SAPPHIRE study: Strengthening China’s rural public health services for hypertension and diabetes care


  • Over the last few decades, the Chinese primary healthcare systemhas progressively weakened following economic liberalisation, rapid growth and changing consumer expectations.
  • In 2009, the Chinese Government launched reforms to provide an essential public health service package’ for primary care activities, including hypertension and type 2 diabetes. Uptake of services varies and large quality gaps exist.


  • The overall goal of this five-year project is to strengthen primary health care systems to enhance uptake of the government’s essential public health services package for hypertension and type 2 diabetes in three diverse regions in China.


  • The SAPPHIRE study will be conducted in four phases, aligned with the Institute for Healthcare Improvement’s ‘Framework for Going to Full Scale’.
  • Phase I (Understand): Rapid health system assessment to develop region- specific logic models.
  • Phase II (Design): Develop a “change package” comprising of clinical decision support, auditing tools and a quality improvement program.
  • Phase III (Test): Evaluate the “change package” in 60 village clinics over two years as part of a cluster randomised controlled trial.
  • Phase IV (Scale): Conduct economic modelling and policy development to support implementation of the enhanced system at scale.


  • The SAPPHIRE study will provide robust evidence on scalable strategies to strengthen the primary health care system in China for the management of hypertension and diabetes.
  • Through close collaboration with government and service providers, there is potential to make major improvements to health care for millions of people across China.

Our Partners

Chinese Center for Disease Control and Prevention
The George Institute for Global Health, China
UNSW Sydney, Australia
University of Oxford, UK
Anzhen Hospital, China
Ningbo Center for Disease Control and Prevention, China
Yichang Center for Disease Control and Prevention, China
​Wenchuan Health Bureau, China