Government-led four-dimensional integrated diabetes governance policy: A four-year implementation evaluation of county-level medical-prevention alliance in Shunde, China

Background Diabetes imposes a heavy population health burden worldwide, and integrated chronic disease management has become a core national health policy priority under the Healthy China 2030 initiative. Most county-level health systems suffer fragmented medical-prevention resources, insufficient grassroots workforce and weak cross-sector policy coordination. Hospital-led medical alliances rely solely on clinical collaboration without binding government administrative mechanisms, while Western Chronic Care Model (CCM) and Integrated Care Pathways (ICPs) require mature primary care systems and sustained high fiscal investment, which cannot be directly replicated in Chinese counties and low- and middle-income countries (LMICs). This study systematically evaluates a government-initiated four-dimensional diabetes governance policy framework (Shunde Diabetes Medical-Prevention Collaborative Alliance, SDM-PCA) built over four years, interprets its institutional operation mechanism, and extracts replicable county-level chronic disease governance policy experience for global public health practice. Methods This study adopts qualitative policy evaluation methodology based on four-year official annual work reports submitted by all alliance member institutions. We systematically archived and coded institutional operation documents covering the full four-year reform cycle. Thematic content analysis was applied to sort out policy design logic, multi-sector coordination rules and institutional defects of the four-dimensional governance system. No population questionnaire surveys or clinical intervention trials were carried out in this research; all analytical work centers on institutional operation logic rather than population clinical efficacy comparison. The research protocol obtained institutional ethical approval prior to document collation work. Results After four consecutive rounds of full-district policy implementation, a closed-loop cross-department diabetes governance system was fully established in Shunde District. The local government issued binding joint working policies covering health, medical insurance and civil affairs departments, constructed a standardized tiered training system for grassroots diabetes practitioners, launched a unified regional digital health management platform, and incorporated narrative medicine into routine grassroots humanistic supporting service policies. Four mutually interactive policy dimensions (institutional cross-department governance, regional digital health infrastructure, standardized primary workforce development, narrative medicine auxiliary intervention) jointly formed a complete county-level chronic disease governance system targeting fragmented grassroots service resources. Conclusions This government-led four-dimensional integrated diabetes governance policy effectively addresses structural institutional defects of fragmented county medical and preventive services. The multi-sector coordinated, data-driven policy framework can be simplified and localized according to local resource endowments, providing operable reform pathways for underdeveloped counties and LMICs to optimize chronic disease governance systems.