The contribution of primary care to health and health systems in low- and middle-income countries: A critical review of major primary care initiatives

Abstract

a b s t r a c tIt has been 30 years since the Declaration of Alma Ata. During that time, primary care has been the central strategy for expanding health services in many low-and middle-income countries. The recent global calls to redouble support for primary care highlighted it as a pathway to reaching the health Millennium Development Goals. In this systematic review we described and assessed the contributions of major primary care initiatives implemented in low-and middle-income countries in the past 30 years to a broad range of health system goals. The scope of the programs reviewed was substantial, with several interventions implemented on a national scale. We found that the majority of primary care programs had multiple components from health service delivery to financing reform to building community demand for health care. Although given this integration and the variable quality of the available research it was difficult to attribute effects to the primary care component alone, we found that primary care-focused health initiatives in low-and middle-income countries have improved access to health care, including among the poor, at reasonably low cost. There is also evidence that primary care programs have reduced child mortality and, in some cases, wealth-based disparities in mortality. Lastly, primary care has proven to be an effective platform for health system strengthening in several countries. Future research should focus on understanding how to optimize the delivery of primary care to improve health and achieve other health system objectives (e.g., responsiveness, efficiency) and to what extent models of care can be exported to different settings.

Salud global 2035: un mundo convergiendo en el lapso de una generación

“…Agnes Binagwaho, MD Pediatr, (6) Flavia Bustreo, MD, (7,8) David Evans, PhD, (7,8) Richard GA Feachem, DSc Med, (9,10) Julio Frenk, MD, (11) Gargee Ghosh, MSc, (12) Sue J Goldie, MD, (11) Yan Guo, MPH, (13) Sanjeev Gupta, PhD, (14) Richard Horton, MedSci, (15) Margaret E Kruk, MD, (16) Adel Mahmoud, MD, (17) Linah K Mohohlo, MSc, (18) Mthuli Ncube, PhD, (19) Ariel Pablos-Mendez, MD, (20,21) K Srinath Reddy, DM Card, (22) Helen Saxenian, PhD, (23) Agnes Soucat, MD, (24) Karen H Ulltveit-Moe, PhD, (25) Gavin Yamey, MD.…”

“…En varios países, las clínicas robustas de atención primaria con proveedores calificados y una infraestructura fuerte y cadenas de suministro de productos básicos han demostrado ser una plataforma eficaz para el FSS. 23 En algunos países, se han desarrollado sistemas de atención a pacientes crónicos en gran escala a fin de proporcionar servicios a los pacientes infectados con VIH; estos sistemas pueden ser utilizados para impulsar programas "de arranque" para las ENT crónicas. 24 Sin embargo, las clínicas de atención primaria y los trabajadores comunitarios de la salud por sí solos son insuficientes.…”

The impact of rural health system reform on hospitalization rates in the Islamic Republic of Iran: an interrupted time series

“…16 The network has relied primarily on community health workers (behvarz) as first-line service providers. The behvarz are selected from the locality where they live, receive training for two years and provide basic services at a "health house".…”

Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition

“…38,40 Additionally, geographical access to facilities can be an important determinant of use. 45 One review 46 of largescale, compre hensive primary health-care initiatives showed that establish ment of a network of primary-care facilities can have an important eff ect on increasing coverage in underserved rural populations in particular.…”

“…46,78 Unless the bottlenecks faced by poor and marginalised people in access to and use of health interventions and services are explicitly addressed, inequities will probably worsen as more expensive and elaborate interventions are introduced. 79 We believe that our overview provides a broad summary of relevant information for health planners and policy makers that seek to reduce inequities and accelerate progress towards the health Millennium Development Goals and other commitments to children.…”