Expanding primary care in South and East Asia

Weel, Chris van; Kassai, Ryuki

doi:10.1136/bmj.j634

Cited by 23 publications

(16 citation statements)

References 2 publications

(3 reference statements)

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“…In many LMICs, competing political and economic agendas and the burden of disproportionately high demand/supply ratios may limit evaluation of what works and what does not. 13 This study should inform PHC reforms and prioritize research evaluation. Other strengths include our use of robust qualitative analysis methods, with a high degree of interrater coding reliability, and 2 Delphi rounds, facilitating consensus of research question priorities.…”

Section: Strengthsmentioning

confidence: 99%

Primary Care Research Priorities in Low-and Middle-Income Countries

et al. 2019

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PURPOSE To identify and prioritize the needs for new research evidence for primary health care (PHC) in low-and middle-income countries (LMICs) about organization, models of care, and financing of PHC. METHODS Three-round expert panel consultation of LMIC PHC practitioners and academics sampled from global networks, via web-based surveys. Iterative literature review conducted in parallel. Round 1 (pre-Delphi survey) elicited possible research questions to address knowledge gaps about organization and models of care and about financing. Round 2 invited panelists to rate the importance of each question, and in round 3 panelists provided priority ranking. RESULTS One hundred forty-one practitioners and academics from 50 LMICs from all global regions participated and identified 744 knowledge gaps critical to improving PHC organization and 479 for financing. Four priority areas emerged: effective transition of primary and secondary services, horizontal integration within a multidisciplinary team and intersectoral referral, integration of private and public sectors, and ways to support successfully functioning PHC professionals. Financial evidence priorities were mechanisms to drive investment into PHC, redress inequities, increase service quality, and determine the minimum necessary budget for good PHC. CONCLUSIONS This novel approach toward PHC needs in LMICs, informed by local academics and professionals, created an expansive and prioritized list of critical knowledge gaps in PHC organization and financing. It resulted in research questions, offering valuable guidance to global supporters of primary care evaluation and implementation. Its source and context specificity, informed by LMIC practitioners and academics, should increase the likelihood of local relevance and eventual success in implementing research findings.

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Section: Strengthsmentioning

confidence: 99%

Primary Care Research Priorities in Low-and Middle-Income Countries

et al. 2019

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“…Strengthening primary health care represents a fundamental shift from health care delivery focused on treating disease toward health systems that address the specific health needs of patients and communities, with a predominant focus on generalism, comprehensiveness and continuity of care (Box 1). 1,4,22 No one size fits all. The process must account for the historical, social, cultural and economic features that shape a country's health system.…”

Section: How Can Strong Primary Health Care Be Achieved?mentioning

confidence: 99%

“…24,25 Anticipating spending increases could deter governments from making the investment required to achieve universal health coverage, which is why health care reform needs to be understood and committed to over the long term, with a particular focus on strengthening primary health care. Strong primary health care will improve population health through integration of primary care services with public health, thus lowering overall health care expenditure over time, improving the performance of the health Box 1: Criteria that must be fulfilled to strengthen primary health care 1,22 • Care provided must be comprehensive (i.e., address all health problems in all patients at all stages of life) and continuous over time.…”

Section: How Can Strong Primary Health Care Help With Realizing Univementioning

confidence: 99%

Why strengthening primary health care is essential to achieving universal health coverage

Weel

Kidd

2018

CMAJ

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trengthening primary health care 1 and the attainment of universal health coverage 2,3 are both important current global health policy initiatives. Primary health care is essential and affordable care that is accessible to everyone in the community, and includes health promotion, disease prevention, health maintenance, education and rehabilitation. 4 The concept of universal health coverage, as noted in the United Nations' 2015 Sustainable Development Goals, is an aspiration to provide all people with access to essential high-quality health services and to safe, effective and affordable medicines and vaccines, while ensuring financial risk protection by providing care regardless of a person's ability to pay for it. 2,5 It is clear from these two definitions that there is overlap between the aims of primary health care and universal health coverage; indeed, many have noted that primary health care is essential to achieving universal coverage. 6,7 The two agendas have developed largely independently of each other, and yet the goal of both is to see healthier people living in healthier communities. There seems to be a natural synergy between the two. Yet the World Bank, the Bill and Melinda Gates Foundation and the World Health Organization (WHO) have referred to primary health care as a "black box" for policymakers 8-complex, mysterious and difficult to understand. Many health care policy-makers and funders have a poor understanding of primary health care, finding it difficult to quantify and assess its contributions to health systems. Here, we shine a light into the "black box." We emphasize the importance of performance indicators to monitor health system reform to show how strong primary health care contributes to the realization of universal health coverage.

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“…In addition, there was too much focus on health systems' structure without acknowledgment of the importance of professionalism of the providers of care to add performance to structure. 18 The Astana declaration may be better timed, with its concerns about global sustainable development and planned actions to address this. 19 Improvement of health is seen as a condition for social-economic development.…”

Section: Editorialmentioning

confidence: 99%