Primary health care in practice: is it effective?

Abstract

Primary health care is accepted as the model for delivering basic health care to low income populations in developing countries. Using El Salvador as a case study, the paper draws on three data sets and a qualitative survey to assess health care access and utilization across public and private sector options (including NGOs). Multivariate analysis is used to estimate the quantitative determinants of health seeking behavior. Physical and financial access is generally good. Households do not value the community health workers, and prefer high cost private care, even the poorest families, because of the lower waiting times and higher probability of successful treatment. Similarly, higher level public facilities--health centers and hospitals--are preferred because they are less costly in terms of time as they offer "one stop shopping" and do not require multiple visits, and treatment success is higher than among health posts, health units or community health workers. These results combined with the small size of El Salvador suggest that alternative strategies to community health workers may be a more cost effective approach. While prevention is desirable, community health workers do not have the skills or services that the communities value, which makes them less effective in promoting prevention. Alternative modes of reaching the community could reduce costs and raise the effectiveness of public health spending.

A baseline survey of the Primary Healthcare System in South Eastern Nigeria

“…However, what respondents like least has provided quality indicators, which will be useful for monitoring and evaluation Perceived incompetence of community health workers and long waiting times are also important quality issues evidenced by the responses. This is in line with the findings of Lewis et al [18] which shows that households do not value communily health workers and prefer private care because of lower waiting times and high probability of success, unfortunately the majority of our people may not be able to afford the private hospital charges thus leading to gross inequity of care delivery. Also, in a study by Hadad et al [19] it was observed that the community perceptions laid emphasis more on outcomes of health interventions rather than preventive care, consequently perceived quality by the community were categorized under technical competence of healthcare personnel, interpersonal relations between patients and care providers, availability and adequacy of resources and services, accessibility and effectiveness of care; these appear to be in line with our findings.…”

Quality of Private and Public Ambulatory Health Care in Low and Middle Income Countries: Systematic Review of Comparative Studies

“…None of the quantitative studies compared the quality of drugs available in the public versus private sector. Qualitative studies reported that the private sector was more trusted for drug quality [43] and that the drugs were more readily available [39],[40],[44],[45].…”

Specialist consultations in primary health care—A possible substitute for hospital care?

“…At the same time many studies in Europe have dealt with the equality and equity in the access to care, especially to specialist care [10][11][12][13]. An Australian study reports on the effects of financial incentives on waiting lists [14].…”