Hospital-provision of essential primary care in 56 countries: determinants and quality

Arsenault, Catherine; Kim, Min kyung; Aryal, Amit; Faye, Adama; Joseph, Jean Paul; Kassa, Munir; Degfie, Tizta Tilahun; Yahya, Talhiya; Kruk, Margaret E

doi:10.2471/blt.19.245563

Cited by 17 publications

(16 citation statements)

References 34 publications

(24 reference statements)

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“…It is estimated that around 20% of all outpatient consultations in Ethiopia take place in hospitals rather than health centers, health posts or clinics [ 30 ]. A study across 56 LMICs also found that between 17 and 23% of people use hospitals for primary care, rather than health centers or clinics [ 31 ]. Meanwhile, many hospitals in LMICs struggle to provide high-quality specialized and surgical care and to save the lives of those with complex injuries or obstetric complications [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Patient volume and quality of primary care in Ethiopia: findings from the routine health information system and the 2014 Service Provision Assessment survey

Arsenault

Yakob

Tilahun

et al. 2021

BMC Health Serv Res

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Background Several studies have reported inadequate levels of quality of care in the Ethiopian health system. Facility characteristics associated with better quality remain unclear. Understanding associations between patient volumes and quality of care could help organize service delivery and potentially improve patient outcomes. Methods Using data from the routine health management information system (HMIS) and the 2014 Ethiopian Service Provision Assessment survey + we assessed associations between daily total outpatient volumes and quality of services. Quality of care at the facility level was estimated as the average of five measures of provider knowledge (clinical vignettes on malaria and tuberculosis) and competence (observations of family planning, antenatal care and sick child care consultations). We used linear regression models adjusted for several facility-level confounders and region fixed effects with log-transformed patient volume fitted as a linear spline. We repeated analyses for the association between volume of antenatal care visits and quality. Results Our analysis included 424 facilities including 270 health centers, 45 primary hospitals and 109 general hospitals in Ethiopia. Quality was low across all facilities ranging from only 18 to 56% with a mean score of 38%. Outpatient volume varied from less than one patient per day to 581. We found a small but statistically significant association between volume and quality which appeared non-linear, with an inverted U-shape. Among facilities seeing less than 90.6 outpatients per day, quality increased with greater patient volumes. Among facilities seeing 90.6 or more outpatients per day, quality decreased with greater patient volumes. We found a similar association between volume and quality of antenatal care visits. Conclusions Health care utilization and quality must be improved throughout the health system in Ethiopia. Our results are suggestive of a potential U-shape association between volume and quality of primary care services. Understanding the links between volume of patients and quality of care may provide insights for organizing service delivery in Ethiopia and similar contexts.

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Section: Discussionmentioning

confidence: 99%

Patient volume and quality of primary care in Ethiopia: findings from the routine health information system and the 2014 Service Provision Assessment survey

Arsenault

Yakob

Tilahun

et al. 2021

BMC Health Serv Res

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“…High rates of hospital use for non-emergency care, as observed in this study and others [ 35 , 49 ], present a challenge for achieving the Sustainable Development Goal for universal health coverage [ 50 ]. The World Health Organization (WHO) has called for a shift of the entry point to the health system from hospitals to primary care centers to promote efficient use of resources, equitable access to care, and continuity of care [ 51 ].…”

Section: Discussionmentioning

confidence: 74%

“…Bypassing in urban areas, where patients have more options for where to seek care and their choices are less constrained by distance, may be particularly revealing of patient preferences. While evidence on bypassing patterns in urban areas is relatively scarce, the existing evidence suggests that there are often higher rates of hospital use in urban areas relative to rural areas [ 31 , 35 , 38 ].…”

Section: Introductionmentioning

confidence: 99%

Health care seeking in modern urban LMIC settings: evidence from Lusaka, Zambia

et al. 2022

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Background In an effort to improve population health, many low- and middle-income countries (LMICs) have expanded access to public primary care facilities and removed user fees for services in these facilities. However, a growing literature suggests that many patients bypass nearby primary care facilities to seek care at more distant or higher-level facilities. Patients in urban areas, a growing segment of the population in LMICs, generally have more options for where to seek care than patients in rural areas. However, evidence on care-seeking trajectories and bypassing patterns in urban areas remains relatively scarce. Methods We obtained a complete list of public health facilities and interviewed randomly selected informal sector households across 31 urban areas in Lusaka District, Zambia. All households and facilities listed were geocoded, and care-seeking trajectories mapped across the entire urban area. We analyzed three types of bypassing: i) not using health centers or health posts for primary care; ii) seeking care outside of the residential neighborhood; iii) directly seeking care at teaching hospitals. Results A total of 620 households were interviewed, linked to 88 health facilities. Among 571 adults who had recently sought non-emergency care, 65% sought care at a hospital. Among 141 children who recently sought care for diarrhea, cough, fever, or fast breathing, 34% sought care at a hospital. 71% of adults bypassed primary care facilities, 26% bypassed health centers and hospitals close to them for more distant facilities, and 8% directly sought care at a teaching hospital. Bypassing was also observed for 59% of children, who were more likely to seek care outside of the formal care sector, with 21% of children treated at drug shops or pharmacies. Conclusions The results presented here strongly highlight the complexity of urban health systems. Most adult patients in Lusaka do not use public primary health facilities for non-emergency care, and heavily rely on pharmacies and drug shops for treatment of children. Major efforts will likely be needed if the government wants to instate health centers as the principal primary care access point in this setting.

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“…However, provision of essential PHC services is often challenged by skewed allocation of public resources to hospital-based spending ( Arsenault, 2020 ; Kraef and Kallestrup, 2019 ) and regressive financing models, wherein households with lower incomes contribute a higher share of their income towards health than do those with higher incomes ( Asante et al. , 2016 ).…”

Section: Resultsmentioning

confidence: 99%

Modified scoping review of the enablers and barriers to implementing primary health care in the COVID-19 context

Edelman

Marten

Montenegro

et al. 2021

Health Policy and Planning

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Since the Alma Ata Declaration of 1978, countries have varied in their progress towards establishing and sustaining comprehensive primary health care (PHC) and realizing its associated vision of ‘Health for All’. International health emergencies such as the coronavirus-19 (COVID-19) pandemic underscore the importance of PHC in underpinning health equity, including via access to routine essential services and emergency responsiveness. This review synthesizes the current state of knowledge about PHC impacts, implementation enablers and barriers, and knowledge gaps across the three main PHC components as conceptualized in the 2018 Astana Framework. A scoping review design was adopted to summarize evidence from a diverse body of literature with a modification to accommodate four discrete phases of searching, screening and eligibility assessment: a database search in PubMed for PHC-related literature reviews and multi-country analyses (Phase 1); a website search for key global PHC synthesis reports (Phase 2); targeted searches for peer-reviewed literature relating to specific components of PHC (Phase 3) and searches for emerging insights relating to PHC in the COVID-19 context (Phase 4). Evidence from 96 included papers were analysed across deductive themes corresponding to the three main components of PHC. Findings affirm that investments in PHC improve equity and access, healthcare performance, accountability of health systems and health outcomes. Key enablers of PHC implementation include equity-informed financing models, health system and governance frameworks that differentiate multi-sectoral PHC from more discrete service-focussed primary care, and governance mechanisms that strengthen linkages between policymakers, civil society, non-governmental organizations, community-based organizations and private sector entities. Although knowledge about, and experience in, PHC implementation continues to grow, critical knowledge gaps are evident, particularly relating to country-level, context-specific governance, financing, workforce, accountability and service coordination mechanisms. An agenda to guide future country-specific PHC research is outlined.

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Hospital-provision of essential primary care in 56 countries: determinants and quality

Cited by 17 publications

References 34 publications

Patient volume and quality of primary care in Ethiopia: findings from the routine health information system and the 2014 Service Provision Assessment survey

Patient volume and quality of primary care in Ethiopia: findings from the routine health information system and the 2014 Service Provision Assessment survey

Health care seeking in modern urban LMIC settings: evidence from Lusaka, Zambia

Modified scoping review of the enablers and barriers to implementing primary health care in the COVID-19 context

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