The contribution of primary care to health and health systems in low- and middle-income countries: a critical review of major primary care initiatives.
Kruk, Margaret Elizabeth; Porignon, Denis; Rockers, Peter C.et al.
2010 • In Social Science and Medicine, 70 (6), p. 904-11
Delivery of Health Care/economics/organization & administration; Developing Countries; Global Health; Health Services Accessibility/economics/organization & administration; Humans; Organizational Objectives; Primary Health Care/organization & administration; Socioeconomic Factors
Abstract :
[en] It 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.
Disciplines :
General & internal medicine
Author, co-author :
Kruk, Margaret Elizabeth
Porignon, Denis ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique : aspects spécifiques
Rockers, Peter C.
Van Lerberghe, Wim
Language :
English
Title :
The contribution of primary care to health and health systems in low- and middle-income countries: a critical review of major primary care initiatives.
Arredondo A., Orozco E. Effects of health decentralization, financing and governance in Mexico. Rev Saude Publica 2006, 40(1):152-160.
Atun R. What are the advantages and disadvantages of restructuring a health care system to be more focused on primary care services? 2004, Health Evidence Network, London.
Baicker K., Chandra A. Medicare spending, the physician workforce, and beneficiaries' quality of care. Health Affairs (Millwood) 2004, (Suppl. Web Exclusives):W184-W197.
Bennett S., Adam T., Zarowsky C., Tangcharoensathien V., Ranson K., Evans T., et al. From Mexico to Mali: progress in health policy and systems research. Lancet 2008, 372(9649):1571-1578.
Berman P. Organization of ambulatory care provision: a critical determinant of health system performance in developing countries. Bulletin of the World Health Organisation 2000, 78(6):791-802.
Briggs C.J., Capdegelle P., Garner P. Strategies for integrating primary health services in middle- and low-income countries: effects on performance, costs and patient outcomes. Cochrane Database of Systematic Reviews 2001, (4). CD003318.
Brockerhoff M., Derose L.F. Child survival in East Africa: the impact of preventive health care. World Development 1996, 24(12):1841-1857.
Bryce J., Gouws E., Adam T., Black R.E., Schellenberg J.A., Manzi F., et al. Improving quality and efficiency of facility-based child health care through integrated management of childhood illness in Tanzania. Health Policy Plan 2005, 20(Suppl. 1):i69-i76.
Chan M. The contribution of primary health care to the millennium development goals. International conference on health for development 2007, WHO, Buenos Aires, Argentina.
Chan M. Return to Alma-Ata. The Lancet 2008, 372(9642):865-866.
Chen L., Evans T., Anand S., Boufford J.I., Brown H., Chowdhury M., et al. Human resources for health: overcoming the crisis. Lancet 2004, 364(9449):1984-1990.
Declaration of Alma-Ata. International conference on primary health care, Alma-Ata, USSR 1978.
Dovlo D. Using mid-level cadres as substitutes for internationally mobile health professionals in Africa. A desk review. Human Resource for Health 2004, 2(1):7.
Dugbatey K. National health policies: sub-Saharan African case studies (1980-1990). Social Science & Medicine 1999, 49(2):223-239.
Engstrom S., Foldevi M., Borgquist L. Is general practice effective? A systematic literature review. Scandinavian Journal of Primary Health Care 2001, 19(2):131-144.
Farmer P., Leandre F., Mukherjee J.S., Claude M., Nevil P., Smith-Fawzi M.C., et al. Community-based approaches to HIV treatment in resource-poor settings. Lancet 2001, 358(9279):404-409.
Franks P., Fiscella K. Primary care physicians and specialists as personal physicians. Health care expenditures and mortality experience. Journal of Family Practice 1998, 47(2):105-109.
Frenk J., Gonzalez-Pier E., Gomez-Dantes O., Lezana M.A., Knaul F.M. Comprehensive reform to improve health system performance in Mexico. Lancet 2006, 368:1524-1534.
Gakidou E., Lozano R., Gonzalez-Pier E., Abbott-Klafter J., Barofsky J.T., Bryson-Cahn C., et al. Assessing the effect of the 2001-2006 Mexican health reform: an interim report card. Lancet 2006, 368(9550):1920-1935.
Health Council of the Netherlands. (2004). European primary care. The Hague.
Hill A.G., MacLeod W.B., Joof D., Gomez P., Walraven G. Decline of mortality in children in rural Gambia: the influence of village-level primary health care. Tropical Medicine and International Health 2000, 5(2):107-118.
Johns Hopkins University, & Indian Institute of Health Management Research. (2006). 2006 Afghanistan Household Survey.
Kalda R., Polluste K., Maaroos H.I., Lember M. Patients' opinions on family doctor accessibility in Estonia. Croatian Medical Journal 2004, 45(5):578-581.
Kekki P. Primary health care and the millennium development goals: Issues for discussion 2006, University of Helsinki, Helsinki.
Knaul F.M., Arreola-Ornelas H., MEndez-Carniado O., Bryson-Cahn C., Barofsky J., Maguire R., et al. Evidence is good for your health system: policy reform to remedy catastrophic and impoverishing health spending in Mexico. The Lancet 2006, 368(9549):1828-1841.
Kruk M.E., Freedman L.P. Assessing health system performance in developing countries: a review of the literature. Health Policy 2008, 85:263-276.
Laurell A.C. Health system reform in Mexico: a critical review. International Journal of Health Services 2007, 37(3):515-535.
Lewis M., Eskeland G., Traa-Valerezo X. Primary health care in practice: is it effective?. Health Policy 2004, 70(3):303-325.
Macinko J., Guanais F.C., de Fatima M., de Souza M. Evaluation of the impact of the family health program on infant mortality in Brazil, 1990-2002. Journal of Epidemiology and Community Health 2006, 60(1):13.
Macinko J., Starfield B., Erinosho T. The impact of primary healthcare on population health in low - and middle-income countries. Journal of Ambulatory Care Management 2009, 32(2):150-171.
Macinko J., Starfield B., Shi L. The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970-1998. Health Services Research 2003, 38(3):831-865.
Magnani R.J., Rice J.C., Mock N.B., Abdoh A.A., Mercer D.M., Tankari K. The impact of primary health care services on under-five mortality in rural Niger. International Journal of Epidemiology 1996, 25(3):568-577.
Manzi F., Schellenberg J.A., Adam T., Mshinda H., Victora C.G., Bryce J. Out-of-pocket payments for under-five health care in rural southern Tanzania. Health Policy & Planning 2005, 20(Suppl. 1):i85-i93.
Masanja H., Schellenberg J.A., de Savigny D., Mshinda H., Victora C.G. Impact of integrated management of childhood illness on inequalities in child health in rural Tanzania. Health Policy Plan 2005, 20(Suppl. 1):i77-i84.
Ministry of Health of Brazil Department of Primary Care. (2007). Atencao basica e a saude da familia [Primary care and family health].
Ministry of Public Health of Afghanistan 2008, Ministry of Public Health News, Kabul.
Montegut A.J. To achieve " health for all"we must shift the world's paradigm to " primary care access for all" Journal of American Board of Family Medicine 2007, 20(6):514-517.
Mullan F., Frehywot S. Non-physician clinicians in 47 sub-Saharan African countries. Lancet 2007, 13:13.
Nair V.M. Health in South Asia: future of Kerala depends on its willingness to learn from past. British Medical Journal 2004, 328(7454):1497.
Nasseri K., Sadrizadeh B., Malek-Afzali H., Mohammad K., Chamsa M., Cheraghchi-Bashi M.T., et al. Primary health care and immunisation in Iran. Public Health 1991, 105(3):229-238.
van Palenstein Helderman W., Mikx F., Begum A., Adyatmaka A., Bajracharya M., Kikwilu E., et al. Integrating oral health into primary health care-experiences in Bangladesh, Indonesia, Nepal and Tanzania. International Dental Journal 1999, 49(4):240-248.
Pence B.W., Nyarko P., Phillips J.F., Debpuur C. The effect of community nurses and health volunteers on child mortality: the Navrongo Community Health and Family Planning Project. Scandinavian Journal of Public Health 2007, 35(6):599-608.
Perry H.B., Shanklin D.S., Schroeder D.G. Impact of a community-based comprehensive primary healthcare programme on infant and child mortality in Bolivia. Journal of Health Population and Nutrition 2003, 21(4):383-395.
Perry H., Robison N., Chavez D., Taja O., Hilari C., Shanklin D., et al. The census-based, impact-oriented approach: its effectiveness in promoting child health in Bolivia. Health Policy Plan 1998, 13(2):140-151.
Peters D.H., Noor A.A., Singh L.P., Kakar F.K., Hansen P.M., Burnham G. A balanced scorecard for health services in Afghanistan. Bulletin World Health Organisation 2007, 85(2):146-151.
Polluste K., Kalda R., Lember M. Primary health care system in transition: the patient's experience. International Journal of Quality of Health Care 2000, 12(6):503-509.
Polluste K., Kalda R., Lember M. Evaluation of primary health care reform in Estonia from patients' perspective: acceptability and satisfaction. Croatian Medical Journal 2004, 45(5):582-587.
Polluste K., Kalda R., Lember M. Satisfaction with the access to the health services of the people with chronic conditions in Estonia. Health Policy 2007, 82(1):51-61.
Ravishankar N., Gubbins P., Cooley R.J., Leach-Kemon K., Michaud C.M., Jamison D.T., et al. Financing of global health: tracking development assistance for health from 1990 to 2007. Lancet 2009, 373(9681):2113-2124.
Rohde J., Cousens S., Chopra M., Tangcharoensathien V., Black R., Bhutta Z.A., et al. 30 years after Alma-Ata: has primary health care worked in countries?. Lancet 2008, 372(9642):950-961.
Rosero-Bixby L. Spatial access to health care in Costa Rica and its equity: a GIS-based study. Social Science & Medicine 2004, 58(7):1271-1284.
Schieber G.J., Gottret P., Fleisher L.K., Leive A.A. Financing global health: mission unaccomplished. Health Affairs 2007, 26(4):921-934.
Starfield B. Primary care: Concept, evaluation, and policy 1992, Oxford University Press, New York.
Starfield B., Shi L., Macinko J. Contribution of primary care to health systems and health. Milbank Q 2005, 83(3):457-502.
Tanzania IMCI Multi-country Evaluation Health Facility Survey Study Group The effect of integrated management of childhood illness on observed quality of are of under-fives in rural Tanzania. Health Policy and Planning 2004, 19(1):1-10.
Unger J.-P., De Paepe P., Buitron R., Soors W. Costa Rica: achievements of a heterodox health policy. American Journal of Public Health 2008, 98(4):636-643.
Vapattanawong P., Hogan M.C., Hanvoravongchai P., Gakidou E., Vos T., Lopez A.D., et al. Reductions in child mortality levels and inequalities in Thailand: analysis of two censuses. The Lancet 2007, 369(9564):850-855.
Varatharajan D., Thankappan R., Jayapalan S. Assessing the performance of primary health centres under decentralized government in Kerala, India. Health Policy and Planning 2004, 19(1):41-51.
Velema J.P., Alihonou E.M., Gandaho T., Hounye F.H. Childhood mortality among users and non-users of primary health care in a rural west African community. International Journal of Epidemiology 1991, 20(2):474-479.
Victora C.G., Huicho L., Amaral J.J., Armstrong-Schellenberg J., Manzi F., Mason E., et al. Are health interventions implemented where they are most needed? District uptake of the integrated management of childhood illness strategy in Brazil, Peru and the United Republic of Tanzania. Bulletin World Health Organisation 2006, 84(10):792-801.
Villalbi J.R., Guarga A., Pasarin M.I., Gil M., Borrell C., Ferran M., et al. Aten Primaria 1999, 24(8):468-474.
Walton D.A., Farmer P.E., Lambert W., Leandre F., Koenig S.P., Mukherjee J.S. Integrated HIV prevention and care strengthens primary health care: lessons from rural Haiti. Journal of Public Health Policy 2004, 25(2):137-158.
Welch W.P., Miller M.E., Welch H.G., Fisher E.S., Wennberg J.E. Geographic variation in expenditures for physicians' services in the United States. New England Journal of Medicine 1993, 328(9):621-627.
WHO. (2000). World health report: health systems improving performance. Geneva, Switzerland.
WHO Macroeconomics and health: Investing in health for economic development; Report of the commission on macroeconomics and health 2001, World Health Organization, Geneva.
WHO. (2007). World Health Organization statistical information system: Core health indicators.
WHO Integrating mental health into primary care: A global perspective 2008, WHO, Geneva.
WHO World Health Report 2008: Primary health care - Now more than ever 2008, WHO, Geneva.
Withanachchi N., Uchida Y. Healthcare rationing: a guide to policy directions in Sri Lanka. Health Policy 2006, 78(1):17-25.