A Comparative Case Study: Does the Organization of Primary Health Care in Brazil and Turkey Contribute to Reducing Disparities in Access to Care?

Abstract

Brazil and Turkey are among the few high-middle-income countries that explicitly chose to strengthen their primary health care (PHC) systems as the centerpiece of much broader health system reforms aiming to narrow inequities in access to care. This comparative case study reviews the organization of Brazil and Turkey's PHC systems to derive lessons that can apply to other countries that may consider reforming the organization of PHC systems as a way to address health inequities. The analysis uses the Flagship Framework to investigate how the organization of PHC delivery in Brazil and Turkey can lead to measurable improvements in access to care. It compares (1) the degree of decentralization in PHC service delivery responsibilities, (2) the use of multiprofessional PHC teams, and (3) patient impanelment strategies. The comparative analysis offers three important lessons. First, changes in the organization of PHC systems can contribute to observable improvements in the level and distribution of health outcomes, but organizational strategies do not guarantee eliminating disparities in access. Second, PHC systems can operate in health systems with varying degrees of decentralization, but the level of decentralization may influence implementation. Third, relying on multi-professional PHC teams that serve geographically empaneled populations can improve equitable access to care, but course corrections may be needed to address evolving health demands.

Development and validation of a minimum requirements checklist for snakebite envenoming treatment in the Brazilian Amazonia

“…CHWs were not included in the checklist—likely due to its explicit focus on clinical care. In terms of practice, the MoH states services provided by CHCs include preventative care, public health interventions, maternal and child health care, management of chronic non-communicable diseases, referrals to higher-level care as well as social, sanitation, and other services [ 42 , 43 ]. The Equipment, Supplies, and Medicines items listed in the checklist, excluding antivenom, fall under those required to perform these services [ 44 ].…”

Empanelment of the Population to the Primary Medical Care Institution of Sri Lanka: A Mixed-Methods Study on Outcomes and Challenges

“…Empanelment is becoming a key part of recent reforms in primary health care in different parts of the world, including lower-middle income countries (LMICs) [5,6]. Sri Lanka, a LMIC in the Southeast Asian region, has been going through a process of re-organisation of PHC under the World Bank supported Primary Health Care System Strengthening Project (PSSP) [7,8].…”