The Impact of Primary Healthcare on Population Health in Low- and Middle-Income Countries

Abstract

This article assesses 36 peer-reviewed studies of the impact of primary healthcare (PHC) on health outcomes in low- and middle-income countries. Studies were abstracted and assessed according to where they took place, the research design used, target population, primary care measures, and overall conclusions. Results indicate that the bulk of evidence for PHC effectiveness is focused on infant and child health, but there is also evidence of the positive role PHC has on population health over time. Although the peer-reviewed literature is lacking in rigorous experimental studies, a small number of relatively well-designed observational studies and the consistency of findings generally support the contention that an integrated approach to primary care can improve health. A few large-scale experiences also help identify elements of good practice. The review concludes with several recommendations for future studies, including a focus on better conceptualizing and measuring PHC, further investigation into the advantages of comprehensive over selective PHC, need for experimental or quasi-experimental research designs that allow testing of the independent effect of primary care on outcomes over time, and a more detailed conceptual framework guiding overall evaluation design that places limits on the parameters under consideration and describes relationships among different levels and types of data likely to be collected in the evaluation process.

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

“…While it is not possible to unequivocally attribute mortality reductions to primary care alone in these countries, as all of the initiatives involved multiple components, it is likely that the concerted effort to strengthen primary care services was a core contributor to the observed declines. The findings of positive impact on health are consistent with a recent review of primary care by Macinko et al (Macinko et al, 2009). …”

“…Such evaluations should be planned in tandem with the roll out of new primary care programs to permit prospective study and carefully chosen, ideally random, comparison groups (Berman, 2000;Macinko et al, 2009). Implementation research in primary care should become an integral component of health system research agendas in low-income countries and needs to be supported by development partners.…”

“…Although primary care has been on the development agenda for at least the past three decades since Alma Ata, there are few systematic reviews of the impact of primary care on health in the developing world (Macinko, Starfield, & Erinosho, 2009;Rohde et al, 2008). In addition, while there is an increasing number of single-country evaluations, relatively few of these include non-health goals such as measures of health system responsiveness (Berman, 2000) or economic impacts of seeking (Briggs, Capdegelle, & Garner, 2001).…”

Children's health care assistance according to their families: a comparison between models of Primary Care

“…On the international scene, it has been observed (5)(6) that increasing ESF coverage is linked to reducing infant mortality and promoting greater equity. Such evidence is present in the national results (7)(8) , studies which also indicate a higher quality of prenatal care, child care, offering use of health services, although in a low effectiveness context throughout the public health system.…”

Global Family Medicine: A ‘UNIVERSAL’ Mnemonic

“…Strong evidence-our dismal record at successfully lowering overall rates of morbidity and mortality at home 40 (even with extraordinarily high medically related expenditures in contrast with other countries 41 ), coupled with ample validation of family medicine's role as an appropriate alternative to this failure 42,43 -belies this suggestion. Although all global medical practitioners risk being sucked into the vortex of transmitting inappropriate models of medical care to environments where they are neither sustainable nor feasible-such actions can actually do grievous harm to the general health of the population by encouraging priorities incompatible with the local realities of those most in need-global family physicians have the potential to understand this susceptibility and minimize untoward consequences.…”