluations. Over the past decade, China continues to demonstrate its policy commitment to strengthen the PHC system for NCD prevention and control. We recommend future policies to facilitate multi-sectoral collaboration, enhance community engagement, and improve performance evaluation mechanisms.

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Background China has undergone a comprehensive primary healthcare(PHC) reform since 2009 aiming to deliver accessible, higher-quality, and equitable healthcare. However, there is limited understanding of the effectiveness of this reform. This systematic review synthesizes evidence on health system and health impacts of this reform. Methods We searched 13 international databases and three Chinese databases for quantitative studies assessing the impacts of this reform published between January 2009 and March 2020. We searched for studies in English or Mandarin. Eligible study designs were RCTs, quasi-experimental studies and controlled before-after studies. We included studies that: assessed PHC policies since 2009; had geographical, temporal or population comparators; and assessed any outcome measures of health expenditures, health service utilisation, quality of care or health outcomes. Study quality was assessed using ROBINS-I, and results synthesized narratively. PROSPERO: CRD42021239991. Results Of 35,480 titles, 37 studies were included (27 in English and ten in Mandarin). Eight were considered at low risk of bias. The 37 studies covered all major PHC policies since 2009, but mostly focused on the essential medicine (N = 15) and financing (N = 10). The quantity and quality of studies on service delivery policies(e.g., family physician and essential health services), were low(N = 3,with moderate or serious risk of bias). 17 studies found that the PHC reforms promoted primary care utilisation. Its impacts on quality and health improvement appear limited to people with chronic diseases(N = 11). Evidence on primary care costs and OOPs were not clear. Some evidence showed that the reforms were pro-equity with benefits accrued in disadvantaged regions and groups. Conclusions Comprehensive PHC reforms can deliver some benefits related to utilisation and health for high-risk and vulnerable populations. Policymakers should continue to prioritize PHC to achieve Universal Health Coverage. Key messages • The finding suggests that large-scale and comprehensive primary healthcare reforms can deliver benefits related to utilisation and health for high-risk and vulnerable populations. • Future research should include more robust study designs and seek to better understand the impact of major PHC reforms on quality of care, health outcomes and equity.

China’s comprehensive primary health care (PHC) reforms since 2009 aimed to deliver accessible, efficient, equitable and high-quality health care services. However, knowledge on the system-wide effectiveness of these reforms is limited. This systematic review synthesizes evidence on the reforms’ health and health system impacts. In August 2022, 13 international databases and three Chinese databases were searched for randomised controlled trials, quasi-experimental studies and controlled before-after studies. Included studies assessed large-scale PHC policies since 2009; had a temporal comparator and a control group; and assessed impacts on expenditures, utilisation, care quality, and health outcomes. Study quality was assessed using ROBINS-I and results were synthesized narratively. From 49,174 identified records, 42 studies were included - all with quasi-experimental designs, except for one randomised control trial. Nine studies assessed as at low risk of bias. Only five low to moderate quality studies assessed the comprehensive reforms as a whole and found associated increases in health service utilisation, whilst the other 37 studies examined single-component policies. The National Essential Medicine Policy (N=15) and financing reforms (N=11) were the most studied policies, whilst policies on primary care provision (i.e., family physician policy and the National Essential Public Health Services) were poorly evaluated. The PHC reforms were associated with increased primary care utilisation (N=17) and improved health outcomes in people with non-communicable diseases (N=8). Evidence on healthcare costs was unclear and impacts on patients’ financial burden and care quality were understudied. Some studies showed disadvantaged regions and groups accrued greater benefits (N=8). China’s comprehensive PHC reforms have made some progress in achieving their policy objectives including increasing primary care utilisation, improving some health outcomes, and reducing health inequalities. However, China’s health system remains largely hospital-centric and further PHC strengthening is needed to advance Universal Health Coverage.

Summary Malaysia's first waterflood, a seawater injection system, was placed in service in the Tapis field in 1982. This paper outlines the design basis and describes the system. Then water quality during and after startup and the formulation of a water quality guide using Millipore membrane filtration tests are discussed. The experience gained and data presented can be applied to current and future waterfloods. Introduction Geological and reservoir engineering studies of the Tapis field' located approximately 209 km 11 30 miles] northeast of Kuala Trengganu in the South China Sea (Fig. 1) have indicated that recovery can be almost doubled by gas injection and waterflooding. For the Tapis reservoirs, gas injection was initiated in late 1981 and is being used to help maintain reservoir pressure. In addition to gas injection, waterflooding was pressure. In addition to gas injection, waterflooding was initiated in Aug. 1982 to maintain pressure and to displace the oil in the reservoir. Water is lifted from the sea by seawater lift pumps (Fig. 2). Filtration removes the organic and inorganic materials from the seawater to prevent wellbore plugging. Deaeration removes oxygen from prevent wellbore plugging. Deaeration removes oxygen from seawater to minimize corrosion and wellbore plugging from corrosion products. Booster and injection pumps provide the required pressure for injection into the provide the required pressure for injection into the reservoir. The waterflood plant is designed to handle 35 772 M3 [225,000 bbl] of water a day at a maximum injection pressure of 19 300 kPa [2,800 psig]. The water is injected into the Tapis field oil zone. The injected water displaces oil toward the producing wells and maintains reservoir pressure. The type of flooding pattern chosen for the Tapis field is a "3-to-1 line drive." pattern chosen for the Tapis field is a "3-to-1 line drive." In this pattern there are three rows of oil producers to every row of water injectors (Fig. 3). The waterflood plant is installed on the Tapis B platform. Treated water is then transported from Tapis B to Tapis A, Tapis C, and Tapis D by subsea pipelines (Fig. 4). This water will be transported to Esso Production Malaysia Inc.'s (EPMI's) future Guntong field for injection. Design Basis It is of prime importance to inject water that contains carefully controlled levels of oxygen, suspended solids, and bacteria. Injection of poor-quality water, which is often the result of poor design or improper maintenance, can lead to plugging (e.g., suspended solids, calcium carbonate scale, and bacteria) and corrosion. Both of these can be minimized by careful plant design and operation and monitoring of water quality. To meet these requirements, the plant has to operate under steady-state conditions, meaning the avoidance of large changes in flow rate, which cause surging and imbalance in the treating system. To achieve high-quality water continuously, we have divided the overall water-injection plant into two separate sections. These arethe water treatment plant, comprising all equipment from the seawater lift pumps to the outlet of the vacuum tower, andthe pumping, distribution, and injection section, which we call the distribution plant (Fig. 2). The vital element in designing for a continuous steady-state operation was the provision of an overboard line from the discharge of the vacuum tower. This allows the water treatment plant to be run continuously even when problems are experienced in the distribution plant. This problems are experienced in the distribution plant. This makes startup easier and quicker. Water from the treatment plant is dumped overboard until all water-quality problems have been resolved and only injection-quality problems have been resolved and only injection-quality water is produced by the plant. The distribution plant may then be started as desired without upsetting the water treatment plant. Design Specification-Water Quality Prior to the design of the system described, a survey (including pilot plant tests) was carried out in 1978 to determine the optimal design basis. Water Sampling Water depth in the Tapis field area of the South China sea is about 64 m [210 ft]. The South China seawater was sampled at different depths to determine the optimal depth to obtain the best-quality source water. Water at 44.2 m [145 ft] below sea level was deemed most suitable as it represented the best-quality water in terms of suspended solids. A typical South China seawater analysis in the vicinity of the Tapis field is shown in Table 1. The suspended solids in the water were determined by Millipore filtration to be between 0.2 and 0.9 mg/L. This is generally considered to be good-quality water and compares very closely with North Sea water 2 containing between 0.2 and 0.8 mg/L of suspended solids. While the total weight of this material is small, it consists principally of small plant and animal organisms (marine plankton). The organism typically is a single cell filled with a gelatinous matter and surrounded by an outer skin. In the procedure of determining the suspended solids, most if procedure of determining the suspended solids, most if not all of the gelatinous matter is driven off during drying. Hence, suspended solids quoted may not be representative of the plugging tendency of the water. JPT P. 1689